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["Baseline assessment: Fever in under 5s: assessment and initial management "]
["NG143"]
[]
[]
["Published: 7  November 2019"]
["Updated: 26 November 2021"]

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["Baseline assessment tool for fever in under 5s: assessment and initial management  (NICE guideline NG143)"]
[]
["This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Fever in under 5s: assessment and initial management .  It can also help to plan activity to meet the recommendations."]
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["The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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["It should be used in conjunction with Fever in under 5s: assessment and initial management (NICE guideline NG143)."]
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["In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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["Is the guideline relevant?"]
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[]
["The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
[]
["The table can be adapted to include any other local information that is thought to be useful."]
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["If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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["Tools and resources to help put the guidance into practice are available on the NICE website. "]
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["National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2022. All rights reserved. Subject to Notice of rights.\n"]

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["Baseline assessment tool for fever in under 5s: assessment and initial management  (NICE guideline NG143)"]
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[]
["NICE recommendation","Guideline reference","Year of recommendation","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
["1.1  Thermometers and the detection of fever"]
["Oral and rectal temperature measurements"]
["Do not routinely use the oral and rectal routes to measure the body temperature of children aged 0–5 years. ","1.1.1",2007]
["Measurement of body temperature at other sites"]
["In infants under the age of 4 weeks, measure body temperature with an electronic thermometer in the axilla. ","1.1.2",2007]
["In children aged 4 weeks to 5 years, measure body temperature by one of the following methods:\n•\telectronic thermometer in the axilla\n•\tchemical dot thermometer in the axilla\n•\tinfra-red tympanic thermometer. ","1.1.3",2007]
["Healthcare professionals who routinely use disposable chemical dot thermometers should consider using an alternative type of thermometer when multiple temperature measurements are required. ","1.1.4",2007]
["Forehead chemical thermometers are unreliable and should not be used by healthcare professionals. ","1.1.5",2007]
["Subjective detection of fever by parents and carers"]
["Reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals.","1.1.6",2007]
["1.2 Clinical assessment of children with fever"]
["Life-threatening features of illness in children"]
["First, healthcare professionals should identify any immediately life-threatening features, including compromise of the airway, breathing or circulation, and decreased level of consciousness. ","1.2.1",2007]
["Think “Could this be sepsis?” and refer to the NICE guideline on sepsis: recognition, diagnosis and early management if a child presents with fever and symptoms or signs that indicate possible sepsis. \n\nSepsis is a condition of life-threatening organ dysfunction due to a dysregulated host response to infection.","1.2.2",2017]
["Assessment of risk of serious illness"]
["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 2). ","1.2.3",2013]
["When assessing children with learning disabilities, take the individual child’s learning disability into account when interpreting the traffic light table. ","1.2.4",2013]
["\tRecognise that children with any of the following symptoms or signs are in a high-risk group for serious illness:\n•\tpale/mottled/ashen/blue skin, lips or tongue\n•\tno response to social cues \n•\tappearing ill to a healthcare professional\n•\tdoes not wake or if roused does not stay awake\n•\tweak, high-pitched or continuous cry\n•\tgrunting\n•\trespiratory rate greater than 60 breaths per minute\n•\tmoderate or severe chest indrawing\n•\treduced skin turgor\n•\tbulging fontanelle. ","1.2.5",2013]
["\tRecognise that children with any of the following symptoms or signs are in at least an intermediate-risk group for serious illness:\n•\tpallor of skin, lips or tongue reported by parent or carer \n•\tnot responding normally to social cues\n•\tno smile\n•\twakes only with prolonged stimulation\n•\tdecreased activity\n•\tnasal flaring\n•\tdry mucous membranes\n•\tpoor feeding in infants\n•\treduced urine output\n•\trigors. ","1.2.6",2013]
["\tRecognise that children who have all of the following features, and none of the high- or intermediate-risk features, are in a low-risk group for serious illness:\n•\tnormal colour of skin, lips and tongue\n•\tresponds normally to social cues\n•\tcontent/smiles\n•\tstays awake or awakens quickly\n•\tstrong normal cry or not crying\n•\tnormal skin and eyes\n•\tmoist mucous membranes. ","1.2.7",2013]
["Measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine assessment of a child with fever. ","1.2.8",2007]
