In November 2019, NICE updated and replaced this guideline with NICE guideline NG143 on fever in under 5s: assessment and initial management. NICE's original guidance on feverish illness in children was published in 2007 as NICE guideline CG47 and then updated and replaced by NICE guideline CG160 in 2013. A further update took place to NICE guideline CG160 in 2017. This document preserves evidence reviews and committee discussions for areas of the guideline that were not updated in 2019.
Feverish Illness in Children
NICE Clinical Guidelines, No. 160
Authors
National Collaborating Centre for Women's and Children's Health (UK).Excerpt
In November 2019, we updated and replaced this guideline with NICE guideline NG143 on fever in under 5s: assessment and initial management.
It is a requirement of the Children’s National Service Framework that all ill children should have access to high-quality, cost-effective, evidence-based care. Because it is difficult to evaluate the severity of the illness, there is a need for evidence-based guidance to inform healthcare professionals about how to judge whether a child who presents with a fever is likely to develop a serious illness. Healthcare professionals also need advice to support their decision on whether to observe the child, perform diagnostic tests, start treatment such as antibiotics or refer onwards for specialist care. The guidance should also include advice on the best ways to detect fever, the management of fever itself, and what to tell parents and carers who have made contact with healthcare services. The guidance should be applicable to primary and secondary care and should take account of the number of agencies that are involved in giving health care and giving advice to parents and carers. It is also important that parental preferences, as well as the child’s best interests in terms of health outcomes, should be taken into account when considering the various options for investigation and treatment.
The decision to update the guideline was made based on deveopments in the NHS and new evidence becoming available that could affect existing recommendations.
The introduction of new vaccination programmes in the UK may have significantly reduced the level of admissions to hospital resulting from diseases covered by this guideline. For example, early analysis of the pneumococcal vaccination programme in England shows that the incidence of pneumococcal related disease has fallen 98% in children younger than 2 years since vaccination was introduced. However, evidence suggests a 68% increase in the prevalence of disease caused by sub-types of bacteria not covered by vaccination programmes. Also, potentially serious cases of feverish illness are likely to be rare, so it is important that information is in place to help healthcare professionals distinguish these from mild cases.
In addition, new evidence is available on a number of the clinical questions covered by the guideline: the relationship of heart rate to fever in predicting the risk of serious illness in children, clinical effectiveness of combination or alternating therapy with paracetamol and ibuprofen in the management of fever in children, and predictive value and accuracy of pro-calcitonin as a marker of serious bacterial illness in children with fever without apparent source.
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This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient.
Implementation of this guidance is the responsibility of local commissioners and/or providers.
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