Assessment and initial management of feverish illness in children younger than 5 years: summary of NICE guidance

Infectious diseases remain a major cause of childhood mortality and morbidity in the United Kingdom (personal communication, R MacFaul, Department of Health) with some evidence that this is associated with deficiencies in health care.1 Fever in young children usually indicates an underlying infection, but identifying the cause can pose a diagnostic challenge. In the absence of national guidance, feverish illness is variably managed across the UK. There is thus a perceived need to improve its assessment and management. This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on how to assess and initially manage feverish illness in children aged under 5 years.2 NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*). The recommendations are largely based around an evidence based traffic light system that is used to assess the risk of serious illness as low (green), intermediate (amber), or high (red), and to direct management accordingly (figs 1-3⇓⇓⇓). This guideline applies until the underlying condition is diagnosed, at which point the child should be treated according to guidance for that condition. Assessing the risk of serious illness in feverish children under age 5 years Managing feverish children under age 5 years in primary care Managing feverish children under age 5 years in paediatric care Clinical assessment should consist of three stages: