Some Common Causes and Features of Fever in Children
Cause | Common Features* | Tests |
|---|---|---|
Acute fever (lasting 14 days or less) | ||
Respiratory infections due to a virus | A runny or congested nose Usually a sore throat and cough Sometimes swollen lymph nodes in the neck, without redness and tenderness | A doctor’s examination Sometimes testing of swab of nasal mucus |
Other infections due to a virus | In some infants or children, no symptoms except fever | A doctor's examination |
Diarrhea Often vomiting Possibly recent contact with infected people or certain animals or consumption of contaminated food or water | A doctor’s examination Sometimes examination and testing of stool | |
Ear infection (otitis media) | Pain in one ear (difficult to detect in infants and young children who do not talk) Sometimes rubbing or pulling at the ear | A doctor’s examination |
Throat infections (pharyngitis) | A red, swollen throat Pain when swallowing | A doctor’s examination Sometimes a throat culture or rapid strep test (both done on a sample taken from the back of the throat with a swab) |
In children under 3 years old No other symptoms | Blood tests | |
Cough and rapid breathing Often chest pain, shortness of breath, or both | A doctor's examination Usually a chest x-ray | |
Skin infections (cellulitis) | A red, painful, slightly swollen area of skin | A doctor’s examination |
Pain during urination Sometimes blood in urine Sometimes back pain In infants, vomiting and poor feeding | Urine tests | |
Encephalitis (a rare infection of the brain) | Infants: Sometimes bulging of the soft spots (fontanelles) between the skull bones, sluggishness (lethargy) or inconsolability Older children: Headache, confusion, or lethargy | A spinal tap (lumbar puncture) |
Meningitis (uncommon) | Newborns: Bulging of the soft spots (fontanelles) between the skull bones, inconsolability, poor feeding, and/or lethargy Infants: Fussiness and irritability especially when held, inconsolability, poor feeding, and/or lethargy Older children: Headache, sensitivity to light, lethargy, vomiting, and/or a stiff neck that makes lowering the chin to the chest difficult | A spinal tap |
Vaccines | Recent vaccination | A doctor’s examination |
Certain drugs | Recent addition of a new drug | A doctor’s examination |
Fever for more than 5 days Red eyes, lips, and tongue Painful swelling of hands and feet Often a rash Sometimes swollen lymph nodes in the neck | A doctor's examination Blood tests ECG and echocardiography Sometimes urine tests, ultrasonography of the abdomen, or an eye examination | |
Acute rheumatic fever | Swollen, painful joints New heart murmur detected during a doctor's examination Sometimes a rash or bumps under the skin Sometimes jerky, uncontrollable movements or changes in behavior Often a history of strep throat | Blood tests A throat culture ECG and echocardiography |
Chronic fever (lasting more than 14 days) | ||
Infections due to a virus, such as
| Long-lasting weakness and tiredness Sometimes swollen lymph nodes in the neck, a sore throat, or both Sometimes yellow discoloration of the whites of the eyes (jaundice) | Blood tests |
Intermittent headaches, a runny nose, and congestion | CT of the sinuses | |
Abdominal abscess (a pocket of pus inside the abdomen) | Abdominal pain and often tenderness to the touch | CT of the abdomen |
Joint infection (septic arthritis) | Swollen, red, painful joint | Testing of a sample of fluid taken from the joint with a needle |
Bone infection (osteomyelitis) | Pain in affected bone Sometimes a skin infection near the affected bone | Bone scan, MRI of bone, or both Sometimes biopsy of bone to check for bacteria (culture) |
Sometimes a heart murmur | Blood tests for bacteria (blood culture) Echocardiography | |
Tuberculosis (uncommon) | Poor weight gain or weight loss Night sweats Cough | Chest x-ray Skin tests Possibly culture of a sputum sample, and/or blood tests |
Malaria (varies by geographic location) | A shaking chill followed by a fever that can exceed 104° F (40° C) Fatigue and vague discomfort (malaise), headache, body aches, and nausea | Blood tests |
Sometimes headache and neck pain Sometimes a swollen, painful joint (such as the knee) Sometimes a bull’s-eye rash in one or more locations Occasionally a known history of a tick bite | A doctor's examination Sometimes blood tests | |
Often a swollen, painful lymph node Sometimes a bump on the skin where scratched by a cat | Blood tests | |
Blood in stool, crampy abdominal pain, weight loss, and loss of appetite Sometimes arthritis, rashes, sores in the mouth, and tears in the rectum | Colonoscopy Sometimes CT or x-rays after barium is inserted in the rectum (barium enema) | |
Joint and connective tissue disorders, such as | Swollen, red, tender joints Often a rash Sometimes fatigue | Blood tests |
Cancer, such as | Poor weight gain or weight loss and loss of appetite Night sweats Possibly bone pain | A complete blood cell count Removal (aspiration) of a sample of bone marrow for examination Sometimes a bone scan, and/or MRI of bone Sometimes CT of the chest or abdomen |
Periodic fever syndromes, such as
| Fever that recurs in often predictable cycles with periods of wellness in between Sometimes mouth sores, sore throat, and swollen lymph nodes Sometimes chest or abdominal pain Sometimes family members who have had similar symptoms or have been diagnosed with one of the familial periodic fever syndromes | A doctor's examination during episodes of fever Blood tests during and between fever episodes Sometimes genetic testing |
Pseudo fever of unknown origin | Usually a misinterpretation of normal fluctuations in body temperature or overinterpretation of frequent, minor viral illnesses Usually no other symptoms of concern Normal examination findings | A doctor's examination Thorough and accurate recording of illnesses and temperatures as well as a description of the overall function of the child and family Occasionally blood tests to rule out other causes and reassure parents |
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. Disorders that cause chronic fever also cause fever during the first 7 to 10 days. | ||
CT = computed tomography; ECG = electrocardiogram; MRI = magnetic resonance imaging. | ||