["Recognise that a capillary refill time of 3 seconds or longer is an intermediate-risk group marker for serious illness (‘amber’ sign). ","1.2.9",2013]
["Measure the blood pressure of children with fever if the heart rate or capillary refill time is abnormal and the facilities to measure blood pressure are available. ","1.2.10",2007]
["In children older than 6 months do not use height of body temperature alone to identify those with serious illness. ","1.2.11",2013]
["Recognise that children younger than 3 months with a temperature of 38°C or higher are in a high-risk group for serious illness. (Note that some vaccinations have been found to induce fever in children aged under 3 months.) ","1.2.12",2013]
["Recognise that children aged 3–6 months with a temperature of 39°C or higher are in at least an intermediate-risk group for serious illness. ","1.2.13",2013]
["Do not use duration of fever to predict the likelihood of serious illness. However, children with a fever lasting 5 days or longer should be assessed for Kawasaki disease (see the recommendation on additional features of Kawasaki disease in the section on symptoms and signs of specific illnesses). ","1.2.14","2013, amended 2019"]
["Recognise that children with tachycardia are in at least an intermediate‑risk group for serious illness. Use the Advanced Paediatric Life Support criteria in table 1 to define tachycardia. ","1.2.15",2013]
["\tAssess children with fever for signs of dehydration. Look for:\n•\tprolonged capillary refill time\n•\tabnormal skin turgor\n•\tabnormal respiratory pattern\n•\tweak pulse\n•\tcool extremities. ","1.2.16",2007]
["Symptoms and signs of specific illnesses"]
["Look for a source of fever and check for the presence of symptoms and signs that are associated with specific diseases (see table 3). ","1.2.17",2007]
["Meningococcal disease and bacterial meningitis"]
["Consider meningococcal disease in any child with fever and a non-blanching rash, particularly if any of the following features are present: \n•\tan ill-looking child\n•\tlesions larger than 2 mm in diameter (purpura)\n•\ta capillary refill time of 3 seconds or longer\n•\tneck stiffness. ","1.2.18",2007]
["\tConsider bacterial meningitis in a child with fever and any of the following features: \n•\tneck stiffness\n•\tbulging fontanelle\n•\tdecreased level of consciousness\n•\tconvulsive status epilepticus. ","1.2.19","2007, amended 2013"]
["Be aware that classic signs of meningitis (neck stiffness, bulging fontanelle, high-pitched cry) are often absent in infants with bacterial meningitis. ","1.2.20",2007]
["Herpes simplex encephalitis"]
["Consider herpes simplex encephalitis in children with fever and any of the following features:\n•\tfocal neurological signs\n•\tfocal seizures\n•\tdecreased level of consciousness. \n\n","1.2.21",2007]
["Pneumonia"]
["\tConsider pneumonia in children with fever and any of the following signs:\n•\ttachypnoea (respiratory rate greater than 60 breaths per minute, age 0–5 months; greater than 50 breaths per minute, age 6–12 months; greater than 40 breaths per minute, age older than 12 months)\n•\tcrackles in the chest\n•\tnasal flaring\n•\tchest indrawing\n•\tcyanosis\n•\toxygen saturation of 95% or less when breathing air.\nBe aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes.","1.2.22",2007]
["Urinary tract infection"]
["Consider urinary tract infection in a baby or child under 5 with fever. See the symptoms and signs that increase the likelihood that a UTI is present in the section on symptoms and signs in the NICE guideline on urinary tract infection in under 16s. ","1.2.23","2007, amended 2022"]
["Septic arthritis or osteomyelitis"]
["Consider septic arthritis or osteomyelitis in children with fever and any of the following signs: \n•\tswelling of a limb or joint\n•\tnot using an extremity\n•\tnon-weight bearing","1.2.24",2007]
["Kawasaki disease"]
["\tBe aware of the possibility of Kawasaki disease in children with fever that has lasted 5 days or longer. Additional features of Kawasaki disease may include:\n•\tbilateral conjunctival injection without exudate\n•\terythema and cracking of lips; strawberry tongue; or erythema of oral and pharyngeal mucosa\n•\toedema and erythema in the hands and feet\n•\tpolymorphous rash\n•\tcervical lymphadenopathy.","1.2.25",2019]
["Ask parents or carers about the presence of these features since the onset of fever, because they may have resolved by the time of assessment. ","1.2.26",2019]
["Be aware that children under 1 year may present with fewer clinical features of Kawasaki disease in addition to fever, but may be at higher risk of coronary artery abnormalities than older children. ","1.2.27",2019]
["Imported infections"]
["When assessing a child with feverish illness, enquire about recent travel abroad and consider the possibility of imported infections according to the region visited.\n\nBe aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes.","1.2.28",2007]
["1.3  Management by remote assessment"]
["Remote assessment refers to situations in which a child is assessed by a healthcare professional who is unable to examine the child because the child is geographically remote from the assessor (for example, telephone calls to NHS 111). Therefore, assessment is largely an interpretation of symptoms rather than physical signs. The guidance in this section may also apply to healthcare professionals whose scope of practice does not include the physical examination of a young child (for example, community pharmacists)."]
