Date Published: 23 May 2007
Guidance to help assess children with fever (UK)
The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Women and Children’s Health have today issued a guideline on assessing and managing children with fever. This is the first guideline to provide all healthcare professionals, including GPs, nurses, pharmacists and paediatricians with a practical tool to assess the symptoms of a child with fever and advise them on how they should be cared for within the appropriate setting.
Feverish illness is very common in young children, with between 20% and 40% of parents seeking healthcare for such an illness each year. Most fevers will settle by themselves but a few are caused by serious infections such as meningitis or pneumonia and infections remain the leading cause of death in children under the age of 5 years.
The guideline recommends that:
- 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 tool.
- Children with any ‘red’ features (those who are at high risk) should be urgently assessed by a healthcare professional in a face-to-face setting.
- Parental perception of a fever should be considered valid and taken seriously by healthcare professionals.
- If symptoms suggest the child is not at a high risk and can be cared for at home, the parent or carer should be provided with a safety net of information which can include, verbal and/or written information on warning symptoms, direct access to other out-of-hours healthcare professionals and follow up appointments if required.
Andrew Dillon, Executive Lead for the guideline and Chief Executive, NICE said:
“ This is an extremely important guideline for thousands of children and their parents or carers. Infections remain the leading cause of death in children under the age of 5 years with fever being one of the main symptoms. This guideline will help healthcare professionals to pick up the high-risk symptoms that indicate a child needs urgent medical attention - this will save children’s lives.”
Dr Monica Lakhanpaul, Co-director National Collaborating Centre for Women and Child’s health, Consultant Paediatrician and Senior Lecturer In Child Health, University of Leicester:
“ This is the first practical problem based guideline which will help all healthcare professionals to assess children with fever and decide how sick a child is so that they can be followed up by the right people, at the right time and within the right healthcare setting. Not all children will need to be taken to hospital and this guideline aims to identify those children who have symptoms that need further investigation and those who can go home.”
Dr Martin Richardson, Consultant Paediatrician and GDG Chair said:
“ Not all cases of fever are symptoms of serious illness - most children will just get better by themselves. The new ‘traffic light’ tool we have produced will enable doctors, nurses, pharmacists and other healthcare professionals to look at all the different symptoms of a child with fever and decide whether that child needs to be referred to a specialist or whether they would be best cared for at home under the supervision of a parent or carer. I am already using this tool when assessing the children I see on the wards and I find it really useful.”
Dr James Cave, GP and GDG member said:
“ As a GP I see hundreds of children in my practice who have a fever. Most of the time it is not because of a serious illness but it is often the cause of great anxiety and concern to parents and carers. This guideline will help all GPs to confidently identify the children who may need urgent care and the children that can go home and provided with a safety net of advice and information which can include, verbal and/or written information on warning symptoms, direct access to other out-of-hours healthcare professionals and follow up appointments if required.”
Jennifer Elliott, patient representative and GDG member said:
“ As a parent to three young children, I am often concerned when my children have a fever. This guideline sets out to empower parents and carers so that they can work in partnership with healthcare professionals to look after their child. A parent or carer is also often best at recognising when their child is ill. The guideline acknowledges this, and will ensure that our instinct or perception of fever is taken seriously by healthcare professionals. Often parents or carers will prefer to look after their children at home. The guideline will support them in doing this by ensuring that they are provided with a safety net of advice and information if things change and this will be very reassuring.”
Source: Leicester University and NICE (UK).