A5V4d

8 Management by the
paediatric specialist
Introduction
Young children with fever presenting to a paediatric specialist may be assessed initially by a non-
paediatric practitioner or they may present directly to specialist care. Those children referred by a
healthcare professional after an initial assessment are probably in a higher risk group for having a
serious illness than those who are self-referred, although some may be referred simply for the opinion
of a specialist because of uncertainty. Children who are reassessed because of parental concerns are
probably also in a higher risk group for having a serious illness. For this reason, the recommendations
have been separated into the assessment made by the non-paediatric practitioner and by the
paediatric specialist. It has been assumed that both the paediatric specialist and non-paediatric
practitioner have the skills required to make a clinical assessment of a feverish child. However, it has
also been assumed that the paediatric specialist will have the training to perform, and access to,
some investigations that may be necessary to complete the assessment of some febrile children.
Almost all the tests and initial management considered in this chapter are part of the standard
package of routine care for children with suspected severe bacterial infection (SBI) referred for
specialist paediatric management. The guideline has reviewed the evidence of effectiveness for each
intervention individually. In cases where the clinical benefit of a specific test or intervention has not
been established, the recommendation is that these tests should not be performed, thus increasing
the potential cost-effectiveness of care in this setting.
8.1 Clinical assessment
It is assumed that children with feverish illnesses presenting to paediatric specialist care will be
assessed or reassessed using the ‘traffic light’ features described in Chapter 5. In addition to looking
for these features, the clinician will look for a focus of infection or other symptoms and signs that
might suggest a particular diagnosis.
Recommendations
Number Recommendation
Children younger than 5 years
47 Management by the paediatric specialist should start with a clinical assessment as
described in chapter 5. The healthcare professional should attempt to identify
symptoms and signs of serious illness and specific diseases as summarised in
tables 5.2 and 5.63. [2007]
8.2 Children less than 3 months old
Although fever in the young infant is relatively uncommon, when it occurs there is a higher risk of SBI
than in later life. Hospital Episode Statistics suggest that the incidence of the serious illnesses defined
in this guideline are 19,316 per 100,000 for infants less than 3 months old in England, compared with
1400 per 100,000 for all children less than 5 years old. The neonate is at risk of rapidly developing
infection because of a relatively poorly developed immune system and of permanent disability,
especially from meningitis. Babies born preterm or with low birthweight are particularly vulnerable.
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