Fever (Pediatric Inpatient)

Clinical Description

Care of the hospitalized child experiencing elevated body temperature.

Key Information

Core temperature monitoring (intravascular, esophageal, bladder) is most accurate. If noncore monitoring is used, only oral and rectal electronic measurement should be used to support clinical decision-making, based on current evidence.

Fever has a protective role with infection; however, it has been proven harmful in the presence of septic shock or cerebral damage. It may be harmful for children with heart failure, respiratory comorbidity, hemodynamic instability or neuropsychiatric disorder.

Recommendations vary regarding temperature value at which antipyretic pharmacologic therapy or active cooling method should be initiated. Management should be individualized by baseline temperature and symptoms.

Febrile seizures are felt to be caused by genetic susceptibility. Use of antipyretic medication does not prevent seizures.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:

Body Temperature in Desired Range

B. Patient, family or significant other will teach back or demonstrate education topics and points:

Education: Overview
Education: Self Management
Education: When to Seek Medical Attention

Correlate Health Status

Correlate health status to:
- history, comorbidity, congenital anomaly
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- child and family/caregiver:
- safety risks
- family interaction
- plan for transition of care

Fever

Signs/Symptoms/Presentation

agitation
diaphoresis
irritability
lethargic
level of consciousness decreased
seizure activity
shivering
skin flushed
skin pale
skin warm to touch

Vital Signs

heart rate increased
respiratory rate increased
blood pressure increased or decreased
core body temperature elevated

Problem Intervention

Promote Normothermia

Identify and address underlying cause.
Monitor body temperature and trend; manage variability.
Provide optimal hydration; consider increased need due to insensible loss.
Administer antipyretic medication to reduce temperature and discomfort.
Encourage sleep/rest to minimize oxygen and metabolic demand.
Provide oxygen therapy judiciously, if hypoxemia present.
Provide comfort measures; adjust environment to minimize body temperature (e.g., offer cool cloths, encourage lightweight clothing and covers, reduce room temperature, increase air circulation, decrease stimulation).
Consider active cooling measures (e.g., external-cooling device, tepid sponge or tub bath, internal-cooling method); cool gradually to avoid shivering.

Associated Documentation

Fever Reduction/Comfort Measures

Education

CPG-Specific Education Topics

Overview

description

Self Management

fever reduction measures
fluid intake
provider follow-up

When to Seek Medical Attention

unresolved/worsening symptoms

General Education Topics

General Education

admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan

Safety Education

call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support

References

Barbi, E.; Marzuillo, P.; Neri, E.; Naviglio, S.; Krauss, B. S.. Fever in children: Pearls and pitfalls. Children (Basel, Switzerland). 2017;4(9) doi:10.3390/children4090081 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Chiappini, E.; Venturini, E.; Remaschi, G.; Principi, N.; Longhi, R.; Tovo, P.; Becherucci, P.; Bonsignori, F.; Esposito, S.; Festini, F.; Galli, L.; Lucchesi, B.; Mugelli, A.; Marseglia, G. L.; de Martino, M. 2016 update of the Italian pediatric society guidelines for management of fever in children. Journal of Pediatrics. 2017;180, 177-183.e1. doi:10.1016/j.jpeds.2016.09.043 [Quality Measures,Clinical Practice Guidelines]
Kiekkas, P.; Aretha, D.; Almpani, E.; Stefanopoulos, N.. Temporal artery thermometry in pediatric patients: systematic review and meta-analysis. Journal of Pediatric Nursing. 2019;46, 89-99. doi:10.1016/j.pedn.2019.03.004 [Metasynthesis,Systematic Review]
Lim, J.; Kim, J.; Moon, B.; Kim, G.. Tepid massage for febrile children: a systematic review and meta-analysis. International Journal of Nursing Practice. 2018;24(5), 1-11. doi:10.1111/ijn.12649 [Metasynthesis,Systematic Review]
National Institute for Health and Care Excellence (NICE). (2019). Fever in under 5's: assessment and initial management . Source[Clinical Practice Guidelines]
Nettina, S. M. (2019). Lippincott manual of nursing practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Offringa, M.; Newton, R. Prophylactic drug management for febrile seizures in children. Cochrane Database of Systematic Reviews. 2012;(4) doi:10.1002/14651858.CD003031.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
Offringa, M.; Newton, R. Prophylactic drug management for febrile seizures in children. Cochrane Database of Systematic Reviews. 2012;(4) doi:10.1002/14651858.CD003031.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
Ryan-Wenger, N. A.; Sims, M. A.; Patton, R. A.; Williamson, J.. Selection of the most accurate thermometer devices for clinical practice: Part 1: Meta-analysis of the accuracy of non-core thermometer devices compared to core body temperature. Pediatric Nursing. 2018;44(3), 116-133. [Metasynthesis,Meta-analysis,Systematic Review]
Ryan-Wenger, N. A.; Sims, M. A.; Patton, R. A.; Williamson, J.. Selection of the most accurate thermometer devices for clinical practice: Part 1: Meta-analysis of the accuracy of non-core thermometer devices compared to core body temperature. Pediatric Nursing. 2018;44(3), 116-133. [Metasynthesis,Meta-analysis,Systematic Review]
Shi, D.; Zhang, L.; Li, H.. Diagnostic test accuracy of new generation tympanic thermometry in children under different cutoffs: a systematic review and meta-analysis. BMJ Pediatrics. 2020;20, 1-10. doi:10.1186/s12887-020-02097-7 [Meta-analysis,Systematic Review]
Trippella, G.; Ciarcia, M.; de Martino, M.; Chiappini, E.. Prescribing controversies: an updated review and meta-analysis on combined/alternating use of Ibuprophen and Paracetamol in febrile children. Frontiers in Pediatrics. 2019;7(217), 1-14. doi:10.3389/fped.2019.00217 [Meta-analysis,Systematic Review]
Wong, T.; Stang, A. S.; Ganshorn, H.; Hartling, L.; Maconochie, I. K.; Thomsen, A. M.; Johnson, D. W. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Cochrane Database of Systematic Reviews. 2013;(10) doi:10.1002/14651858.CD009572.pub2 [Metasynthesis,Meta-analysis,Systematic Review]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.