Excerpt

This guideline has been designed for the assessment and initial management of children aged up to 5 years who present to health services with a feverish illness. In accordance with the remit received from the Department of Health and Welsh Assembly Government, the guideline includes: assessment of severity of illness, including how to measure and interpret height of fever; clinical management in primary care, including investigations, use of antibiotics and when to refer for specialist care; initial assessment by paediatric specialists, including appropriate investigation and initial treatment. The guideline also includes suggested advice that can be given to parents and carers following an encounter with a healthcare professional.

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Introduction
  • 1.1 Feverish illness in children
  • 1.2 Aim of the guideline
  • 1.3 For whom is the guideline intended?
  • 1.4 Who has developed the guideline?
  • 1.5 Other relevant documents
  • 1.6 Definitions and care pathway
  • 1.7 Guideline development methodology
• 2. Summary of recommendations
  • 2.1 Key priorities for implementation (key recommendations)
  • 2.2 Summary of recommendations
  • 2.3 Research recommendations
• 3. Thermometers and the detection of fever
  • 3.1 Introduction
  • 3.2 Thermometers and the site of measurement
  • 3.3 Subjective detection of fever by parents and carers
• 4. Clinical assessment of the child with fever
  • 4.1 Introduction
  • 4.2 Priorities in the clinical assessment of feverish illness in children
  • 4.3 Life-threatening features of illness in children
  • 4.4 Assessment of risk of serious illness
  • 4.5 Non-specific symptoms and signs of serious illness
  • 4.6 Symptoms and signs of specific serious illnesses
  • 4.7 Imported infections
• 5. Management by remote assessment
  • 5.1 Introduction
  • 5.2 Clinical assessment
  • 5.3 Management according to risk of serious illness
• 6. Management by the non-paediatric practitioner
  • 6.1 Introduction
  • 6.2 Clinical assessment
  • 6.3 Management according to risk of serious illness
  • 6.4 Tests by the non-paediatric practitioner
  • 6.5 Use of antibiotics by the non-paediatric practitioner
• 7. Management by the paediatric specialist
  • 7.1 Introduction
  • 7.2 Clinical assessment
  • 7.3 Children less than 3 months old
  • 7.4 Children aged 3 months or older
  • 7.5 Immediate treatment by the paediatric specialist
  • 7.6 Causes and incidence of serious bacterial infection
  • 7.7 Admission to and discharge from hospital
  • 7.8 Referral to paediatric intensive care
  • 7.9 Suspected meningococcal disease
• 8. Antipyretic interventions
  • 8.1 Introduction
  • 8.2 Physical and drug interventions
  • 8.3 Effects of body temperature reduction
• 9. Advice for home care
  • 9.1 Introduction
  • 9.2 Care at home
  • 9.3 When to seek further help
• Appendices
  • Appendix A The formal consensus survey
  • Appendix B Cost analysis of thermometers for use in children and infants with fever
  • Appendix C Economics of referral to a specialist paediatric team of a child with fever without source
  • Appendix D Economic evaluation of C-reactive protein versus procalcitonin
  • Appendix E 2 hour time limit for an urgent face-to-face consultation following remote assessment: GDG reasoning and justification in the absence of data to inform a formal economic analysis
  • Appendix F Declaration of interests
• References
• Search strategies
• Evidence tables

Commissioned by the National Institute for Health and Clinical Excellence

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.