Introduction

One of the most common concerns parents have when bringing a child to ED is for a fever. Children, more so than adults, can deteriorate very quickly due to a relatively immature immune system, particularly in the neonatal period. This tutorial aims to help you think about sepsis in a child, depending on the age of a child, and appropriately work up a febrile child.

• It requires 1 hour preparation.

• It can be taught in 1.5 hours

Teaching approach

As with all modules, familiarise yourself with the NPMT principles.

session learning objectives:

• Developing a framework for thinking about fever in a child

• Identifying risk factors for neonatal sepsis

• Familiarise with common signs and symptoms in a septic neonate

• Working up a fever in a child under 28 days of age

• Working up a fever in a child between 28 days and 3 months of age

• Working up a fever in a child between 3 months and 3 years of age

• Working up a fever in a child older than 3 years of age

Tips & Tricks on running an effective session:

• This handout is meant to be used in conjunction with the case studies on the attached Powerpoint. There is a case study provided for each group until 3 years of age, as those tend to be the most common ones to present to hospital requiring admission, with key learning points for those above 3 years of age provided as well.

• Try to think of the distinguishing features in investigating and managing each age group, and reinforce how investigations and management get more rationalised as a child gets older. 

• Stress that in any age group, if the child is septic looking, always do a full septic workup and treat aggressively with antibiotics – SEPSIS KILLS is an important message to reinforce.

• Summarise at the end of each aim (can use take home messages in Powerpoint), and refresh students on key learning points (e.g. common risk factors for sepsis, what a full septic workup consists of).

• More specialised topics, such as Kawasaki’s disease, immunodeficiency screens for recurrent infections or haematological malignancies are not covered, and could be something for further reading for students (a couple of examples are provided below).

Download Resources:

• Curriculum pack

• Powerpoint

• RACGP: Evaluating for immunodeficiency in children with recurrent infection

  • https://www.racgp.org.au/afp/2014/september/evaluating-for-immunodeficiency-in-children-with-recurrent-infection/

• RCH clinical guidelines for a febrile child

  • https://www.rch.org.au/clinicalguide/guideline_index/Febrile_child/

• RCH clinical guidelines for Kawasaki’s disease

  • https://www.rch.org.au/clinicalguide/guideline_index/Kawasaki_disease/