Calculators & Tools

Rochester Criteria (Febrile Infant)

Identifies febrile infants ≤60 days at LOW risk of serious bacterial infection. All criteria must be met.

1 What is the Rochester Criteria (Febrile Infant)?

The Rochester Criteria (Febrile Infant) is a infectious scoring tool used in paediatric practice. Identifies febrile infants ≤60 days at LOW risk of serious bacterial infection. All criteria must be met. It scores 7 criteria and interprets the total across 2 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in infectious
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 7 criteria: Infant appears generally well; Previously healthy - term (≥37 wk), no perinatal antibiotics, no underlying disease, not hospitalised longer than mother; No skin, soft-tissue, bone, joint or ear infection on examination; WBC 5 000-15 000 /µL; Absolute band count ≤ 1 500 /µL; Urine ≤ 10 WBC per high-power field; Stool ≤ 5 WBC per high-power field (only if diarrhoea). Totals are then banded: any score - NOT low risk: one or more low-risk criteria are not met - this infant is NOT low risk. Full sepsis evaluation, empirical antibiotics and admission per local protocol; 7 low-risk criteria met or more - Low risk: all criteria met - low risk of serious bacterial infection (negative predictive value ≈98.9%). Some protocols permit observation without empirical antibiotics; always follow local guidance and ensure reliable follow-up.
  • ALL criteria must be satisfied to call an infant low risk - a partial count is not meaningful.
  • Source: Jaskiewicz JA et al. Febrile infants at low risk for serious bacterial infection. Pediatrics 1994;94:390-6.

4 Frequently asked questions

How many criteria does the Rochester Criteria (Febrile Infant) use?

7. They are Infant appears generally well; Previously healthy - term (≥37 wk), no perinatal antibiotics, no underlying disease, not hospitalised longer than mother; No skin, soft-tissue, bone, joint or ear infection on examination; WBC 5 000-15 000 /µL; Absolute band count ≤ 1 500 /µL; Urine ≤ 10 WBC per high-power field; and others.

What do the bands of the Rochester Criteria (Febrile Infant) mean?

The total is interpreted as: any score - NOT low risk: one or more low-risk criteria are not met - this infant is NOT low risk. Full sepsis evaluation, empirical antibiotics and admission per local protocol; 7 low-risk criteria met or more - Low risk: all criteria met - low risk of serious bacterial infection (negative predictive value ≈98.9%). Some protocols permit observation without empirical antibiotics; always follow local guidance and ensure reliable follow-up.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

ALL criteria must be satisfied to call an infant low risk - a partial count is not meaningful.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.