Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Thermometers and the detection of fever

  • In children aged 4 weeks to 5 years, measure body temperature by one of the following methods:

    • electronic thermometer in the axilla

    • chemical dot thermometer in the axilla

    • infra-red tympanic thermometer. [2007]

  • Reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals. [2007]

Clinical assessment of the child with fever

  • Assess children with feverish illness 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 (see table 1). [2013]

  • Measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine assessment of a child with fever. [2007]

  • Recognise that children with tachycardia are in at least an intermediate-risk group for serious illness. Use the Advanced Paediatric Life Support (APLS)[1] criteria below to define tachycardia: [new 2013]


Heart rate (bpm)

<12 months


12–24 months


2–5 years


Management by remote assessment

  • Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be urgently assessed by a healthcare professional in a face-to-face setting within 2 hours. [2007]

Management by the non-paediatric practitioner

  • If any 'amber' features are present and no diagnosis has been reached, provide parents or carers with a 'safety net' or refer to specialist paediatric care for further assessment. The safety net should be 1 or more of the following:

    • providing the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be accessed (see section 1.7.2)

    • arranging further follow-up at a specified time and place

    • liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required. [2007]

Management by the paediatric specialist

  • Perform the following investigations in infants younger than 3 months with fever:

    • full blood count

    • blood culture

    • C-reactive protein

    • urine testing for urinary tract infection[2]

    • chest X-ray only if respiratory signs are present

    • stool culture, if diarrhoea is present. [2013]

Antipyretic interventions

  • Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose. [2007]

  • When using paracetamol or ibuprofen in children with fever;

    • continue only as long as the child appears distressed

    • consider changing to the other agent if the child's distress is not alleviated

    • do not give both agents simultaneously

    • only consider alternating these agents if the distress persists or recurs before the next dose is due. [new 2013]

[1] Advanced Life Support Group (2004) advanced paediatric life support: the practical approach (4th edn). Wiley-Blackwell.

[2] See urinary tract infection in children (2007) NICE clinical guideline 54.

  • National Institute for Health and Care Excellence (NICE)