12
The Febrile Child
Children often have fevers. Most have a self-limiting illness needing only advice and do not need a course of antibiotics. However, in some the diagnosis is serious, with potentially catastrophic outcomes if missed. An added challenge for GPs is that children with a serious illness may present in the early stages when there are few symptoms or signs. In babies and infants, features of life-threatening illnesses are frequently non-specific (e.g. irritability or lethargy).
Assessment of the Child with a Fever
History
Listen to the parents; take their concerns seriously. If the child can answer don’t forget to ask the child about the symptoms.
- Ask about the symptoms and duration of the illness.
- Are there any signs of a URTI (e.g. coryza, cough)?
- Ask about diarrhoea or vomiting, rashes or symptoms suggesting a urinary tract infection (UTI) or meningitis.
- What treatment or management including medication have they tried? Has it helped?
- Have they taken the temperature or subjectively assessed the fever?
- Is the child deteriorating?
- Ask about foreign travel and contact with infection.
- Check their immunisation history.
- Take a past medical history, social and developmental history including risk factors such as poor immunity, sickle cell disease.
- Has there been a fit (seizure)? Febrile fits are associated with fever in children aged 6 months to 5 years. While often caused by a URTI you must exclude the possibility of a serious illness.
Management and Advice for Non-Serious Fever
- Keep the child or baby cool – do not wrap up or sponge down.
- Give fluids. Continue breast-feeding.
- Use paracetamol or ibuprofen. Both are effective; either can be used. If one is not effective then try the alternative. A fever is a normal physiological response and the well child may not need medication. Ask about allergies, any contraindication (e.g. asthma with NSAIDs) (see BNF for Children).
- Keep the child away from nursery.
- Give the parents clear advice about what to look for if there is deterioration and what to do if the child does not improve.
Indications for Referral
- Any baby under 3 months who has a temperature of >38°. They have a poor immune system, and may rapidly deteriorate.
- Any infant over 3 months who has a persistent fever >39.9° or any red flag signs.
Meningococcal Disease
Infants may present with non-specific signs such as drowsiness, lethargy or poor feeding.
Children over 2 years can present early before the signs evolve.
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