["Management according to risk of serious illness"]
["Healthcare professionals performing a remote assessment of a child with fever should seek to identify symptoms and signs of serious illness and specific diseases as described in the section on clinical assessment of children with fever and summarised in tables 2 and 3. ","1.3.1",2007]
["Children whose symptoms or combination of symptoms suggest an immediately life-threatening illness (see the recommendations on life-threatening features of illness in children) should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance). ","1.3.2",2007]
["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. ","1.3.3",2007]
["Children with 'amber' but no 'red' features should be assessed by a healthcare professional in a face-to-face setting. The urgency of this assessment should be determined by the clinical judgement of the healthcare professional carrying out the remote assessment. ","1.3.4",2007]
["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, including advice on when to seek further attention from the healthcare services (see the section on care at home). ","1.3.5","2007, amended 2013"]
["1.4   Management by the non-paediatric practitioner"]
["In this guideline, a non-paediatric practitioner is defined as a healthcare professional who has not had specific training or who does not have expertise in the assessment and treatment of children and their illnesses. This term includes healthcare professionals working in primary care, but it may also apply to many healthcare professionals in general emergency departments."]
["Clinical assessment"]
["Management by a non-paediatric practitioner should start with a clinical assessment as described in the section on clinical assessment of children with fever. Healthcare practitioners should attempt to identify symptoms and signs of serious illness and specific diseases as summarised in tables 2 and 3. ","1.4.1",2007]
["Management according to risk of serious illness"]
["Children whose symptoms or combination of symptoms and signs suggest an immediately life-threatening illness (see the recommendation on identifying life-threatening features) should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance). ","1.4.2",2007]
["Children with any ‘red’ features but who are not considered to have an immediately life-threatening illness should be referred urgently to the care of a paediatric specialist.","1.4.3",2007]
["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:\n•\tproviding the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be accessed (see the recommendation on advising parents or carers in the section on advice for care at home)\n•\tarranging further follow-up at a specified time and place\n•\tliaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required. ","1.4.4",2007]
["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, including advice on when to seek further attention from the healthcare services (see the section on advice for care at home). ","1.4.5","2007, amended 2013"]
["Tests by the non-paediatric practitioner"]
["Children with symptoms and signs suggesting pneumonia who are not admitted to hospital should not routinely have a chest X-ray.","1.4.6",2007]
["See the section on symptoms and signs in the NICE guideline on urinary tract infection in under 16s for when to test the urine of babies and children with fever for a UTI. ","1.4.7",2007]
["When a child has been given antipyretics, do not rely on a decrease or lack of decrease in temperature to differentiate between serious and non-serious illness. ","1.4.8",2017]
["Use of antibiotics by the non-paediatric practitioner"]
["Do not prescribe oral antibiotics to children with fever without apparent source. ","1.4.9",2007]
["Give parenteral antibiotics to children with suspected meningococcal disease at the earliest opportunity (either benzylpenicillin or a third‑generation cephalosporin). See the NICE guideline on meningitis (bacterial) and meningococcal septicaemia in under 16s. ","1.4.10",2007]
["1.5   Management by the paediatric specialist"]
["In this guideline, the term paediatric specialist refers to a healthcare professional who has had specific training or has recognised expertise in the assessment and treatment of children and their illnesses. Examples include paediatricians, or healthcare professionals working in children's emergency departments."]
