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Fever in Children (cont.)

Diagnosis of Fever in Children

After arriving in the clinic or emergency department, a nurse will determine how quickly the child needs to be seen by a doctor. The nurse is usually very experienced and will bring the child immediately into the emergency room if a life-threatening condition appears to be present. Otherwise, the nurse will place the child in line to be seen ahead of people less ill but after those people appearing most ill.

The doctor will evaluate a child by obtaining a history from you and, if possible, the child. 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 usually will order two views to be taken, one sideways and one from front to back. The doctor may request this test if a child displays cough, chest pain, or shortness of breath.
  • A complete blood count, electrolytes, and cultures are taken from a blood sample.
    • It is much more difficult to find and enter the small veins in children. It may take more than one attempt to draw a child's blood.
    • 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 in the blood are useful for evaluating dehydration and whether certain electrolytes need replacement or other therapies. For example, a high blood sugar may suggest treatment with insulin.
    • 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 abnormal.
  • Urine may be obtained for a urinalysis and urine culture. A child may be asked to urinate into a sterile cup, or a bag may be placed over a 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.
    • Urinalysis is useful to look for infections of the urinary tract and may be helpful for evaluating dehydration.
    • Urine culture helps to assess 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.
    • A doctor will have you sign a consent form for this procedure. The doctor will review the potential complications of the procedure.
    • Lumbar puncture is a very safe procedure with extremely rare complications in children.
    • A child either lies on his or her side or sits up, and a needle is inserted between the backbones into the space that contains fluid that flows around the spinal cord and also the brain.
    • The fluid is sent to the laboratory, where specialists use a microscope to check for bacteria in the CSF.
    • 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 CSF culture results are abnormal.
    • The lumbar puncture is most often performed to check for meningitis, which is an infection of the brain or its surrounding tissues.
      • Signs and symptoms of meningitis may include headache, stiff neck, sensitivity to light, nausea and vomiting, or altered mental status.
      • If a 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.

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