A5V4d

Feverish illness in children
The GDG was unable to be prescriptive about safety netting since this will be determined by the
actual practitioner carrying out the assessment and their professional competences and the range of
services available locally. For example, a rural GP might use a different set of safety nets than a
nurse working in an urban walk-in centre when dealing with the same child.
The GDG felt that safety netting was particularly important when a child presents with ‘amber’
features (see below), which were not felt to require automatic referral to secondary care at that time.
7.1 Clinical assessment
It is assumed that children with feverish illnesses presenting to a non-paediatric practitioner will
undergo a face-to-face clinical assessment as described in Chapter 5. The first priority is to identify
any immediately life-threatening features, including compromise of the airway, breathing, circulation
and level of consciousness. Children with feverish illness should then be assessed for the presence
or absence of symptoms and signs that predict the risk of serious illness using the traffic light system
(see Table 5.2). Finally, the healthcare professional should look for a focus of infection or other
symptoms and signs that might suggest a particular diagnosis.
Recommendations
Number Recommendation
146
Clinical assessment
38 Management by a non-paediatric practitioner should start with a clinical assessment
as described in chapter 5. Healthcare practitioners should attempt to identify
symptoms and signs of serious illness and specific diseases as summarised in
tables 5.2 and 5.63. [2007]
7.2 Management according to risk of serious illness
Evidence summary
The GDG was unable to find evidence to direct the management of children with fever in terms of
referral to specialist care or care at home according to the risk of serious illness.
GDG statement
After an assessment of a febrile child has been made, the non-paediatric specialist has the following
management options:
If a diagnosis has been reached:
reassurance to parents and carers that this is a self-limiting illness
explanation, discussion and organising treatment options
home care advice and safety netting
refer for specialist paediatric treatment.
If no diagnosis has been reached:
reassurance to parents and carers that this is probably a self-limiting illness given the
absence of significant symptoms or signs
perform some tests to help determine the diagnosis
provide a safety net
refer for specialist paediatric assessment.