["Children younger than 5 years"]
["Management by the paediatric specialist should start with a clinical assessment as described in the section on clinical assessment of children with fever. The healthcare professional should attempt to identify symptoms and signs of serious illness and specific diseases as summarised in tables 2 and 3. ","1.5.1",2007]
["Children younger than 3 months "]
["\tInfants younger than 3 months with fever should be observed and have the following vital signs measured and recorded:\n•\ttemperature\n•\theart rate\n•\trespiratory rate. ","1.5.2",2007]
["\tPerform the following investigations in infants younger than 3 months with fever:\n•\tfull blood count\n•\tblood culture\n•\tC-reactive protein\n•\turine testing for urinary tract infection (see NICE’s guideline on urinary tract infection in under 16s)\n•\tchest X-ray only if respiratory signs are present\n•\tstool culture, if diarrhoea is present. ","1.5.3",2013]
["Perform lumbar puncture in the following children with fever (unless contraindicated):\n•\tinfants younger than 1 month\n•\tall infants aged 1 to 3 months who appear unwell\n•\tinfants aged 1 to 3 months with a white blood cell count (WBC) less than 5 times 109 per litre or greater than 15 times 109 per litre. ","1.5.4","2007, amended 2013"]
["When indicated, perform a lumbar puncture without delay and, whenever possible, before the administration of antibiotics. ","1.5.5",2007]
["Give parenteral antibiotics to:\n•\tinfants younger than 1 month with fever\n•\tall infants aged 1 to 3 months with fever who appear unwell\n•\tinfants aged 1 to 3 months with WBC less than 5 times 109 per litre or greater than 15 times 109 per litre. ","1.5.6","2007, amended 2013"]
["When parenteral antibiotics are indicated for infants younger than 3 months of age, a third-generation cephalosporin (for example cefotaxime or ceftriaxone) should be given plus an antibiotic active against listeria (for example, ampicillin or amoxicillin). ","1.5.7",2007]
["Children aged 3 months or older"]
["Perform the following investigations in children with fever without apparent source who present to paediatric specialists with 1 or more 'red' features:\n•\tfull blood count\n•\tblood culture\n•\tC-reactive protein\n•\turine testing for urinary tract infection (see NICE’s guideline on urinary tract infection in under 16s). ","1.5.8",2013]
["\tThe following investigations should also be considered in children with 'red' features, as guided by the clinical assessment:\n•\tlumbar puncture in children of all ages (if not contraindicated)\n•\tchest X-ray irrespective of body temperature and WBC\n•\tserum electrolytes and blood gas. ","1.5.9",2007]
["1.5.10\tChildren with fever without apparent source presenting to paediatric specialists who have 1 or more ‘amber’ features, should have the following investigations performed unless deemed unnecessary by an experienced paediatrician:\n•\turine should be collected and tested for urinary tract infection (see the sections on urine collection, preservation and testing in the NICE guideline on urinary tract infection in under 16s)\n•\tblood tests: full blood count, C-reactive protein and blood cultures\n•\tlumbar puncture should be considered for children younger than 1 year\n•\tchest X-ray in a child with a fever greater than 39°C and WBC greater than 20 times 109 per litre.","1.5.10",2007]
["Children who have been referred to a paediatric specialist with fever without apparent source and who have no features of serious illness (that is, the ‘green’ group), should have urine tested for urinary tract infection and be assessed for symptoms and signs of pneumonia (see table 3 and the sections on urine collection, preservation and testing in the NICE guideline on urinary tract infection in under 16s). ","1.5.11",2007]
["Do not routinely perform blood tests and chest X-rays in children with fever who have no features of serious illness (that is, the ‘green’ group). ","1.5.12",2007]
["Viral co-infection"]
["Febrile children with proven respiratory syncytial virus or influenza infection should be assessed for features of serious illness. Consideration should be given to urine testing for urinary tract infection (see NICE’s guideline on urinary tract infection in under 16s). ","1.5.13",2007]
["Observation in hospital"]
["In children aged 3 months or older with fever without apparent source, a period of observation in hospital (with or without investigations) should be considered as part of the assessment to help differentiate non-serious from serious illness. ","1.5.14",2007]
