Skip to main content
PEDIATRÍA INTEGRAL - Revista de formación continuada dirigida al pediatra y profesionales interesados de otras especialidades médicas


The Corner
1. Roll Play: Patient with fever without focus


C. García Mauriño, A. Molina García

1. Roll Play: Patient with fever without focus

Paediatrician: Hello, I’m Dr. Smith, what is wrong with your child Bryan? How old is he?

Mother: I came here to the hospital because he has been having a fever already for 2 days, and I am very worried because he is not eating well. He was born 20 days ago.

Paediatrician: How much fever has he had? And does he have any other symptoms? Cough, diarrhoea, vomits?

Mother: No. He only vomits sometimes after I breastfeed him, but that happens since he was born. Does this have anything to do with the fever? He has had high temperatures but only during the nights, it spiked up to 37.9ºC last night.

Paediatrician: Before you continue, I would like to put together a bit of information about Bryan’s birth. Was the pregnancy followed up? Was everything normal? Was he delivered normally? Any perinatal complications? What was his birth weight? Are the vaccines updated?

Mother: yes, everything normal. His birth weight was 3 kg.

Paediatrician: Ok, let’s continue then. Is there someone at home with a cold or fever?

Mother: Well… not currently. We went to visit my mother’s house with the kids because she was feeling sick, three days ago. My other child seems fine, and the rest are feeling well.

Paediatrician: You told me before he was not eating well. Do you breastfeed him only or do you bottle-feed him also? How many times a day does he feed, on demand?

Mother: I only breastfeed him. He usually nurses on demand, and normally every three hours or so, but today it makes two days that he is sleeping all the time, and I have to wake him up.

Paediatrician: And when you try to stimulate him to wake him up, does he respond?

Mother: Yes he does, but i need to be very insistent, he maybe nurses for five minutes and then goes back to sleep again.

Paediatrician: How many diapers do you have to change in a day?

Mother: 5-6 every day, more or less. Is he very sick doctor?

Paediatrician: After examining your baby, what he seem to have is what us doctors call fever without focus. That means he probably has an infection, but he doesn’t show any symptoms which can guide us to where the infection site is located. We have to find the origin of Bryan’s fever in order to treat him properly, because he is very little and his immune system is not well establish yet, so he cannot protect himself as us adults can.

We are therefore going to perform a series of tests such as a blood and urine analysis and we are going to extract some spinal fluid with a lumbar puncture so that we can rule out a central nervous system infection. After all the tests we will probably start with empiric antibiotherapy until we have the results.


Fever without focus: fiebre sin foco.

Breastfeeding: lactancia materna.

Follow up: Seguimiento.

Delivery (to be delivered): nacimiento.

Perinatal complications: Complicaciones perinatales.

Vaccines updated: vacunas actualizadas.

Bottle-feeding: Alimentación con lactancia artificial.

On demand: a demanda.

To nurse: alimentarse.

Diapers: pañales.

To examine: realizar una exploración física.

Tests: pruebas diagnósticas.

Spinal fluid: líquido cefalorraquídeo.

Lumbar puncture: punción lumbar,

To rule out: descartar.


Copyright © 2024 Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria