The diagnosis and management of children with fever is an important part of primary care. Parents and children put their trust in general practitioners, who rightly worry about making a correct judgment. Although general practitioners have substantial clinical experience of assessing febrile children, half of children with meningococcal disease are sent home at first primary care consultation.1 How can this be and what can we do to improve our assessment of febrile children?

Several diagnostic difficulties face us. Firstly, serious bacterial infection in children is now rare. The successful introduction of Haemophilus influenzae type B and meningococcal C vaccines into the UK childhood immunisation schedule has led to a dramatic reduction in the prevalence of invasive infections caused by these organisms.2 3 Early reports suggest that the recently introduced conjugate pneumococcal vaccine will do the same.4 Studies have reported a large variation in estimated incidences of invasive bacterial disease in preschool children, but the quoted 1%5 is almost certainly now a …