Children over the age of 3 are easier to evaluate. They can specify their complaints and have illnesses similar to younger children, particularly upper respiratory infections and gastroenteritis. The risk of bacteremia appears lower in this age group, but the incidence of streptococcal pharyngitis is higher, especially in children between the ages of 5 and 10 and those with hyperpyrexia.11 Infectious mononucleosis may present with fever, tonsillar hypertrophy, and exudate, like streptococcal pharyngitis. Marked lymphadenopathy or hepatosplenomegaly would support the diagnosis. Pneumonia in this age group may be caused by Mycoplasma pneumoniae. These children present with cough and fever. Rales may not be apparent early in the illness, although the chest film would show evidence of an infiltrate. Bedside cold agglutinins, if positive, provide a clue to the correct diagnosis. Children with pneumonia secondary to mycoplasma should be treated with erythromycin, 30 to 40 mg/kg per day (maximum dose, 1 g).
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