Feverish illness in children

National Institute for Health and Clinical Excellence

Key priorities for implementation

Detection of fever

• In children aged 4 weeks to 5 years, healthcare professionals should measure body temperature by one of the following methods:
  • electronic thermometer in the axilla
  • chemical dot thermometer in the axilla
  • infra-red tympanic thermometer
• Reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals

Clinical assessment of the child with fever

• Children with feverish illness should be assessed for the presence or absence of symptoms and signs that can be used to predict the risk of serious illness using the traffic light system (see Table 1)
• Healthcare professionals should measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine assessment of a child with fever

Management by remote assessment

• Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be urgently assessed by a healthcare professional in a face-to-face setting within 2 hours

Management by the non-paediatric practitioner

• If any 'amber' features are present and no diagnosis has been reached, healthcare professionals should provide parents or carers with a 'safety net' or refer to specialist paediatric care for further assessment. The safety net should be one or more of the following:
  • providing the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be accessed
  • arranging further follow-up at a specified time and place
  • liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required
• Oral antibiotics should not be prescribed to children with fever without apparent source

Management by the paediatric specialist

• Infants younger than 3 months with fever should be observed and have the following vital signs measured and recorded:
  • temperature
  • heart rate
  • respiratory rate
• Children with fever without apparent source presenting to paediatric specialists with one or more 'red' features should have the following investigations performed:
  • full blood count
  • blood culture
  • C-reactive protein
  • urine testing for urinary tract infection
• The following investigations should also be considered in children with 'red' features, as guided by the clinical assessment:
  • lumbar puncture in children of all ages (if not contraindicated)
  • chest X-ray irrespective of body temperature and white blood cell count
  • serum electrolytes and blood gas

Antipyretic interventions

• Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose