A5V4d

Feverish illness in children
To further complicate the problem of assessment and diagnosis, the clinical picture often changes
rapidly in young children. The condition of young children with serious illness may deteriorate within
hours of onset but, on the other hand, an ill-appearing child with a viral illness may make a rapid
recovery. Thus, another challenge for healthcare professionals is to determine when to observe the
child for a period of time, and when to investigate and begin treatment.
Most healthcare professionals are aware that infectious diseases were, and remain, an important
cause of mortality and morbidity in childhood. In the past hundred years there have been impressive
reductions in childhood mortality. The infant mortality rate in the UK, for example, has fallen from 20%
to 0.5% since 1890. Much of this improvement has been due to public health measures, and
immunisation against infectious disease has increasingly been an important factor. In recent years,
the reduction in childhood mortality has changed only a little. In other countries, mortality rates have
continued to fall and some European countries now have childhood mortality rates that are 30–40%
lower than that of the UK. These figures suggest that more can be done to reduce childhood mortality
in this country.
Figure 2.2 shows that infection is a major cause of mortality in children aged 0–5 years. There are
over 100 deaths from infection in children aged 1–12 months each year in England and Wales. In the
first year of life, infection is second only to congenital defects as a cause of death. In children aged 1–
4 years there are around 30 deaths from infection per year of life, and infection is the most common
cause of death in this age group.
It is possible that the childhood mortality rate in the UK could be reduced to a figure in line with other
European countries if the proportion due to infections could be reduced. Immunisation will probably
play an important part in this process. For example, the new pneumococcal conjugate vaccine, which
was introduced into the UK schedule in 2006, has led to a dramatic reduction in invasive disease due
to Streptococcus pneumoniae in other countries. 10 However, it is likely that improved recognition,
evaluation and treatment of febrile illnesses in children could also lead to a reduction in mortality from
infectious disease. For instance, a recent national study investigated deaths from meningococcal
disease, which is the leading cause of mortality from infectious diseases in children. 11 The researchers
found that mortality from meningococcal disease is often associated with late identification, suboptimal
treatment and other deficiencies in health care.
Figure 2.2 Contributions of the four major causative categories to childhood mortality, England and Wales, 2004;
neonatal deaths and deaths due to perinatal events have been excluded; data from the Department of Health,
courtesy of R MacFaul
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