After-hours management of febrile children.

During a nine-month period approximately 15 percent of the children less than ten years of age in a university family practice had an after-hours medical contact for a febrile illness. Children less than two years of age accounted for 55 percent of the encounters. The most frequent diagnoses were upper respiratory tract infection, acute otitis media, and undifferentiated fever. Slightly less than one half of the children were seen by the on-call resident, and age and level of fever did not correlate with the likelihood of being seen. Very few of the children had a white blood cell count obtained, and none had a blood culture or lumbar puncture. In this practice, after-hours management of the febrile infant differed substantially from guidelines in the literature based on experiences in university emergency rooms and walk-in clinics.