Why read this summary?

Infectious diseases remain a major cause of childhood mortality and morbidity in the United Kingdom (personal communication, R MacFaul, Department of Health) with some evidence that this is associated with deficiencies in health care.1 Fever in young children usually indicates an underlying infection, but identifying the cause can pose a diagnostic challenge. In the absence of national guidance, feverish illness is variably managed across the UK. There is thus a perceived need to improve its assessment and management. This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on how to assess and initially manage feverish illness in children aged under 5 years.2

Recommendations

NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*).

The recommendations are largely based around an evidence based traffic light system that is used to assess the risk of serious illness as low (green), intermediate (amber), or high (red), and to direct management accordingly (figs 1-3⇓⇓⇓).

This guideline applies until the underlying condition is diagnosed, at which point the child should be treated according to guidance for that condition.

Assessment and management according to the risk of serious illness

Clinical assessment should consist of three stages:

• Identify life threatening features (airway, breathing, circulation, disability). If any are present, refer immediately for emergency medical care

• Assess the risk of serious illness using the traffic light system (fig 1⇑; based on prospective cohort studies and validated scoring systems)

• Attempt to …