Research by the Nuffield Trust identified that, in 2015/16, viral infections, acute bronchitis and upper respiratory tract infections were the most common reasons why children and young people were admitted to hospital in an emergency. Reducing pressure on emergency hospital services is identified as a priority in the NHS Long Term Plan.
NICE’s guidance on assessing, diagnosing and managing infections in children can help reduce the pressure on hospital services while making sure that serious infections are managed well.
Fever in young children
Fever is very common in young children and it can be difficult to distinguish between simple viral illnesses and life-threatening bacterial infections in this group. Our guideline on fever in under 5s aims to improve clinical assessment and help healthcare professionals diagnose serious illness.
The Royal College of Emergency Medicine’s Feverish Child national audit found that, in 2018/19, nearly 70% of emergency departments assessed risk and managed children aged under 5 with a fever and with no apparent source of infection in line with NICE’s recommended traffic light system.
There is still room for improvement in this important area; the audit report notes that nationally we we should aim for 100%. Not achieving this could lead to some children being inappropriately admitted to hospital or the signs and symptoms of serious infection being missed.
After assessment using the traffic light system, NICE recommends that children with ‘green’ features and none of the ‘amber’ or ‘red’ features can be cared for at home with appropriate advice for parents and carers. The audit found that 67% of children who were discharged home left with appropriate safety net information and advice. Without this advice parents may not know what to look out for, delaying the response if a child’s health was to deteriorate.
Think 'could this be sepsis?'
The number of children and young people who were in hospital and diagnosed with sepsis has increased from just under 8,000 in 2015/16 to nearly 14,000 in 2018/19. Sepsis is a life-threatening reaction to an infection which happens when the immune system overreacts and starts to damage tissues and organs. It can be especially hard to spot in babies and young children. A key recommendation in our guidance is that clinicians think ‘Could this be sepsis?’ if a child presents with fever and symptoms or signs that indicate possible sepsis.
92% of emergency departments use a stratified risk assessment or screening tool for sepsis
The Feverish Child national audit reported that 70% of trusts with emergency departments provided training on recognising paediatric sepsis for clinicians managing children with a fever. Most emergency departments reported using a stratified risk assessment or screening tool such as those produced by the UK Sepsis Trust and endorsed by NICE to assess children at risk.
However, records reviewed during the audit showed that only 38% of children aged under 5 who presented to an emergency department with fever as part of their complaint had their risk of sepsis assessed using a tool. Not carrying out this assessment could mean that children at risk of serious illness do not receive the urgent intervention they need.
Prescribing antibiotics for common infections
NICE has been commissioned by the Department of Health and Social Care to develop evidence-based antimicrobial prescribing guidance to help manage common infections. Antimicrobial resistance poses a significant threat to public health, so it’s important that antibiotics are not prescribed when they are unnecessary. It’s also important that serious infections are identified, and the right antibiotic is prescribed if this is appropriate.
Each of the NICE guidelines has a visual summary, which provides an overview of the guideline recommendations along with a prescribing table with recommended doses for children and adults. The guidelines also include advice on self-care and when onward referral to hospital or specialist advice is needed. They cover many common childhood infections including cough, sore throat, otitis media (ear infection) and sinusitis.
Data collected by the English surveillance programme for antimicrobial utilisation and resistance show that children under 5 are prescribed more antibiotics than people aged 5 to 64. However, there has been an encouraging recent decrease in primary care antibiotic prescribing across all age ranges under 65.