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NICE updates guidance on fever in children

The National Institute for Health and Clinical Excellence is updating its 2007 guidance on the assessment and initial management of feverish illness in children younger than five years.

It has issued a draft update for consultation, which includes recommendations based on new evidence about the relationship of heart rate to fever in predicting the risk of serious illness and the effectiveness of combination or alternating therapy with paracetamol and ibuprofen.

It also includes a new summary table for symptoms and signs suggestive of specific diseases such as meningitis.

Draft key priorities for implementation include:

  • Assess children with feverish illness for the presence or absence of symptoms and signs that can be used to predict the risk of serious illness using the traffic light system
  • Recognise that children with tachycardia are in at least an intermediate-risk group for serious illness. Use the Advanced Paediatric Life Support (APLS) criteriai to define tachycardia;
  • When using paracetamol or ibuprofen in children with fever: continue only as long as the child appears distressed; consider changing to the other agent if the child’s distress is not alleviated; do not give both agents simultaneously; and only consider alternating these agents if the distress persists or if it recurs before the next dose is due.

The guideline consultation closes on 11 January 2013, with final guidance due in May.

Mark Baker, director of the Centre for Clinical Practice at NICE, said: “In 2007 NICE published the first national guideline to provide all healthcare professionals… with a practical tool to assess the symptoms of a child with fever and advise them on how they should be cared for within the appropriate setting.

“Updating the NICE guideline to take into account new evidence will ensure that it remains current and relevant.”

Professor Baker added: “Not all children will need to be taken to hospital and this guideline will help doctors, nurses, pharmacists and other healthcare professionals to pick up the high-risk symptoms that indicate a child needs urgent medical attention.”

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