A5V4d

5 Clinical assessment of
children with fever
Introduction
Concerned parents or carers of young children commonly seek access to healthcare services when
their child has a fever.
The initial assessment of the feverish child is very important. The majority of children presenting with
fever will have either a self-limiting viral condition or an obvious cause for their fever for which specific
treatment can be given. A minority will present with fever with no obvious underlying cause, and a
small number of these will have a serious illness.
Initial contact may be made remotely (e.g. by telephone) or the child may present directly to a facility
where a face-to-face assessment can take place. Wherever the assessment is carried out, the
assessor needs to understand the significance of certain symptoms and signs. A careful and thorough
assessment should mean that in the majority of cases:
the child with a potentially serious illness is recognised and managed appropriately
the child with a minor self-limiting illness is not burdened with unnecessary medical
intervention and the parents/carers are supported with appropriate self-care advice.
5.1 Priorities in the clinical assessment of feverish
illness in children
Although most children with a fever will have a self-limiting illness, a minority will have a serious or
even life-threatening illness. The over-riding priority for healthcare professionals should be to reduce
the mortality of children with feverish illness in the UK. The priorities for healthcare professionals
should be to:
identify any immediately life-threatening features
assess the child’s likelihood of having a serious illness or self-limiting illness, without
necessarily diagnosing any one particular condition
determine a source of the illness to direct appropriate management decisions based
upon the results of the assessment.
The clinical assessment is similar wherever it takes place and is described in detail in this chapter.
Adaptations will need to be made to the assessment if the child cannot be physically examined or if
the parents or caregivers of the child are not present, but the priorities and principles remain the
same. Care also needs to be taken when assessing children with learning disabilities, and healthcare
professionals should be aware that some features of the traffic light table might not apply to these
children. The management of children after assessment, however, will be determined not only by the
results of the assessment but also by the facilities available to the healthcare professional (for
example a nurse consultant on the phone at NHS Direct, a GP in a surgery or a paediatrician in a
hospital). Management is therefore dealt with separately in subsequent chapters.
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2013 Update