Pediatric emergency medicine trisk 0661 0661
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catheterization, or bag specimen as opposed to catheterized specimen in children
older than 6 months of age. If the bag specimen UA is positive, a catheterized
urine specimen must be obtained for culture. In children who are not toilet
trained, aseptic urethral catheterization or suprapubic aspiration is the appropriate
method to obtain urine for the diagnostic urine cultures. An additional
noninvasive method of urine collection in infants is suprapubic cutaneous
stimulation, where cold saline-soaked gauze is rubbed in the suprapubic region to
stimulate urination allowing for a clean-catch specimen to be obtained.
TABLE 31.4
FEVER WITHOUT LOCALIZING SIGNS IN CHILDREN 56 DAYS TO
24 MONTHS
Consider UTI
Consider occult pneumonia
- If >3–4 days of fever in setting of respiratory symptoms, hypoxia,
tachypnea, abdominal pain, chest pain
Consider occult bacteremia
- If unimmunized or not fully immunized, especially those under 6 mo of age
Consider sinusitis
- If ≥1 year of age, fever ≥39°C for at least 3 days and purulent nasal
discharge
Consider Kawasaki, including incomplete
- If fever >3–4 days with signs of Kawasaki or if <6 mo of age with fever ≥7
days without any other explanation
Consider fever of unknown origin
- If >8 days of fever without a source
Consider seasonal or locally endemic infection
- For example, influenza
If the child between 2 and 24 months of age with a temperature of 39°C
(102°F) or higher does not have localizing symptoms or laboratory/radiograph
results (when performed) indicative of definitive focal infection, the child should
be assessed for the risk of occult bacteremia especially if younger than 6 months
of age or not fully immunized for Hib and Streptococcus pneumoniae. A “well”
clinical appearance does not decrease the risk for occult bacteremia (otherwise
the bacteremia would not be “occult”). Children with occult bacteremia are at risk
