While 46 percent of febrile children, aged 3 months to 24 months, will be well without treatment within 24 to 48 hours, and another 12 percent well within 72 to 96 hours, approximately 6 percent will have serious bacterial infections. The incidence of such infections tends to increase with decreasing age and increasing degree of fever. Physicians, who make specific observations of the child's color, hydration, social response, consolability, and degree of alertness after the child has been made comfortable, can identify about two thirds of those with benign illness and the one tenth who require inpatient evaluation. Of the remaining patients, those with serious illness can be further identified if their white blood count is greater than 15,000/microL, neutrophils are greater than 10,000/microL, band cells are greater than 500/microL, or sedimentation rate is more than 30 mm/h. Children with these laboratory findings should then have a chest film and blood culture and, if the former is negative, should be considered for a lumbar puncture and urine culture. Whether further observation or treatment at this point can be done as an outpatient depends on physician judgment.
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