Important conditions to be considered in a child with a fever
Diagnosis to be considered | Symptoms and signs in conjunction with fever in a child under 5 years of age |
Meningococcal disease | Non-blanching rash, particularly with 1 or more of the following:
|
Bacterial meningitis | Neck stiffness Bulging fontanelle Decreased level of consciousness Convulsive status epilepticus |
Herpes simplex encephalitis | Focal neurological signs Focal seizures Decreased level of consciousness |
Pneumonia | Tachypnoea (respiratory rate >60 breaths/minute, age 0-5 months; >50 breaths/minute, age 6-12 months; >40 breaths/minute, age >12 months) Crackles in the chest Nasal flaring Chest indrawing Cyanosis Oxygen saturation <=95% |
Urinary tract infection | Vomiting Poor feeding Lethargy Irritability Abdominal pain or tenderness Urinary frequency or dysuria |
Septic arthritis | Swelling of a limb or joint Not using an extremity Non-weight bearing |
Kawasaki Disease | Fever for 5 days or longer and may have some of the following:
|
Do not use duration of fever to predict the likelihood of serious illness. However, children with a fever lasting 5 days or longer should be assessed for Kawasaki disease
Reference:
- NICE. Fever in under 5s: assessment and initial management. NICE guideline NG143. Published November 2019, last updated November 2021.
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