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Feverish illness is a common occurrence in childhood. It is the most frequent reason for parents to consult a doctor about their child, and is the second most common cause of hospital admission in childhood.1 Most are self-limiting, however despite this, infections are the most common cause of death in those aged less than 5 years.1 Therefore it is important to identify those with potentially severe infections and initiate treatment rapidly.
Feverish Illness is diagnosed in all children (<5years) who present with a temperature over 38°C as measured by the following as advised by NICE guidelines1
All children who present with fever/parental reports of fever at home should have the following recorded at triage1
Those children who have any ABC compromise, appear ill to health care professional, or have markedly deranged physiology should be taken immediately to the resuscitation area and a senior doctor should be involved. Treat according to APLS guidance 1,2
The remaining children should continue to be triaged appropriately and if pyrexia is present, one anti-pyretic agent should be administered if not already done so prior to presentation, doses of which can be found in the BNFc3
If ABC compromise/ill looking child/markedly deranged physiology the child should be taken to resus and managed according to APLS guidance2
The following should be assessed and documented in all feverish children1
These children should then be assigned to a colour group in keeping with the NICE guidance on feverish children” 2013’s traffic light system1. This will help determine further management.
Children will be classified into either into GREEN, AMBER or RED groups depending on their clinical assessment.1 Re-assess the child once anti-pyretic medications have been administered as this may alleviate some clinical features and the child may be grouped into a lower severity group.
Figure 1: Table taken from NICE Clinical Guideline 160 - Feverish illness in children 2013.
ALL children under 1 month of age with a documented fever >38° or those that appear unwell should undergo a full septic screen which should consist of:
IV antibiotics should be given in accordance with local guidelines.
*Please see RHSC lumbar puncture guideline for contraindications to LP
in whom no apparent source is found, the following investigations are advised1, and the patient should be admitted under medical paediatrics.
Administer IV antibiotics (refer to local guidance) if
In addition, children <3 months who have fever with a clear source should be discussed with the ED consultant on duty or medical registrar out of hours for admission to CDU or ARU for an extended period of monitoring +/- further investigation.
These children are likely to be septic, and should be managed with the early input of a senior clinician and early administration of IV antibiotics considered.
Children with a clear source of infection should be treated appropriately as per local guidance specific to that febrile illness, with written and verbal advice given to parents.
Children in the green category with no clear cause of pyrexia may be discharged home after assessment and appropriate investigations are completed. There should be a responsible adult at home and parental anxiety should be addressed.
Children not deemed suitable for discharge home after ED assessment should be admitted either to the CDU or directly to the ARU, following discussion with the senior doctor on the ED floor.
Advice sheet for parents (pdf):
Last reviewed: 23 October 2018
Next review: 06 April 2021
Author(s): Marie Spiers
Approved By: Paediatric & Neonatal Clinical Risk & Effectiveness Committee