Fever in Under 5s
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Background
Fever/pyrexia is a very common presentation, especially in the paediatric population.
It can be the initial underlying symptom of potentially extremely serious conditions for the under 5-year-old patient, therefore thorough investigation and assessment is required.
Thankfully NICE have very clear and comprehensive guidance detailing assessment and management of these patients.
Presentation
The NICE traffic light system is an extremely useful tool to aid in the identification of concerning presenting symptoms.
Management
- Identify fever (1)
- <4weeks = axilla electric thermometer
- >4weeks = tympanic temp.
- Any risk factors for infection?
- Illness in family members or nursery/school
- Not up to date with immunisations
- Immunocompromised?
- Assess severity of fever
- NICE traffic light system (1)
- Examine for focus of infection.
Potential Sources of Infection in a Child with Fever
- Upper Respiratory Track Infection (URTI) – very common
- Tonsilitis – check tonsils
- Otitis Media – check tympanic membranes
- Pneumonia – increased work of breathing (WOB), unilateral crackles
- Gastroenteritis – diarrhoea, potentially with blood and/or mucus
- UTI – good differential if no clear source
- Meningitis – can be hard to recognise, so always have high suspicion
- Sepsis – can be hard to recognise, so always have high suspicion
- Septic Arthritis / Osteomyelitis – reluctance to move joint / painful
Initial Management Summary…
- Not serious illness
- Home with safety netting advice
- Consider PO Abx
- Moderate illness
- Admit
- Regular Obs
- Septic screen and further investigation
- Severe illness
- Admit
- Regular Obs
- Septic screen and further investigation
- Immediate IV Abx
Septic Screen
- FBC
- Blood culture
- VBG / capillary gas
- CRP
- U&E
- LFTs
- Urine MCS
Consider…
- LP
- CXR
- PCR
Guidelines
NICE: Fever in under 5s: assessment and initial management. (1)
NICE guideline [NG143]Published: 07 November 2019 Last updated: 26 November 2021
https://www.nice.org.uk/guidance/ng143
References
- Overview | Fever in under 5s: assessment and initial management | Guidance | NICE [Internet]. NICE; 2019 [cited 2024 Apr 30]. Available from: https://www.nice.org.uk/guidance/ng143