Avoiding Serious Illness In Children With Unexplained Fever


Unexplained fever is a concern for many parents and every year, almost half (40%) of young children will be taken to the doctor because of it. Fever is the second most common reason that a child will be admitted to hospital.

NICE has published a new quality standard to help healthcare professionals quickly identify and treat under-5s seriously ill with fever and reduce their chances of dying or disability.

[private] Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said: “In many cases fever is caused by a viral infection and children will recover quickly without treatment. However in some cases it can be the first sign of a more serious bacterial illness such as meningitis or pneumonia. This new quality standard sets out clear priorities that will help doctors, nurses, pharmacists and other healthcare professionals pick up the high-risk symptoms that indicate a child needs urgent medical attention.”

The standard includes 4 statements aimed at healthcare professionals, particularly those working in general practice and emergency departments, highlighting where improvements are most needed. It states that all under-5s with suspected fever who are seen face to face by a healthcare professional must have their vital signs checked, including temperature, heart rate and breathing. All reports of fever from parents or carers must be acted upon.

The standard highlights that under-5s who present with unexplained fever over 38°C should have their urine tested within 24 hours as they may have a urinary tract infection which can be managed with antibiotics.

The standard also states that physicians should use the traffic light system for identifying the risk of serious illness. This system groups signs and symptoms of serious illness into high (red), medium (amber) and low (green) to help determine how to manage fever.

Dr Andrew Riordan, Consultant, Alder Hey Children’s NHS Foundation Trust and specialist member of the committee that developed the standard said: “Identifying the cause of fever can be very difficult, particularly in very young children, and some children can deteriorate very quickly. The standard encourages healthcare professionals to use the ‘traffic light system’ which may help pick up high-risk symptoms earlier and potentially prevent long-term harm. We hope this quality standard will improve the assessment of young children with unexplained fever.”

There will be times when unexplained fever can be treated at home and the standard stresses the importance of making sure parents and carers are given advice about how to keep their child safe and when to seek help if their child’s condition deteriorates further or if they need more support.

Parents are advised to keep their child away from nursery or school, give them plenty of fluids and check on them regularly through the night. They should look out for signs such as a rash which doesn’t disappear or symptoms deteriorating, which may mean they need to seek further help.

Professor Leng added: “Designed to work alongside our NICE clinical guideline published last year, we now have a robust set of tools and guidance to support healthcare professionals and commissioners in delivering high-quality care to young children suffering from fever.”

Christopher Head, Chief Executive at Meningitis Research Foundation said: “Meningitis and septicaemia become life-threatening within hours of the onset of fever, so identification and treatment are time critical. Our charity shares NICE’s commitment to identifying seriously ill children from amongst those with milder feverish illnesses. We believe the new NICE quality standard to identify and treat under-5s seriously ill with fever will ensure that commissioners and health professionals have the information they need to deliver the best care for these children.”[/private]

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