See also:
Age-appropriate Pediatric Fever Without a Source workup
Hx
Severity
Duration
Associated localizing symptoms
Appetite
Rash
Sick contacts
Day care
Immunizations
PMHx
Anything remarkable
PE
Vital signs
HEENT
Neck exam
CV exam
Abdominal exam
Skin exam--rash
Almost any virus can be accompanied by rash in the pediatric patient, and it is not always necessary to ascertain which virus is causing the illness. If the illness is prolonged or particularly bothersome, antibody titers can be ordered to determine the exact etiology of the illness.
Workup
Physical exam
CBC, electolytes
UA
Urine culture
Blood culture
CXR
LP-CSF analysis, esp if <3mo
Ddx
Neonatal sepsis
Acute otitis media
Meningitis
Gastroenteritis (viral, bacterial, parasitic)
Rubeola (Measles)
Other viral exanthem
Occult bacteremia
Food poisoning
Volvulus
Intussusception
Rubella
Roseola
Fifth disease (Parvovirus B19 infection)
Varicella
Scarlet fever
Pneumonia
UTI
URI
Workup
Pneumatic otoscopy--key to look for the decreased TM mobility seen in otitis media
Tympanometry--useful in infants >6 months of age; confirmed abnormal TM mobility in otitis media
CBC with differential, blood culture--notably, a WBC >15k/uL is suggestive of occult bacteremia
Platelets, PT/PTT, D-dimer, fibrin split products, fibrinogen--evidence of DIC is often seen in meningococcemia
UA and urine culture--UTI may be occult and must be investigated
LP--CSF analysis--should be performed if there is any concern for meningitis.
CSF analysis includes cell count and differential, glucose, protein, Gram stain, culture, latex agglutination for common bacterial antigens, and occasionally PCR for specific viruses
CT-head--used mainly to rule out brain abscess or hemorrhage
CXR--to dx pneumonia
Throat culture--to isolate Streptococcus pyogenes (which causes Scarlet fever)
Parvovirus B19 IgM antibody--the best marker of acute or recent infection in suspected fifth disease
Skin lesion scrapings--varicella antigens are identifiable by PCR or direct immunofluorescence (DFA) of skin lesions. Also a Tzanck smear may show multinucleated giant cells in varicella infection.
Varicella antibody titer--may be useful in uncertain cases (look for a fourfold rise in antibody titer following acute infection)
Bronchoscopy--a diagnostic aid in severe or refractory pneumonia cases
Serum antibody titers--to identify causative viruses in pediatric infections (not commonly used)
U/S--renal--to look for anatomic anomalies that predispose to UTI
Voiding cystourethrogram--to look for vesicourethral reflex in UTI
