fever in children
Last edited 12/2021 and last reviewed 02/2023
Pyrexia is a physiological response to illness, and may be is due to an increase in the set point of temperature in the hypothalamic regulatory centre. Older children suffer higher fevers than neonates in whom mechanical thermogenesis by shivering is limited.
There is little evidence that reducing fever improves the outcome of childhood infections. It is not clear if fever act as a defence against infection but what evidence there is suggests it does.
Some pathogens such as Strep.pneumoniae may be directly inhibited by fever.
- NICE state that:
- recognise that children younger than 3 months with a temperature of
38°C or higher are in a high-risk group for serious illness
- recognise that children aged 3-6 months with a temperature of 39°C
or higher are in at least an intermediate-risk group for serious illness
- recognise that children younger than 3 months with a temperature of 38°C or higher are in a high-risk group for serious illness
- 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
- think "Could this be sepsis?" and refer to the NICE guideline on sepsis: recognition, diagnosis and early management if a child presents with fever and symptoms or signs that indicate possible sepsis
- sepsis is a condition of life-threatening organ dysfunction due to a dysregulated host response to infection
NICE guidance - thermometers and detection of fever in children younger than 5 years
NICE guidance - use of paracetamol and ibuprofen for management of fever in child under 5 years old
primary care assessment and management of feverish child less than 5 years old
traffic light system table for identifying risk of serious illness in child under 5 years with fever (feverish)
important conditions to be considered in a child with a fever