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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a 14 month old whose parents have chosen not to vaccinate him. He has a fever of 39.2 for one day and no other symptoms. He is circumcised. He appears well and has no known ill contacts. His physical examination is unremarkable.
Lacey January 2, 2019 - 3:13 pm
I think for one day of fever, particularly recognizing how many children we see febrile >39 for simple viral infections, and an otherwise well exam/stable VS I’d be inclined to watch and wait and have them see their PMD or return for re-check. At the same time would educate the parents that the lack of vaccines puts on them the responsibility of close follow up and repeat exams. 😀
Kelly January 2, 2019 - 5:40 pm
I agree! I think it makes our job harder these days that parents come into the ED with the kid only having a few hours of fever. I think practice may vary depending on how good of follow-up one has and what is going around at the time. But I’d prefer to obs a well appearing child a bit to see if any symptoms develop that puts them into the category of fever with source instead of without.