Approach to Fever with Rashes in Children
Introduction to Pediatric Fever with Rash
Key Concepts
- Definition: Temperature >38.0°C (100.4°F) with cutaneous manifestations
- Epidemiology: Accounts for 10-15% of pediatric emergency visits
- Age distribution: Most common in children 6 months to 5 years
- Seasonal variation: Higher incidence during summer and winter months
Initial Assessment Priorities
- Vital sign stability assessment
- General appearance evaluation
- Rash characteristics documentation
- Fever pattern analysis
- Associated symptom identification
Classification & Etiology
Based on Timing
- Fever First Pattern
- Roseola infantum
- Scarlet fever
- Drug reactions
- Kawasaki disease
- Simultaneous Fever and Rash
- Measles
- Rubella
- Meningococcemia
- Toxic shock syndrome
- Rash First Pattern
- Erythema infectiosum
- Hand-foot-mouth disease
Based on Morphology
- Maculopapular Rashes
- Viral exanthems
- Drug eruptions
- Early meningococcemia
- Kawasaki disease
- Vesiculobullous Rashes
- Varicella
- Herpes simplex
- Hand-foot-mouth disease
- Bullous impetigo
- Petechial/Purpuric Rashes
- Meningococcemia
- Rocky Mountain spotted fever
- Henoch-Schönlein purpura
- Viral infections with thrombocytopenia
Clinical Evaluation
History Taking Elements
- Fever Characteristics
- Onset and duration
- Pattern and peak temperature
- Response to antipyretics
- Associated symptoms
- Rash Description
- Time of onset relative to fever
- Initial site and spread pattern
- Evolution of lesions
- Associated symptoms (pruritus, pain)
- Risk Assessment
- Immunization status
- Recent medications
- Exposure history
- Recent travel
- Sick contacts
Physical Examination Focus
- Vital Signs Assessment
- Temperature measurement method
- Heart rate and respiratory rate
- Blood pressure and perfusion
- Oxygen saturation
- Rash Characteristics
- Distribution pattern
- Morphological features
- Color and texture
- Blanching vs non-blanching
- Associated findings (warmth, tenderness)
Common Conditions
Viral Exanthems
- Measles
- Koplik spots precede rash
- Cephalocaudal progression
- Associated with cough, coryza, conjunctivitis
- Complications: pneumonia, encephalitis
- Roseola Infantum
- High fever for 3-5 days
- Rash appears as fever resolves
- Rose-pink blanching macules
- Mainly affects infants 6-24 months
- Hand-Foot-Mouth Disease
- Vesicular lesions on extremities
- Oral ulcers common
- Usually affects children <5 years
- Self-limiting course
Bacterial Infections
- Scarlet Fever
- Sandpaper-like rash
- Strawberry tongue
- Pastia lines in skin folds
- Associated with Group A Strep infection
Emergency Conditions
Life-Threatening Presentations
- Meningococcemia
- Rapid progression
- Petechiae/purpura
- Signs of shock
- High mortality if untreated
- Immediate antibiotic needed
- Toxic Shock Syndrome
- Diffuse erythema
- Hypotension
- Multi-organ involvement
- Desquamation in recovery
- Stevens-Johnson Syndrome
- Severe mucocutaneous reaction
- Usually drug-induced
- Extensive skin involvement
- High mortality risk
Red Flag Signs
- Non-blanching purpuric rash
- Altered mental status
- Poor peripheral perfusion
- Respiratory distress
- Severe pain
- Toxic appearance
Management Principles
Initial Stabilization
- ABCs Assessment
- Airway patency
- Breathing adequacy
- Circulation status
- Emergency Interventions
- IV access establishment
- Fluid resuscitation if needed
- Oxygen supplementation
- Temperature management
Diagnostic Workup
- Basic Investigations
- Complete blood count
- C-reactive protein
- Blood culture
- Throat swab if indicated
- Specific Testing Based on Suspicion
- Viral studies
- Autoimmune markers
- Imaging studies
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
