However, the rate of occult UTI is 2% to 5% in children with concurrent bronchiolitis Therefore, evaluation for UTI should still be considered in the very young infant with fever and clinical signs of bronchiolitis An additional dilemma involves the very young infant who presents to the ED with a description of either tactile fever alone or fever confirmed by rectal temperature at home but who is afebrile on arrival In general, lack of tactile fever at home is a reliable indicator of lack of fever, but evidence is conflicting as to whether the presence of tactile fever at home correlates with measured fever However, all infants who were found to have serious bacterial infections (including five who were afebrile on presentation) were observed to have had an abnormal initial clinical profile and/or laboratory workup Although there is no consensus on the approach to this situation, it seems prudent to consider a careful clinical evaluation in all young infants with a history of fever, including one or more repeat temperatures over to hours in the ED after the baby is unbundled If there is a reliable history of elevated rectal temperature, a sepsis workup should be seriously considered, as described above, along with a subsequent disposition based on the clinical findings and laboratory results The infant with only a history of tactile fever whose repeated temperatures are normal and who has an entirely normal clinical evaluation may be assessed as not requiring laboratory studies All such infants discharged home warrant close follow-up and appropriate short-term monitoring of rectal temperature An additional conundrum is the young infant with fever who recently received vaccinations One study addressed this question and recommends that children with recent vaccinations and fever be treated similarly to those who have not recently received vaccinations, mainly due to risk of UTI Infants younger than month are usually admitted to the hospital for observation with presumptive antibiotic therapy (e.g., ampicillin and ceftazidime) after full evaluation as noted above in the ED Acyclovir should be considered for febrile infants younger than 21 days of age or in those with risk factors or findings concerning for HSV (including ill appearance, vesicular rash, hepatitis, or seizures) Studies have found that children between and months of age, who are not pretreated with any antibiotics and who have a completely normal physical examination and completely benign laboratory evaluation (see Fig 31.2 ), may be safely discharged home with careful observation and close follow-up For such a disposition, parents should be able to watch the infant closely for changes in symptoms, should have ready access to health care, and should be willing to return for evaluation These studies have found that either close