This document is mainly based on the National Institute for Health and Care Excellence (NICE) guidelines 'Fever in under 5s', originally published in May 2007 and updated in 2013, 2017 and 2019[1]. It includes information on assessment and pre-hospital care by non-paediatric specialists. Fever, or pyrexia, occurs when the body temperature rises above normal. The average normal body temperature taken in the mouth is 37°C but anywhere between 36.5°C and 37.2°C is deemed as normal. When temperatures are measured in the axilla they can be 0.2°C to 0.3°C lower than this. Aural (tympanic) thermometers may measure the temperature as higher. NICE guidelines define fever as "an elevation of body temperature above normal daily variation" but recognises that this is generally accepted as a temperature of 38°C or above. Fever is one of the most common reasons for a child to be taken to see a doctor and is the second most common reason for a child to be admitted to hospital. The cause of the fever can sometimes be hard to elicit and this can be a worry for healthcare professionals. It is usually due to a viral infection that is self-limiting but it can also be a sign of serious bacterial infection, including meningitis or septicaemia. Early diagnosis of serious infections in general practice is difficult as incidence is low, the child may present early in the disease process and diagnostic tools are more or less limited to history and examination[2]. History should include asking:
Other points to consider from the history:
Dr Sarah Jarvis, November 2021 Addition of definition of sepsis to NICE guidance
After history and examination have been performed, specific illnesses should be considered.
This is a common scenario, and most often will be due to a viral infection. The NICE traffic light system below helps the primary care practitioner determine which cases are more likely to be due to a serious or life-threatening bacterial infection and should therefore be referred to secondary care for further assessment and management. In primary care, history and examination are the mainstays of assessing fever without an obvious focus to establish severity and to try to ascertain the cause, and urine should be tested In all children with an unexplained fever ≥38°C[4]. In a significant number of cases of children with a fever, no specific cause will be established. Antibiotics should not be used empirically for children with fever without an apparent cause[1]. NICE recommends that a traffic light system should be used to predict the risk of serious illness when the symptoms and signs have been elicited from the history and examination. Allowance should be made for individual disabilities when assessing learning-disabled children.The following table summarises this system. If the child has any of the symptoms or signs in the amber column, they are at intermediate risk of serious illness. If they have any of the symptoms or signs in the red column they are at high risk of serious illness. Children with symptoms or signs in the green column and none in the red or amber column are at low risk of serious illness. Management of fever should be guided by the level of risk. National Institute for Health and Care Excellence (2007) CG160 Feverish illness in children. London: NICE. Available from www.nice.org.uk/guidance/CG1607
This includes professionals working in primary care and also those working in general accident and emergency departments.
Management of specific diseases
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