This guideline covers the assessment and early management of fever with no obvious cause in children aged under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care.

November 2021: We added a definition of sepsis to recommendation 1.2.2. We also added a cross reference to table 2 to guide users to the risk stratification tool for children aged under 5 years with suspected sepsis (table 3 in the NICE guideline on sepsis).

This guideline should be read in conjunction with the NICE guidelines on suspected sepsis, neonatal infection, bacterial meningitis and meningococcal disease, urinary tract infection in under 16s, diarrhoea and vomiting caused by gastroenteritis in under 5s and antimicrobial prescribing for common infections.


This guideline includes new recommendations on Kawasaki disease. These supplement the existing recommendations on:

Who is it for?

  • Healthcare professionals
  • Parents and carers of children under 5 with feverish illness

Guideline development process

How we develop NICE guidelines

This guideline updates and replaces NICE guideline CG160 (May 2013)

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)