Fever in an Immunocompromised Child

A child receiving chemotherapy arrives with an oral temperature of 38.1 °C that has lasted an hour. The child is sitting up and answering questions, but the ANC is 0.3 × 10⁹/L. This is febrile neutropenia until proven otherwise; a reassuring appearance does not make it safe to wait. Neutrophils provide much of the visible inflammatory response. When their number or function is suppressed, an invasive infection may produce fever without pus, redness, swelling, or a clear source. The nurse therefore treats the temperature as a possible bloodstream infection while simultaneously looking for respiratory compromise, poor perfusion, mucositis, abdominal disease, and line infection. The immediate clinical question is not whether an obvious source can be found. It is whether the child is unstable and how quickly cultures and empiric antimicrobial therapy can be started. After assessment, selected stable children may qualify for a Canadian low-risk pathway; that exception is determined by the oncology team and protocol, not by a normal-looking child at triage.