Fever in children: serious illness triage

Overview

Fever is one of the commonest reasons for a child to be brought to a GP, and most febrile children have self-limiting viral infections. The task that defines this topic is not treating the fever but excluding the small minority of children with serious illness — serious bacterial infection, meningococcal disease, Kawasaki disease — in whom hours matter.^[3]

The clinical problem is that the discriminators are weak. No single symptom or sign reliably excludes serious infection, and the height of the fever carries little information in children over 6 months.^[3][38] What carries information is a structured assessment: colour, activity, hydration, respiration, circulation — measured, recorded and interpreted against age-specific thresholds. GPs record numerical vital signs in fewer than a third of children with acute infections, which is the single most correctable gap in the whole pathway.^[35]

Parental perception is part of the assessment. Reported parental perception of fever should be considered valid and taken seriously, and parental concern is itself one of the strongest red flags in primary care (positive likelihood ratio 14.4).^[38][3]

References38ShowHide

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