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NICE updates guidance on assessing and treating fever in children

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Updated clinical guideline on assessing and managing children under the age of five years with fever has been published by the National Institute for Health and Care Excellence.

The guideline advises all healthcare professionals, including nurses, on assessing the symptoms of a child with fever and how they should be cared for.

It is a partial update of NICE clinical guideline 47, published May 2007, and replaces it. The new guidance retains the bulk of the original recommendations including that children with feverish illness should be assessed for symptoms and signs of serious illness using a “traffic light” system.

However, a number of recommendations have been added taking into account new evidence about the relationship of heart rate to fever in predicting the risk of serious illness and the effectiveness of therapy with paracetamol and ibuprofen in fever management.

The guideline also includes a summary table of symptoms and signs suggestive of specific diseases such as meningitis and pneumonia.

Key priorities for implementation include recognising that children with tachycardia are in at least an intermediate-risk group for serious illness and antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose.

When using paracetamol or ibuprofen in children with fever, clinicians are advised to continue their use only as long as the child appears distressed and to consider changing to the other agent if the child’s distress is not alleviated.

Penny McDougall, a children’s nurse and member of the NICE guideline development group, said: “Occasionally fever may be associated with more serious, life threatening illnesses like meningitis or septicaemia, and it is essential that these children are identified and treated as quickly as possible.

“The updated, evidence-based traffic light table, is a fantastic tool that will enable health care professionals to recognise the signs of serious illnesses associated with fever earlier and therefore reduce the risk of death or long term harm.”

Professor Mark Baker, director of NICE’s Centre for Clinical Practice, added: “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.”

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