Fever Care Pathway Overview

Please click the relevant flowchart box to be taken directly to textual information.



Assessment - Traffic Light Features

Document temperature, heart rate, respiratory rate, capillary refill time, colour, activity and hydration status

Traffic light system for identifying severity of illness


Diagnosis to be considered in conjunction with fever:

Symptoms and signs:

  • Non-blanching rash, particularly with one or more of the following;
    • An ill-looking child
    • Lesions larger than 2mm in diameter (purpura)
    • CRT >3 seconds
    • Neck stiffness

Symptoms and signs:

  • Neck stiffness
  • Bulging fontanelle
  • Decreased level of consciousness
  • Convulsive status epilepticus

Key Point

Classical signs (neck stiffness, bulging fontanelle, high-pitched cry) are often absent in infants with bacterial meningitis

Symptoms and signs:

  • Focal neurological signs
  • Focal seizures
  • Decreased level of consciousness

Symptoms and signs:

  • Tachypnoea measured as;
    • 0 – 5 months – RR > 60 breaths/minute
    • 6 – 12 months – RR > 50 breaths/minute
    • > 12 months – RR > 40 breaths/minute
  • Crackles in the chest
  • Nasal flaring
  • Chest indrawing
  • Cyanosis
  • Oxygen saturation < 95%

Symptoms and signs:
  • Vomiting
  • Poor Feeding
  • Lethargy
  • Irritability
  • Abdominal pain or tenderness
  • Urinary frequency or dysuria
  • Offensive urine or haematuria

Key Point

Urinary tract infection should be considered in any child aged younger than 3 months with fever. See ‘Urinary tract infection in children’ NICE clinical guidance, published August 2007

Symptoms and signs:

  • Swelling of a limb or joint
  • Not using an extremity
  • Non-weight bearing

Symptoms and signs:

  • Fever lasting longer than 5 days and at least 4 of the following;
    • Bilateral conjunctival injection
    • Change in upper respiratory tract mucous, membranes (for example, injected pharynx, dry cracked lips or strawberry tongue)
    • Change in the peripheral extremities (for example oedema, erythema or desquamation)
    • Polymorphous rash
    • Cervical lymphadenopathy

Key Point

NB: In rarer cases, incomplete/atypical Kawasaki disease may be diagnosed with fewer features

GP Guidelines

If ANY Red Features:

Administer parenteral antibiotics if meningococcal disease suspected and refer urgently to hospital

Check blood glucose if possible

Practice Point:

When you feel a GP review in a specific time period is clinically appropriate but that falls outside of the ’in hours’ GP service please contact the Paediatric OOH HUB on 0300 369 0461 after 15:30.  Your patient will be contacted during the out of hours period, assessed and the appropriate actions taken. Please see the Urgent/OOH section for further information and the process.


Patient Resources

Please see the Patient & Carer Information & Leaflets section.

Resources for Professionals

National Standards

Please see the National and NICE Guidance section.