Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
When you arrive in the clinic or emergency department, a
nurse will determine how quickly your child needs to be seen by the doctor. The nurse is usually very experienced and will bring your child immediately into the emergency room if a life-threatening condition appears to be present. Otherwise, the nurse will place your child in line to be seen ahead of people less ill but after those people appearing most ill.
The doctor will evaluate your child by obtaining a history from you and the child, if possible. The doctor will then perform a physical examination and may order tests.
A chest radiograph (X-ray) can be useful
for diagnosing some conditions in the chest, lungs, or heart (including some, but not all, pneumonias). The doctor will order two views
to be taken, one sideways and one from front to back. The doctor may request this test if your child displays cough, chest pain, or
shortness of breath.
It is much more difficult to find and enter the
small veins in children. It may take more than one attempt to draw your
A complete blood count (CBC)
is useful for diagnosing bacterial blood infections in very young children.
The CBC may suggest whether an infection is bacterial or viral and can be
useful in determining whether the child's immune system is working properly.
Electrolytes levels are useful for evaluating dehydration and
whether certain electrolytes need replacement.
Samples of blood can assess if bacteria are present
in the bloodstream. Blood culture results may take 24 hours and usually are
complete in 72 hours. You will be notified if the blood culture test is
Urine may be obtained for a urinalysis and urine
culture. Your child may be asked to urinate into a sterile cup, a bag may be
placed over your child's genital area to catch urine, or a catheter (which is
a small tube) may be inserted into the urinary opening (the urethra) to enter
the bladder and collect urine.
The urinalysis is useful to look for infections of
the urinary tract and may be helpful for evaluating dehydration.
The urine culture is tested to see if bacteria are present in the urine. Results from
a urine culture may take 24-72 hours. You will be called if urine culture results are abnormal.
A lumbar puncture (also
called a spinal tap) is a procedure that uses a small needle to remove a
sample of the cerebrospinal fluid (CSF) that surrounds the brain and spinal
cord. This test may be done if meningitis is suspected.
Your doctor will have you sign a consent form for
this procedure. The doctor will review the potential complications of the
Lumbar puncture is a very safe procedure with
extremely rare complications in children.
Your child either lies on his or her side or sits
up, and a needle is inserted between the backbones into a space that
contains fluid that flows all the way up to the brain.
The fluid is sent to the laboratory. There,
specialists look at the fluid under a microscope to check for bacteria.
A machine analyzes the fluid for the presence of red
and white blood cells, glucose, and protein.
Results for the spinal fluid culture may take 24-72
hours. You will be notified if spinal-fluid culture results are abnormal.
The lumbar puncture is performed to check for meningitis, which is an infection of the brain or its surrounding tissues.
Signs of meningitis may include headache, stiff
neck, sensitivity to light, nausea and
vomiting, or altered mental status.
If your doctor suspects this condition, it is very
important that this test be performed.
Without treatment, meningitis can cause permanent disability or death in just a few hours.
This article addresses the often-challenging task of diagnosing and treating febrile illnesses in infants younger than 60 days and discusses appropriate testing, treatment, and disposition of these patients.