The Rochester criteria for low risk in a febrile infant give clinicians a powerful tool for risk stratification. When utilizing the Rochester criteria, it is most important to first distinguish children who appear well from those who do not. Children who appear toxic should be managed aggressively with hospitalization, sepsis evaluation and parenteral antibiotics. The remainder of the criteria may then be applied to the children who appear well. After proper assessment, less aggressive evaluation and treatment and care at home are indicated for many children who previously would have received a more aggressive evaluation and treatment.
Current guidelines make little reference to the beliefs and feelings of parents of febrile children.
The management of the febrile child is often more difficult because the expectations and the health beliefs of the parents differ significantly from those of the physician. This interaction requires further study. Serious bacterial infections are not confined to children with fever. Many of the principles outlined in the recommendations for management of the febrile child apply also to children who are afebrile but have other signs of illness. It is also important to remember that after a decision is made to treat a child empirically with antibiotics, there is still the need for careful observation, whether that be in the hospital or by frequent outpatient contacts with the physician.