["When a child has been given antipyretics, do not rely on a decrease or lack of decrease in temperature at 1–2 hours to differentiate between serious and non-serious illness. Nevertheless, in order to detect possible clinical deterioration, all children in hospital with ‘amber’ or ‘red’ features should still be reassessed after 1–2 hours. ","1.5.15",2013]
["Immediate treatment by the paediatric specialist (for children of all ages)"]
["\nChildren with fever and shock presenting to specialist paediatric care or an emergency department should be:\n•\tgiven an immediate intravenous fluid bolus of 10 ml/kg; the initial fluid should normally be 0.9% sodium chloride\n•\tactively monitored and given further fluid boluses as necessary. ","1.5.16",2007]
["\tGive immediate parenteral antibiotics to children with fever presenting to specialist paediatric care or an emergency department if they are:\n•\tshocked\n•\tunrousable\n•\tshowing signs of meningococcal disease. ","1.5.17",2007]
["Immediate parenteral antibiotics should be considered for children with fever and reduced levels of consciousness. In these cases symptoms and signs of meningitis and herpes simplex encephalitis should be sought (see table 3 and the NICE guideline on meningitis (bacterial) and meningococcal septicaemia in under 16s). ","1.5.18",2007]
["When parenteral antibiotics are indicated, a third-generation cephalosporin (for example, cefotaxime or ceftriaxone) should be given, until culture results are available. For children younger than 3 months, an antibiotic active against listeria (for example, ampicillin or amoxicillin) should also be given. ","1.5.19",2007]
["Give intravenous aciclovir to children with fever and symptoms and signs suggestive of herpes simplex encephalitis (see the section on herpes simplex encephalitis). ","1.5.20",2007]
["Oxygen should be given to children with fever who have signs of shock or oxygen saturation (SpO2) of less than 92% when breathing air. Treatment with oxygen should also be considered for children with an SpO2 of greater than 92%, as clinically indicated. \n\nBe aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes.","1.5.21",2007]
["Causes and incidence of serious bacterial infection"]
["In a child presenting to hospital with a fever and suspected serious bacterial infection, requiring immediate treatment, antibiotics should be directed against Neisseria meningitidis, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and Haemophilus influenzae type b. A third-generation cephalosporin (for example, cefotaxime or ceftriaxone) is appropriate, until culture results are available. For infants younger than 3 months, an antibiotic active against listeria (for example, ampicillin or amoxicillin) should be added. ","1.5.22",2007]
["Refer to local treatment guidelines when rates of bacterial antibiotic resistance are significant.","1.5.23",2007]
["Admission to and discharge from hospital"]
["\tIn addition to the child's clinical condition, consider the following factors when deciding whether to admit a child with fever to hospital:\n•\tsocial and family circumstances\n•\tother illnesses that affect the child or other family members\n•\tparental anxiety and instinct (based on their knowledge of their child)\n•\tcontacts with other people who have serious infectious diseases\n•\trecent travel abroad to tropical/subtropical areas, or areas with a high risk of endemic infectious disease\n•\twhen the parent or carer's concern for their child's current illness has caused them to seek healthcare advice repeatedly\n•\twhere the family has experienced a previous serious illness or death due to feverish illness which has increased their anxiety levels\n•\twhen a feverish illness has no obvious cause, but the child remains ill longer than expected for a self-limiting illness. ","1.5.24",2007]
["If it is decided that a child does not need to be admitted to hospital, but no diagnosis has been reached, provide a safety net for parents and carers if any 'red' or 'amber' features are present. The safety net should be 1 or more of the following:\n•\tproviding the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be accessed (see the recommendation on advising parents or carers in the section on advice for home care)\n•\tarranging further follow-up at a specified time and place\n•\tliaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required. ","1.5.25",2007]
["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, including advice on when to seek further attention from the healthcare services (see the section on advice for home care). ","1.5.26","2007, amended 2013"]
