Fever in children – revised NICE guidelines

FEBRILE children with tachycardia should be considered to be at intermediate risk at least for serious illness according to new updated NICE guidance. Feverish illness in children also provides greater clarity on the use of paracetamol and ibuprofen in children with high temperatures.

The updated NICE guideline retains most of its original recommendations, including use of the traffic light system to predict the risk of serious illness in febrile children. New recommendations take into account recent evidence about the relationship of heart rate to fever in predicting serious risk. Children with tachycardia (raised heart rate) are now judged to be in at least an intermediate-risk group for serious illness. The guidance urges clinicians to use the Advanced Paediatric Life Support (APLS) criteria to define tachycardia.

The new guidance further states that antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose. In using paracetamol or ibuprofen in children with fever it recommends to continue only as long as the child appears distressed. Carers should consider changing to the other agent if the child's distress is not alleviated but should not give both agents simultaneously. Only consider alternating these agents if the distress persists or if it recurs before the next dose is due.

Martin Richardson, consultant paediatrician and Chair of the guideline development group, said: “The updated guideline has two major changes. The first is a revision of the well respected traffic light table of symptoms and signs. In particular, the inclusion of raised heart rate should lead to further improvements in the recognition of seriously ill children. The second major change is that the section on the treatment of fever has been rewritten to encourage the rational, stepwise use of drugs such as paracetamol and ibuprofen."

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

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