A5V4d

Contents
1 Guideline summary 1
1.1 Guideline development group membership, NCC-WCH staff and acknowledgements 1
1.2 Definitions used in the guideline 2
1.3 Who is covered by this guideline 3
1.4 Care pathway 4
1.5 Foreword 6
1.6 Key priorities for implementation 6
1.7 Recommendations 8
1.8 Key research recommendations 22
1.9 Research recommendations 24
1.10 Other versions of the guideline 25
1.11 Schedule for updating the guideline 25
2 Introduction 26
2.1 Feverish illness in children 26
2.2 For whom is this guideline intended 30
2.3 Related NICE guidance 30
3 Guideline development methodology 31
3.1 Methodology for the 2013 Update 31
3.2 Methodology for the 2007 guideline 35
4 Thermometers and the detection of fever 40
4.1 Oral and rectal temperature measurements 40
4.2 Measurement of body temperature at other sites 43
4.3 Subjective detection of fever by parents and carers 47
5 Clinical assessment of the child with fever 49
5.1 Priorities in the clinical assessment of feverish illness in children 49
5.2 Life-threatening features of illness in children 50
5.3 Assessment of risk of serious illness 50
5.4 Non-specific symptoms and signs of serious illness 54
5.5 Symptoms and signs of specific serious illnesses 129
5.6 Imported infections 140
6 Management by remote assessment 141
6.1 Clinical assessment 141
6.2 Management according to risk of serious illness 142
7 Management by the non-paediatric practitioner 145
7.1 Clinical assessment 146
7.2 Management according to risk of serious illness 146
7.3 Tests by the non-paediatric practitioner 148
7.4 Use of antibiotics by the non-paediatric practitioner 149
8 Management by the paediatric specialist 153
8.1 Clinical assessment 153
8.2 Children less than 3 months old 153
8.3 Children aged 3 months or older 155
8.4 Immediate treatment by the paediatric specialist 181
8.5 Causes and incidence of serious bacterial infection 186
8.6 Admission to and discharge from hospital 187
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