Many of the considerations noted in the evaluation of infants younger than 3 months of age apply for older infants. Patients between 3 and 36 months have been the focus of considerable research because this group appears to be at higher risk for occult bacteremia. These studies have sought to identify clinical and laboratory characteristics of bacteremic patients.7242.5

Clinical judgment appears to be more reliable in the assessment of older infants. Characteristics that evaluating physicians should note are willingness of patients to make eye contact, playfulness and positive response to interactions, negative response to noxious stimuli, alertness, and consolability. Toxic infants will not respond appropriately.26

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