Feverish illness in children 2

Patient-centred care

This guideline offers best practice advice on the care of children with feverish illness.
Treatment and care should take into account childrens' needs and preferences and those of their parents or carers. Parents and carers of children with fever should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If parents or carers do not have the capacity to make decisions, healthcare professionals should follow the Department of Health guidelines – 'Reference guide to consent for examination or treatment' (2001) (available from www.dh.gov.uk). Since April 2007, healthcare professionals need to follow a code of practice accompanying the Mental Capacity Act (summary available from www.dca.gov.uk/menincap/bill-summary.htm).
Good communication between healthcare professionals and the parents and carers of children with fever is essential. It should be supported by evidence-based written information. Treatment and care of children with fever, and the information parents and carers are given about it, should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English.
Parents and carers should have the opportunity to be involved in decisions about the patient's care and treatment.
Parents and carers should also be given the information and support they need.

Feverish illness in children

 

 Introduction

Feverish illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. Feverish illness is very common in young children, with between 20 and 40% of parents reporting such an illness each year. As a result, fever is probably the commonest reason for a child to be taken to the doctor. Feverish illness is also the second most common reason for a child being admitted to hospital. Despite advances in healthcare, infections remain the leading cause of death in children under the age of 5 years.
Fever in young children can be a diagnostic challenge for healthcare professionals because it is often difficult to identify the cause. In most cases, the illness is due to a self-limiting viral infection. However, fever may also be the presenting feature of serious bacterial infections such as meningitis or pneumonia. A significant number of children have no obvious cause of fever despite careful assessment. These children with fever without apparent source are of particular concern to healthcare professionals because it is especially difficult to distinguish between simple viral illnesses and life-threatening bacterial infections in this group.
Although there are guidelines for many individual infections, there is no national guidance on the management of fever as a presenting illness. Management varies across the UK and there is some evidence that mortality and morbidity from infectious diseases in children is sometimes associated with deficiencies in the healthcare system and in the diagnosis and treatment of illnesses. There is also some evidence that death rates are higher in the least affluent areas.
As a result, there is a perceived need to improve the recognition, assessment and immediate treatment of feverish illnesses in children. This guideline is designed to assist healthcare professionals in the initial assessment and immediate treatment of young children with fever presenting to primary or secondary care.