Quality standard


This quality standard covers the assessment and initial management of unexplained feverish illness in infants and children (from birth to 5 years). For more information see the topic overview.

Why this quality standard is needed

Unexplained feverish illness is a concern for parents and carers and usually indicates an underlying infection. In most cases it is due to a self-limiting virus infection and recovery is quick without medical intervention. However, fever can be the presenting feature of serious bacterial illnesses such as meningitis, septicaemia, urinary tract infections and pneumonia.

Feverish illness is very common in young children (under 5), with between 20 and 40% of parents reporting such an illness each year. Fever is the most likely reason for a child to be taken to the doctor and the second most common reason for a child being admitted to hospital.

Feverish illness in infants and children can be hard to diagnose because it is often difficult to identify the cause. In some there will be symptoms and signs that suggest a particular infection, but many infants and children will have no obvious cause of fever despite careful assessment and investigation. These are a particular concern because it is especially difficult to distinguish between self-limiting virus infections and life-threatening bacterial infections in this group. The younger the child the more difficult it is to establish a diagnosis and assess the severity of illness.

The clinical picture can often change rapidly. The condition of an infant or child with a serious bacterial illness can deteriorate within hours of onset. On the other hand, those who appear ill with a virus infection can make a rapid recovery.

The quality standard is expected to contribute to improvements in the following outcomes:

  • mortality in infants and children under 5 years

  • morbidity in infants and children under 5 years

  • number of emergency admissions to hospital of infants and children under 5 years

  • parent and carer experience of services.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework, 2016 to 2017


Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost from causes considered amenable to healthcare

ii Children and young people

Improvement areas

Reducing deaths in babies and young children

1.6i Infant mortality*

3 Helping people to recover from episodes of ill health or following injury

Improvement areas

Preventing lower respiratory tract infections (LRTI) in children from becoming serious

3.2 Emergency admissions for children with LRTI

4 Ensuring that people have a positive experience of care

Improvement areas

Improving children and young people's experience of healthcare

4.8 Children and young people's experience of outpatient services

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework

Table 2 Public health outcomes framework for England, 2013 to 2016


Objectives and indicators

4 Healthcare public health and preventing premature mortality


Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities


4.1 Infant mortality*

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework

Coordinated services

The quality standard for feverish illness in children specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole feverish illness care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to infants and children with fever.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality feverish illness service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating infants and children with fever should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

The quality standard recognises the important role families and carers have in identifying fever in infants and children. Healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.