The child's health status, course of the current illness, birth and past medical history, and immunization status are evaluated. Infants can be considered at low risk for serious bacterial infection if they had been healthy with no previous hospitalizations, were delivered at term and discharged home with their mother without complications, and had no previous antimicrobial therapy. Physical Examination Fever Infants Children Fever Infants Children Assessment of cardiopulmonary status includes a determination of vital signs. Children who are toxic require immediate cardiovascular stabilization and a complete sepsis evaluation, with empiric antimicrobial therapy. Axillary and tympanic measurements are unreliable.
Serious infections can also occur in afebrile or hypothermic infants.
Fever may also be related tovaccine reactions. Over bundling of small infants can cause temperature elevations. When this is suspected, the temperature should be rechecked with the child unbundled for 15 minutes. The quality of cry, reaction to parents, color, state of hydration, response to social overtures, affect, respiratory status and effort, and peripheral perfusion should be assessed. Neonates with acute bacterial meningitis often lack meningismus.