GP CCE Cases · child-and-youth-health
Fever in a 7-week-old — CCE clinical encounter
CCE-style clinical encounter: a well-looking 7-week-old with 38.3°C. The candidate must resist reassurance, apply the under-3-month rule, organise the full septic workup pathway, counsel the parent about antipyresis and fever phobia, and close with a structured safety net.
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RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 7-week-old boy is brought in by his mother at 5 p.m. 'He felt hot after his feed.' Axillary temperature 38.3°C. He is alert, feeding at the breast during the consultation, smiling at his mother. Mild nasal congestion; clear chest; normal ears; no rash; moist mucous membranes; capillary refill 2 seconds. His mother says he is 'never sick' and asks whether some Calpol will fix it.
Objectives
- Recognise that any infant under 3 months with a temperature of 38°C or more is high-risk regardless of appearance. [38]
- Complete a structured assessment — vital signs measured and recorded, traffic-light domains examined. [38]
- Arrange the correct investigation pathway: FBC, blood culture, CRP, urine; LP criteria; parenteral antibiotics with listeria cover. [38]
- Counsel on antipyretics for distress only, correcting fever-phobia beliefs without dismissing the parent's concern. [19] [20]
- Close the encounter with a plan that names the destination, the urgency and what happens next. [38]
References6ShowHide
- [9]Vos-Kerkhof E, Gomez B, Milcent K, et al. Clinical prediction models for young febrile infants at the emergency department: an international validation study. Archives of Disease in Childhood, 2018.PMID 29794106
- [16]Subcommittee on Febrile Seizures, American Academy of Pediatrics Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics, 2011.PMID 21285335
- [19]Schmitt BD Fever phobia: misconceptions of parents about fevers. American Journal of Diseases of Children, 1980.PMID 7352443
- [20]Crocetti M, Moghbeli N, Serwint J Fever phobia revisited: have parental misconceptions about fever changed in 20 years? Pediatrics, 2001.PMID 11389237
- [24]Kaufman J How to… collect urine samples from young children. Archives of Disease in Childhood. Education and Practice Edition, 2020.PMID 31444213
- [38]Fields E, Chard J, Murphy MS, et al. Assessment and initial management of feverish illness in children younger than 5 years: summary of updated NICE guidance. BMJ, 2013.PMID 23697671