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Feverish Illness in Children: Assessment and Initial Management in Children Younger Than 5 Years.


National Collaborating Centre for Women's and Children's Health (UK).


London: Royal College of Obstetricians & Gynaecologists (UK); 2013 May.
National Institute for Health and Care Excellence: Clinical Guidelines .


It is a requirement of the Children’s National Service Framework that all ill children should have access to high-quality, cost-effective, evidence-based care. Because it is difficult to evaluate the severity of the illness, there is a need for evidence-based guidance to inform healthcare professionals about how to judge whether a child who presents with a fever is likely to develop a serious illness. Healthcare professionals also need advice to support their decision on whether to observe the child, perform diagnostic tests, start treatment such as antibiotics or refer onwards for specialist care. The guidance should also include advice on the best ways to detect fever, the management of fever itself, and what to tell parents and carers who have made contact with healthcare services. The guidance should be applicable to primary and secondary care and should take account of the number of agencies that are involved in giving health care and giving advice to parents and carers. It is also important that parental preferences, as well as the child’s best interests in terms of health outcomes, should be taken into account when considering the various options for investigation and treatment. The decision to update the guideline was made based on deveopments in the NHS and new evidence becoming available that could affect existing recommendations. The introduction of new vaccination programmes in the UK may have significantly reduced the level of admissions to hospital resulting from diseases covered by this guideline. For example, early analysis of the pneumococcal vaccination programme in England shows that the incidence of pneumococcal related disease has fallen 98% in children younger than 2 years since vaccination was introduced. However, evidence suggests a 68% increase in the prevalence of disease caused by sub-types of bacteria not covered by vaccination programmes. Also, potentially serious cases of feverish illness are likely to be rare, so it is important that information is in place to help healthcare professionals distinguish these from mild cases. In addition, new evidence is available on a number of the clinical questions covered by the guideline: the relationship of heart rate to fever in predicting the risk of serious illness in children, clinical effectiveness of combination or alternating therapy with paracetamol and ibuprofen in the management of fever in children, and predictive value and accuracy of pro-calcitonin as a marker of serious bacterial illness in children with fever without apparent source.

Copyright © 2013 National Collaborating Centre for Women’s and Children’s Health.

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