If there’s no evidence of infection on these relatively rapid tests, proceed to A.

* Send blood and urine to be cultured for bacterial infection, which will take two days.

Send the baby home but consider giving him a shot of antibiotics to “cover” him.

* If the baby looks sick, send him to the emergency room for a spinal tap and a full sepsis workup and admit him to the hospital for intravenous antibiotics while waiting to see if any of the cultures are positive for bacteria.

Each of these responses would have been reasonable and defensible and explainable.

“Paediatricians really wrestle with this issue,” said Dr William V Raszka, professor of paediatrics at the University of Vermont College of Medicine and director of the Paediatric Infectious Diseases Service at Vermont Children’s Hospital.

“There’s a tremendous amount of conflicting data” about which babies need which tests and treatments, he said. “The incidence of serious bacterial illness in children who look well between 1 and 3 months of age is really, really low,” as long as a urine test is negative, Raszka said.

But on the other hand, if the baby is not completely well, “if mother is sure this is not the normal child, I would be more aggressive in working up the baby.”

In this case, the baby looked pretty good. His fever wasn’t going up; his patient mother was nursing him and he was drinking, while his less patient brother dismantled the exam room. He probably did not have a serious bacterial infection.

... contd.