Febrile children pose the diagnostic dilemma of distinguishing those with serious infections from the vast majority with self-limiting diseases at an early stage.
Alarm symptoms can aid in assessing the probability of serious infections in febrile children.
The combined absence of alarm symptoms is useful in ruling out serious infections.
CRP and PCT values are important diagnostic markers in febrile children in hospital settings.
Children without any alarm symptoms and low inflammatory markers can be treated conservatively, provided there are good instructions on reassessment.
Children with amber alarm symptoms or mildly elevated inflammatory markers in whom a serious infection cannot be ruled out require clinical observation or ambulant follow-up; empirical parenteral antibiotic treatment should also be considered and easily accessible.
Children with red alarm symptoms or highly elevated inflammatory markers deserve clinical observation. In children < 3 months, empirical parenteral antibiotic treatment is also indicated.
Conflict of interest: disclosure forms provided by the authors are available along with the full text of this article at www.ntvg.nl, search for A7331; click on ‘Belangenverstrengeling’ (‘Conflict of interest’). Financial support for this article: R.G. Nijman has received grants from the Netherlands Organisation for Health Research and Development (ZonMw), Erasmus Doelmatigheid en Quality Foundation of the Dutch Medical Specialists (SKMS).