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Do you know your JIA from your macrophage activation syndrome? Pediatric rheumatologist Caroline Change sheads some light on the subject.
You mentioned otitis media as a source for fever. Thought current belief is that, like any simple abscess, OM should not be blamed for fever. No?
Sorry for the delayed response- tried taking the kids to AAEM with me to speak- that was an adventure! That's a great question. I do agree that typically, when I see an OM and URI, I feel it likely that the URI is responsible for the fever, not the OM. The AAP guidelines of treating for a high fever certainly indicate that they believe a fever could be due to OM. There isn't literature definitively answering the question. My practice is the following: if I am really worried the fever is from a significant alternate pathology (kid looks terrible, has neutropenia, is <60 days, etc), I still work it up, even with an OM. If it is a kid that I'm not really worried about, I usually let it go with treatment and careful precautions. In that middle group, like the s/p biologics kid Caroline discusses, I'm sort of on the fence and base it on how high the fever is and how the kid looks. So, in a nutshell, while I agree with you, I don't care too much about fever in the majority of pediatric patients.
What you do matters.