Identifying the febrile child at risk for serious illness continues to challenge physicians, especially since conflicting guidelines exist for identification and management. This situation poses a special problem for the pediatrician-in-training. In this study the 35 PL-1, Pl- 2, and PL-3 pediatric house staff of a university-affiliated hospital were surveyed by written questionnaire regarding their practices in dealing with children of less than two years with rectal temperature above 101 deg;F (38.3deg;C).Uniform replies were received from all house staff concerning the significance of patient age, degree of fever, and laboratory data, although there were some differences of opinion regarding the importance of specific data. All three resident levels tended to reduce the number of laboratory tests obtained as patient age increased, with emphasis placed on clinical impression of illness in assessing the older febrile child. Although the house staff indicated that they were satisfied with their handling of the febrile child, the PL-3s were only marginally more satisfied than the PL-Is and PL-2s. In general, the house staff had most confidence in handling the patient under three months of age, for whom it was generally felt that extensive laboratory evaluations and active management were indicated. The perception of the need for a formal protocol was also greatest for this youngest age group and decreased in importance with age.
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