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2 Introduction
2.1 Feverish illness in children
Feverish illness in young children usually indicates an underlying infection of some kind and, as such,
the condition is a cause of concern for parents and carers. The condition can be diagnostic challenge
for healthcare professionals, and infectious diseases remain a major cause of child-hood mortality
and morbidity in the UK. As a result, there is a perceived need to improve the recognition, evaluation
and immediate treatment of feverish illnesses in children.
Incidence and prevalence
Feverish illness is very common in young children. Figure 2.1 shows the proportions of children from
a birth cohort of all infants born in one English county (Avon) whose parents either reported a high
temperature or presented to a doctor for this reason. 1 It can be seen that a high temperature is
reported by nearly 40% of parents of children aged under 6 months, and in over 60% of children in the
other age ranges between 6 months and 5 years. Between 20% and 40% of children in the various
age ranges are taken to a doctor because of fever, with the highest proportions presenting between
the ages of 6 and 18 months. It has been estimated that an average of eight infective episodes occur
in otherwise healthy children during the first 18 months of life. 2
Figure 2.1 Proportions of children reporting and presenting to doctors with high temperature by age range; data
from Hay 1
The prevalence of feverish illness in children is reflected by statistics from primary care. Fever is
probably the most common reason for a child to be taken to the doctor. In a study of 1% of the
national child population, the mean general practice (GP) consultation rate was 3.7 per child per year
and almost double that rate for children aged under 4 years. Infections and respiratory disorders
made up over 40% of the consultations. 3 In the fourth national study of morbidity in general practice,
which included nearly 10 000 children, the annual consultation rates for infections were 60% of the
population aged less than 12 months, 36% aged 1–4 years and 20% aged 5–15 years. 4 Not
surprisingly, fever in children is also a common reason for seeking health advice out of hours. In one
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