A5V4d

7 Management by the
non-paediatric
practitioner
Introduction
Parents or carers of young children may seek a face-to-face assessment of their feverish child or be
directed to do so following a remote assessment. There are an increasing number of professionals
who may make this assessment. These include their GP, a nurse-practitioner in a walk-in centre, a
pharmacist or an emergency department doctor. This guideline uses the term non-paediatric
practitioner for this group. The setting of the assessment, although important, is less relevant than the
experience and training of the healthcare professional undertaking the assessment. For this reason,
the guideline development group (GDG) has separated recommendations pertaining to the nonpaediatric
practitioner assessment from those of the paediatric specialist. It has been assumed
throughout that both the paediatric specialist and non-paediatric practitioner have the skills required to
make a clinical assessment of a feverish child.
The initial face-to-face assessment of the feverish child is very important. The vast majority of children
presenting to the non-paediatric practitioner with fever will have a condition that can be diagnosed,
assessed and treated appropriately there and then or with simple follow-up arrangements.
In some cases, following assessment, the non-paediatric practitioner may refer the child to paediatric
services for an opinion, for further necessary investigations that cannot be carried out in primary care,
or for further treatment and care.
Fever without apparent source
A small number of children with fever will present with no obvious underlying source, and a small
number of these will have a serious illness requiring further investigation and treatment by a
paediatric specialist.
It is not always possible to distinguish serious illness from non-serious illness in the early stages of
the condition. Safety netting is therefore vital to ensure that parents/carers and clinician agree when
further care should be accessed and how. This may include, but not exclusively, a fixed appointment,
formal liaison with other parts of the health system such as out-of-hours providers, or simple advice.
Safety netting
Following a consultation and the making of a provisional diagnosis and management plan, it is good
practice for the healthcare professional to consider the following three questions:
If I am right, what do I expect to happen?
How will we know if I am wrong?
What should happen then?
Safety netting is not a new concept. 151 It may take a number of forms, from dialogue with carer/parent
about ‘amber’ and ‘red’ symptoms and signs they should watch for, review after a set period or liaising
with other healthcare services. Good safety netting ensures continuity of care and a provision for
possible deterioration of a child.
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