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Practice NICE guidelines

Assessment and initial management of feverish illness in children younger than 5 years: summary of NICE guidance

BMJ 2007; 334 doi: (Published 31 May 2007) Cite this as: BMJ 2007;334:1163
  1. Martin Richardson, consultant paediatrician1,
  2. Monica Lakhanpaul, clinical co-director and senior lecturer in child health2
  3. on behalf of the Guideline Development Group and the technical team
  1. 1Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough PE3 6DA
  2. 2National Collaborating Centre for Women and Children's Health, Royal College of Obstetricians and Gynaecologists, London NW1 4RG, and University of Leicester
  1. Correspondence to: M Richardsonmartin.richardson{at}

    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


    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.

    Assessing the risk of serious illness in feverish children under age 5 years

    Managing feverish children under age 5 years in primary care

    Managing feverish children under age 5 years in paediatric care

    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 …

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