Fever Care Pathway Overview

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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

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:

The paediatric hub can be contacted on the following telephone numbers:

Daytime (08:00- 18:30) - 01452 687 000

OOH Healthcare Professional (HCP) Line (18:30-08:00) - 0330 053 6359
Your patient will be contacted during the out of hours period, assessed and the appropriate actions taken.

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