Rectal temperature ≥38.0 °C in infants; evaluate for serious bacterial infection per age and traffic-light system.
History taking
- • Onset, height, response to antipyretic, associated symptoms (cough, vomiting, diarrhoea, rash, ear pain)
- • Activity, feeding, urine output, immunisation status
- • Sick contacts, day-care attendance, travel
Examination
- • General appearance (NICE traffic light)
- • Vitals: HR, RR, SpO₂, capillary refill
- • Head-to-toe: fontanelle, throat, ears, chest, abdomen, rash, neck stiffness
Red flags
- • Age <3 months with any fever — admit
- • Toxic appearance, mottling, lethargy, weak cry, capillary refill >3 s, RR↑, grunting
- • Petechial rash, neck stiffness, bulging fontanelle, seizure
Differential diagnosis
- • Viral URI, otitis media, pharyngitis, pneumonia, UTI, gastroenteritis
- • Meningitis, dengue, malaria, typhoid, Kawasaki, occult bacteraemia
Recommended investigations
- • Age-based; <3 months: full septic work-up
- • Urinalysis & culture in all febrile children without obvious focus
- • CBC, CRP, blood culture, CXR, LP per clinical assessment
Diagnosis
- • Clinical with selected investigations
Initial treatment / management
- • Antipyretic for comfort: Paracetamol 15 mg/kg 6 hourly or Ibuprofen 10 mg/kg 8 hourly
- • Maintain hydration
- • Empirical antibiotic if serious bacterial infection suspected
- • Admit per NICE traffic light
Prescription examples
- • Syrup Paracetamol 250 mg/5 mL — 0.6 mL/kg per dose 6 hourly PRN (max 60 mg/kg/day)
- • Syrup Ibuprofen 100 mg/5 mL — 0.5 mL/kg per dose 8 hourly PRN
- • Adequate oral fluids / ORS
Follow-up advice
- • Review in 24–48 h or earlier if worsening
- • Re-evaluate if fever persists >5 days (Kawasaki, occult infection)
Patient counselling
- • Avoid sponging with cold water/alcohol
- • Watch for warning signs: drowsiness, poor feeding, decreased urine, rash, fast breathing
- • Vaccinations up to date
Referral criteria
- • All <3 months, toxic child, suspected meningitis, sepsis, Kawasaki
Clinical pearls
- • Always rule out UTI in febrile child without focus, especially infants
- • Fever does not damage brain; over-treatment with antipyretics not needed
References
- • NICE NG143: Fever in Under 5s
- • IAP Standard Treatment Guidelines on Fever
Educational outpatient guide — verify against local guidelines before clinical use.
