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Pediatric Sepsis Clinical Presentation

  • Author: Shankar Santhanam, MD; Chief Editor: Russell W Steele, MD  more...
Updated: Sep 29, 2015


Obtain a complete history as part of the evaluation of the infant or child with possible sepsis. Fever is the most common presenting symptom of children with systemic inflammatory response syndrome (SIRS). A parental report of measured (not tactile) fever can generally be assumed to be reliable.

Ask the caregiver whether any of the following have been noted: a racing heart, rapid or labored breathing, cool extremities, or color changes. Identify exposures to infectious illnesses and other sources of insult.

Discuss the child’s activity level. Perform an age-appropriate evaluation of mental status. Ask about urine output because it is the most sensitive historical marker of dehydration and potential renal hypoperfusion. Verify immunizations, and confirm drug allergies.


Physical Examination

Perform a complete physical examination of the infant or child with suspected sepsis. Subtle changes in vital signs (eg, minimal tachycardia, widened pulse pressure, minimal tachypnea, minimally delayed capillary refill) may be the first signs of impending SIRS. Hypotension, mental status changes, and anuria are late signs. Hypothermia is often a more ominous sign than fever.

Elicit localizing signs of infection. A petechial or purpuric rash associated with fever is of particular concern. Frequent reassessment during interventions is required.

Because the manifestations of pediatric sepsis are protean, the possible complications are as well. Complications depend on the nature of the triggering insult and the resultant host response.

Contributor Information and Disclosures

Shankar Santhanam, MD Consulting Staff, Department of Emergency Medicine, Emergency Medical Associates; Consulting Staff, Department of Family Medicine, Capital Health Systems

Shankar Santhanam, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.


Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases,

Mark R Schleiss, MD American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Pathogenesis of sepsis and multiple organ dysfunction syndrome (MODS).
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