["Referral to paediatric intensive care"]
["Children with fever who are shocked, unrousable or showing signs of meningococcal disease should be urgently reviewed by an experienced paediatrician and consideration given to referral to paediatric intensive care.","1.5.27",2007]
["Give parenteral antibiotics to children with suspected meningococcal disease at the earliest opportunity (either benzylpenicillin or a third-generation cephalosporin).","1.5.28",2007]
["Children admitted to hospital with meningococcal disease should be under paediatric care, supervised by a consultant and have their need for inotropes assessed. ","1.5.29",2007]
["1.6  Antipyretic interventions"]
["Effects of body temperature reduction"]
["Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose. ","1.6.1",2007]
["Physical interventions to reduce body temperature"]
["Tepid sponging is not recommended for the treatment of fever.","1.6.2",2007]
["Children with fever should not be underdressed or over-wrapped.","1.6.3",2007]
["Drug interventions to reduce body temperature"]
["Consider using either paracetamol or ibuprofen in children with fever who appear distressed. ","1.6.4",2013]
["Do not use antipyretic agents with the sole aim of reducing body temperature in children with fever.","1.6.5",2013]
["When using paracetamol or ibuprofen in children with fever:\n•\tcontinue only as long as the child appears distressed\n•\tconsider changing to the other agent if the child’s distress is not alleviated \n•\tdo not give both agents simultaneously \n•\tonly consider alternating these agents if the distress persists or recurs before the next dose is due. ","1.6.6",2013]
["1.7   Advice for home care"]
["Care at home"]
["Advise parents or carers to manage their child's temperature as described in the section on antipyretic interventions. ","1.7.1",2007]
["\tAdvise parents or carers looking after a feverish child at home:\n•\tto offer the child regular fluids (where a baby or child is breastfed the most appropriate fluid is breast milk)\n•\thow to detect signs of dehydration by looking for the following features:\n-\tsunken fontanelle\n-\tdry mouth\n-\tsunken eyes\n-\tabsence of tears\n-\tpoor overall appearance\n•\tto encourage their child to drink more fluids and consider seeking further advice if they detect signs of dehydration\n•\thow to identify a non-blanching rash\n•\tto check their child during the night\n•\tto keep their child away from nursery or school while the child's fever persists but to notify the school or nursery of the illness. ","1.7.2",2007]
["When to seek further help"]
["\tFollowing contact with a healthcare professional, parents and carers who are looking after their feverish child at home should seek further advice if:\n•\tthe child has a fit\n•\tthe child develops a non-blanching rash\n•\tthe parent or carer feels that the child is less well than when they previously sought advice\n•\tthe parent or carer is more worried than when they previously sought advice\n•\tthe fever lasts 5 days or longer\n•\tthe parent or carer is distressed, or concerned that they are unable to look after their child. ","1.7.3","2007, amended 2019"]

{"sheet":"Table 1","index":3,"n_rows":5,"n_cols":2,"rows_kept":5,"cut":false,"hidden":false,"merged":[[18,0,18,11]]}
["Table 1 Advanced Paediatric Life Support criteria for tachycardia"]
["Age","Heart rate (bpm)"]
["Less than 12 months","More than 160"]
["12 to 24 months","More than 150"]
["2 to 5 years","More than 140"]

{"sheet":"Table 2","index":4,"n_rows":13,"n_cols":4,"rows_kept":13,"cut":false,"hidden":false,"merged":[]}
["Table 2 Summary table for symptoms and signs suggestive of specific diseases  [2013]"]
["Refer to table 3 in the NICE guideline on sepsis if a child presents with fever and symptoms or signs that indicate possible sepsis."]
["Children with fever and any of the symptoms or signs in the red column should be recognised as being at high risk. Similarly, children with fever and any of the "]
["symptoms or signs in the amber column and none in the red column should be recognised as being at intermediate risk. Children with symptoms and signs in the "]
["green column and none in the amber or red columns are at low risk. The management of children with fever should be directed by the level of risk."]
["This traffic light table should be used in conjunction with the recommendations in this guideline on investigations and initial management in children with fever."]
