Responders to antipyretics may be septic, whereas those who do not respond may have a mild illness. In those greater than 2 to 3 months of age, clinical appearance is the best indicator of severity of illness. Children less than 3 months of age may not manifest signs of systemic illness. Blood cultures are of limited usefulness in determining which patients should be treated, since results are delayed 48 to 72 hours. Additionally, most bacteremic children will clear the bacteremia spontaneously.
Teething is related to fever, but look for other sources in the ill-appearing child.
Tepid bathing does not add much to the efficacy of these drugs. Aspirin should be avoided because of the risk of Reye's syndrome. Known exposures should be reviewed as well as an immunization and travel history. Should begin with a careful consideration of the general appearance. Careful observation and analysis of the vital signs, state of hydration, and peripheral perfusion are required.