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NICE guideline: feverish illness in children—assessment and initial management in children younger than 5 years
  1. Tessa Davis1,2
  1. 1Department of Paediatric Emergency, Sydney Children's Hospital, Sydney, New South Wales, Australia
  2. 2Department of Paediatrics, North Western Deanery, Manchester, UK
  1. Correspondence to Dr Tessa Davis, Department of Paediatric Emergency, Sydney Children's Hospital, Sydney, New South Wales, Australia; tessardavis{at}

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Information about the current guideline

The National Institute for Health and Care Excellence (NICE) guideline for feverish illness in children (assessment and initial management in children younger than 5 years) was partially updated in May 2013.1 Not all sections were reviewed, but the following were: the signs and symptoms of serious illness; the predictive value of tachycardia; the use of inflammatory markers; and the role of paracetamol and ibuprofen. The aim of the guideline is to optimise the management of young children with fever, and in particular to guide health professionals to recognise the signs of serious infection.

The update made new recommendations based on current evidence. This guideline was developed by the National Collaborating Centre for Women's and Children's Health. They worked with the Guideline Development Group to review the evidence and write the recommendations.

It is linked to other NICE guidance on Bacterial meningitis and meningococcal septicaemia and Urinary tract infection in children.2–4

Previous guideline

The previous NICE guideline on feverish illness in children was published in May 2007.

Key issues that the guideline addresses

  • The traffic light system (see ‘Clinical bottom line’ section; figure 1):

    • This uses symptoms and signs to assess the risk of serious illness. Children at highest risk will be red and those at lowest risk will be green (see box 1).

  • Definition of temperature:

    • A baby less than 3 months old with a temperature of 38°C or more will be categorised red; a 3–6-month-old baby with a temperature of 39°C or more will be amber; but once a child is over 6 months old, the height of the temperature does not correlate with the severity of …

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  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.