National Institute for Health and Clinical Excellence (NICE)
Printable version E-mail this to a friend

Updated guidance to help assess children with fever

NICE has updated the traffic light system for predicting the risk of serious illness from fever in children under 5, and issued new advice on the use of paracetamol and ibuprofen.

This follows a partial update to the 2007 guideline on assessing and managing feverish illness in children under 5.

The bulk of the original recommendations remain, but a number of new recommendations have been added that take into account new evidence.

Children should continue to 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, which now includes raised heart rate.

Healthcare professionals should recognise that children with tachycardia are in at least an intermediate-risk group for serious illness, using the Advanced Paediatric Life Support (APLS) criteria to define tachycardia.

When using paracetamol or ibuprofen in children with fever, NICE recommends that treatment should continue only as long as the child appears distressed.

Healthcare professionals should consider changing to the other agent if the child's distress is not alleviated. NICE also advises against giving both agents simultaneously.

Only consider alternating these agents if the distress persists or if it recurs before the next dose is due, says NICE.

The guideline also includes a summary table of symptoms and signs suggestive of specific diseases such as meningitis and pneumonia.

Martin Richardson, consultant paediatrician and Chair of the guideline development group, said: “The updated guideline has two major changes. The first is a revision of the well respected traffic light table of symptoms and signs.

“In particular, the inclusion of raised heart rate should lead to further improvements in the recognition of seriously ill children. The second major change is that the section on the treatment of fever has been rewritten to encourage the rational, stepwise use of drugs such as paracetamol and ibuprofen."

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “By updating the NICE guideline to take into account new evidence, this will ensure that it remains current and relevant.

“Potentially serious cases of feverish illness are likely to be rare, so it is important that information is in place to help healthcare professionals distinguish these from mild cases.

“This guideline will help doctors, nurses, pharmacists and other healthcare professionals to pick up the high-risk symptoms that indicate a child needs urgent medical attention.

“It will also help to empower parents so they can work in partnership with healthcare professionals to care for children with a feverish illness.”

Dr John Crimmins, a GP and member of the guideline development group, said: “While dealing with children with fever is an everyday encounter in general practice, identifying the small number of those children who are in the early stages of a serious bacterial illness remains a difficult and challenging problem.

“As outcomes are largely dependent on early intervention, the initial assessments of these children, which can also occur in a variety of other settings including telephone advice lines, A&E and out-of-hours services, are crucial.

“This guideline will provide help and guidance based on the best currently available evidence, to ensure that early assessment wherever performed, can identify those children who are likely to have a serious bacterial infection and to ensure they are managed effectively, usually by referral for expert paediatric care.”

Penny McDougall, a children's nurse and member of the guideline development group, added: “The updated, evidence based traffic light table, is a fantastic tool that will enable health care professionals to recognise the signs of serious illnesses associated with fever earlier and therefore reduce the risk of death or long term harm.”

A baseline assessment tool, clinical case scenarios, costing statement, a slide set, and electronic audit tools are available to help put this guideline into practice.

A spotting the sick child online learning resource is also available, as well as an educational resource on the traffic light table.

Free, Secure, Compliant UK Public Sector IT Recycling Service