Suspected Bacteremia (Child)

Causes

Bacteremia usually starts with an infection in one area (local), but it then spreads to the blood. Almost any type of infection can cause bacteremia. This includes:

• Skin infection

• Abdominal or intestinal infection such as gastroenteritis

• Infection after surgery

• Lung infection (pneumonia)

• Ear infection

• Infection in the urine

Symptoms

At first, symptoms may seem like any typical infection or illness, but then they get worse. Symptoms of bacteremia can include:

• Fever and chills

• Loss of appetite or trouble feeding

• Nausea or vomiting

• Trouble breathing or fast breathing

• Fast heart rate

• Skin rashes or blotches

• Lethargy

• Confusion or loss of consciousness

• Seizures

Diagnosing bacteremia needs a blood test (culture). The results of the blood culture may take 24 to 48 hours to be available and may not always be positive. Because of the time needed to get the test result, your child’s healthcare provider may start treatment based on other information. The provider will likely ask about your child’s health history and do a physical exam. Other lab and imaging tests may also be done. Most children will need to stay in the hospital. Hospital care may include IV (intravenous) antibiotics, IV fluids, and breathing support.

Home care

Once your child returns home, follow these guidelines.

General care

• Always contact the healthcare provider if you have any questions or concerns about your child's well being. Some things to look out for include new fever, other symptoms getting worse, or possible reactions to medicines for the infection or any other new medicines.

• Follow the healthcare provider's directions when caring for your child.

• Notice any changes in your child’s normal activity and sleep patterns.

• If your child is not eating well, talk to your healthcare provider.

Special note to parents

Wash your hands well with soap and clean, running water before and after caring for your child, to prevent spreading infection.

Medicines

• If antibiotics were prescribed for your child, give them until they are used up or your healthcare provider tells you to stop. It's important to finish the antibiotics. Do this even if your child feels better. This is to make sure the infection clears completely.

• Always follow your healthcare provider's directions when giving your child any medicines. Use children’s acetaminophen for fever, fussiness, or discomfort, unless another medicine was prescribed. Make sure you give your child the correct dose of these medicines. In babies over 6 months of age, you may use children’s ibuprofen or acetaminophen. Talk with the provider before using these medicines if your child has chronic liver or kidney disease or has ever had a stomach ulcer or gastrointestinal bleeding. Never give aspirin to anyone younger than 18 years of age who is ill with a viral infection or fever. It may cause severe liver or brain damage.

Follow-up care

Follow up with your child’s healthcare provider, or as advised:

• You will be notified if the antibiotic needs to be changed based on the blood culture results.

• If X-rays, a CT, or an ultrasound were done, a specialist will review them. You will be notified of any findings that may affect your child’s care.

Call 911

Call 911 if any of the following occur:

• Trouble breathing

• Inability to swallow

• Extreme confusion

• Extreme drowsiness or trouble waking up

• Fainting or loss of consciousness

• Rapid heart rate

• Seizure

• Stiff neck

When to get medical advice

Call your child’s healthcare provider right away if:

• Your child has a fever (see Fever and children, below)

• Your child’s fever does not go down within 24 hours of antibiotic use or gets worse

• Your child is vomiting

• Your child has a bloated stomach

• Your baby is fussy or cries and cannot be soothed

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

• Temperature of 104°F (40°C) or higher in a child of any age

• A fever of ___________ as advised by the provider