Changes to Identifying Fever in Very Young Children

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The National Institute for Health and Care Excellence (NICE) has issued an updated guidance on how the medical profession should deal with under-5’s who have a fever.

Child Baby in a Cot with Fever

Identifying illness in children


The new guidelines retain most of the current traffic light system but make 2 important additions to the rules. The traffic light system is used to identify the risk of serious illnesses such as meningitis or pneumonia. As a general rule if a child has a temperature of over 37.5 degrees Celsius this is considered a 'fever'.

The traffic light system helps to identify the severity of illness in children aged 0-5, with 'green' as low risk, 'amber' as intermediate risk and 'red' as high risk. It involves medical staff looking at a range of factors including the behaviour, temperature, skin, breathing and fluid intake of a child.

Changes for Assessing Infection


There are 2 important changes to the traffic light system which will help medical professionals distinguish between mild, moderate and severe cases of fever.

The first of the 2 changes is to the highly valued traffic light system of signs and symptoms. Notably, they have included an additional symptom of a raised heart rate. It has been recognised that feverish children with a raised heart rate are in at least an intermediate risk group of serious illness. The guide also details guidance on what is considered a ‘raised heart rate.’

Secondly, the NICE guidelines now include information on how drugs such as paracetamol and ibuprofen should be used to manage a fever.

The guidelines say that when using paracetamol and ibuprofen you should:
  • Only continue with the drugs if the child remains distressed
  • Consider switching to an alternative drug if the distress is not alleviated
  • Do not give both drugs at the same time
  • Only alternate the drugs if the suffering carries on or persists before the next dose

Improvements to the system


GPs and healthcare professionals have welcomed the new guidance introducing new evidence for assessing child fevers.

Penny McDougall, a children’s nurse, said: "The updated, evidence based traffic light table, is a fantastic tool that will enable healthcare professionals to recognise the signs of serious illnesses associated with fever earlier and therefore reduce the risk of death or long term harm."

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