A5V4d

Introduction
service, 34% of calls concerned children under 5 years of age. 5 Fever was a concern in 52% of calls
about children aged under 12 months and in 64% of calls about children aged 1–5 years.
Feverish illness is also one of the most common reasons for children to be seen in hospital
emergency departments and it is a leading cause of admission to children’s wards. In a study from an
emergency department in Nottingham, 32% of the 120 000 annual total attendances were for
children. 6 Febrile illness was the second most common medical reason for attendance, accounting for
20% of such cases. On children’s wards, at least 48% of admissions are associated with infection.
Most of these infections present with a feverish illness with or without other symptoms such as
breathing difficulty, fit, rash or cough. Feverish illness is second only to breathing difficulty as the most
common presenting problem leading to acute hospital admission in childhood. 7
Issues for healthcare professionals
Feverish illness in young children can be a diagnostic challenge for healthcare professionals because
it is often difficult to identify the cause. In most cases, the illness is due to a self-limiting virus infection
and the child will recover quickly without intervention. However, fever may also be the presenting
feature of serious bacterial illnesses such as meningitis, septicaemia, urinary tract infections and
pneumonia. Estimates of the incidence of these and other serious infections are given in Table 2.1.
Although there is quite a large variation in the estimated incidences according to the source of data, it
appears that up to 1% of children aged 0–5 years may have one of these infections each year.
In some children with fever there will be symptoms and signs that suggest a particular infection, such
as an inflamed eardrum in a child with otitis media or a non-blanching rash in a child with
meningococcal septicaemia. When these features are identified, the diagnosis can be established
relatively easily and the child can be treated appropriately. There will remain a significant number of
children, however, who have no obvious cause of fever despite careful assessment and investigation.
These children with fever without apparent source (FWS), are a particular concern to healthcare
professionals because it is especially difficult to distinguish between simple viral illnesses and lifethreatening
bacterial infections in this group. 8 In general, FWS tends to be a problem in young
children, and the younger the child the more difficult it is to establish a diagnosis and assess the
severity of illness. Because of these problems, a number of diagnostic and management strategies
have been developed for feverish illness without obvious source in young children. 9
Table 2.1 Estimated incidence of serious infections in children aged 0–5 years in the UK; data from Hospital
Episode Statistics (HES)
Diagnosis group
Incidence (per 100 000)
HES data Published data
Pneumonia 664 92 a
Septicaemia 388 20–50 b
Urinary tract infection 333
Meningitis 30.2
Septic arthritis 9.25 3.75–5.0
Osteomyelitis 6.17 2.9
Other bacterial infection 0.66
Encephalitis 3.65 0.8 c
Kawasaki disease d 10.2 8.1
Total 1445
a
Pneumococcal pneumonia.
b
Meningococcal septicaemia.
c
Herpes simplex encephalitis.
d
Kawasaki disease is not a confirmed infectious disease but it is believed to be caused by a microbiological toxin.
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