[null,"Green – low risk","Amber – intermediate risk","Red – high risk"]
["Colour (of skin, lips or tongue)","Normal colour ","•\tPallor reported by parent/carer","•\tPale/mottled/ashen/blue"]
["Activity","•\tResponds normally to social cues\n•\tContent/smiles\n•\tStays awake or awakens quickly\n•\tStrong normal cry/not crying","•\tNot responding normally to social cues\n•\tNo smile\n•\tWakes only with prolonged stimulation\n•\tDecreased activity","•\tNo response to social cues\n•\tAppears ill to a healthcare professional\n•\tDoes not wake or if roused does not stay awake\n•\tWeak, high-pitched or continuous cry"]
["Respiratory",null,"•\tNasal flaring\n•\tTachypnoea: respiratory rate\n•\t>50 breaths/minute, age 6–12 months;\n•\t>40 breaths/minute, age >12 months\n•\tOxygen saturation ≤95% in air\n•\tCrackles in the chest","•\tGrunting\n•\tTachypnoea: respiratory rate >60 breaths/minute \n•\tModerate or severe chest indrawing"]
["Circulation and hydration","•\tNormal skin and eyes\n•\tMoist mucous membranes","•\tTachycardia:\n•\t>160 beats/minute, age <12 months\n•\t>150 beats/minute, age 12–24 months \n•\t>140 beats/minute, age 2–5 years\n•\tCapillary refill time ≥3 seconds\n•\tDry mucous membranes\n•\tPoor feeding in infants\n•\tReduced urine output","Reduced skin turgor"]
["Other","•\tNone of the amber or red symptoms or signs","•\tAge 3–6 months, temperature ≥39°C \n•\tFever for ≥5 days\n•\tRigors\n•\tSwelling of a limb or joint\n•\tNon-weight bearing limb/not using an extremity","•\tAge <3 months, temperature ≥38°C\n•\tNon-blanching rash\n•\tBulging fontanelle\n•\tNeck stiffness\n•\tStatus epilepticus\n•\tFocal neurological signs\n•\tFocal seizures"]
["Note that some vaccinations have been found to induce fever in children aged under 3 months."]

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["Table 3 Summary table for symptoms and signs suggestive of specific diseases [2013]"]
["Diagnosis to be considered","Symptoms and signs in conjunction with fever"]
["Meningococcal disease","Non-blanching rash, particularly with 1 or more of the following:\n•\tan ill-looking child\n•\tlesions larger than 2 mm in diameter (purpura)\n•\tcapillary refill time of ≥3 seconds\n•\tneck stiffness"]
["Bacterial meningitis","Neck stiffness\nBulging fontanelle\nDecreased level of consciousness\nConvulsive status epilepticus"]
["Herpes simplex encephalitis","Focal neurological signs\nFocal seizures\nDecreased level of consciousness"]
["Pneumonia","Tachypnoea (respiratory rate >60 breaths/minute, age 0–5 months; >50 breaths/minute, age 6–12 months; >40 breaths/minute, age >12 months)\nCrackles in the chest \nNasal flaring\nChest indrawing\nCyanosis\nOxygen saturation ≤95%"]
["Urinary tract infection (UTI)\nThese symptoms and signs increase the likelihood that a UTI is present and should be used to inform a decision about whether urine collection and testing is necessary. They are taken from the section on symptoms and signs in the NICE guideline on urinary tract infection in under 16s","Painful urination (dysuria)\nMore frequent urination\nNew bedwetting\nFoul smelling (malodorous) urine\nDarker urine\nCloudy urine\nFrank haematuria (visible blood in urine)\nReduced fluid intake \nShivering\nAbdominal pain\nLoin tenderness or suprapubic tenderness\nCapillary refill longer than 3 seconds\nPrevious history of confirmed urinary tract infection"]
["Septic arthritis","Swelling of a limb or joint\nNot using an extremity\nNon-weight bearing"]
["Kawasaki disease [2019]","Fever for 5 days or longer and may have some of the following:\n•\tbilateral conjunctival injection without exudate\n•\terythema and cracking of lips; strawberry tongue; or erythema of oral and pharyngeal mucosa\n•\toedema and erythema in the hands and feet\n•\tpolymorphous rash\n•\tcervical lymphadenopathy"]