Paeds Cases · infectious-diseases
Approach to fever by age and immune status — OSCE
OSCE counselling and clinical reasoning station for a febrile young infant and parental concern.
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Target exams
MRCPCH ClinicalRACP DCE
Prompt
You have 8 minutes with a parent and their 5-week-old infant who has had fever for 6 hours. The parent is worried the baby is 'not right.' Explain your age-based assessment approach, outline the work-up, and agree a plan.
Station brief (candidate)
- Explain why age drives the work-up threshold in febrile infants.
- Outline the assessment: threat gate first, then age-banded risk stratification.
- State which investigations a 5-week-old fever without source requires and why.
- Agree a plan that respects parental concern and gives a specific safety-net.
- Avoid reassuring on temperature alone or promising discharge before assessment. [1] [2] [6]
References6ShowHide
- [1]Biondi EA Prevalence of Bacteremia and Bacterial Meningitis in Febrile Neonates and Infants in the Second Month of Life: A Systematic Review and Meta-analysis JAMA Netw Open, 2019.PMID 30901044
- [2]Gomez B Validation of the Step-by-Step Approach in the Management of Young Febrile Infants Pediatrics, 2016.PMID 27382134
- [3]Kuppermann N A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections JAMA Pediatr, 2019.PMID 30776077
- [4]De S Lack of Accuracy of Body Temperature for Detecting Serious Bacterial Infection in Febrile Episodes Pediatr Infect Dis J, 2015.PMID 26065864
- [5]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study Lancet Child Adolesc Health, 2025.PMID 40451224
- [6]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis Br J Gen Pract, 2025.PMID 39117428