Resource Highlights: Fever

Note that the views, thoughts and opinions expressed in this and associated resources relate only to the contributors /speakers and not necessarily to their employer, organisation, the Royal College of Paediatrics and Child Health, or any other group or individual.

Contributors:

Dr Emma Lim Consultant Paediatrician | Great North Children’s Hospital in Newcastle upon Tyne

Dr Christo Tsilifis Clinical Fellow, Academic Paediatric Trainee | Great North Children’s Hospital in Newcastle upon Tyne

1. Investigation

A fever without a source (for less than 5 days) in a well child with no red flag signs or risk factors (see point 5 below) does not need investigation.

2. Fever is a normal physiological response to infection

If you can explain this to parents, you can change their whole perception of febrile illnesses going forwards. This is a worthwhile investment on that first encounter. 

3. The value of observation

Observation of febrile children can be invaluable.  It is normal for febrile children to look dreadful.  Sometimes allowing a bit of time for that fever to come down can save you doing more invasive investigations.  

4. Temperature

• A normal temperature is 36.5 – 37.5 degrees Celsius.

• Above 38 degrees Celsius is a fever

• between 37.5 and 37.9 is a low grade fever

What you do varies, based on local protocols and the clinical context.  There is very little evidence to suggest that the height of fever is related to illness severity. 

5. Identifying patients at high risk

In certain groups of patients, fever should be treated more seriously. This includes:

1. neonates and children under 3 months of age,

2. children with an impaired immune system either due to illness (primary immunodeficiency) or drugs (high dose steroids, chemotherapy, immunosuppressants e.g. monoclonal antibodies)

3. recent surgery, invasive procedure or trauma in last 6 weeks

4. indwelling lines or catheters

5. chronic disease (neuro-disability, chest disease)

Relevant information

The Munro Report. A newsletter with analysis on issues affecting science, medical research, child health and infectious diseases.

The Munro Report – don’t fear the fever

About the contributors:

Dr Emma Lim Consultant Paediatrician
Emma Lim is a Consultant in General Paediatrics and Paediatric Infectious Diseases and Immunology at the Great North Children’s Hospital in Newcastle upon Tyne and Paediatric Sepsis Lead for the trust. She has worked regionally and nationally with the Academic Health Science Network, and the Sepsis Trust to increase awareness and develop sepsis pathways. She is an investigator in the EU PERFORM and DIAMONDS Horizon 2020 study to improve management of febrile patients and is the course lead for the RCPCH How to Manage: Paediatric Sepsis series.  

Dr Christo Tsilifis Clinical Fellow, Academic Paediatric Trainee
Christo Tsilifis is a Paediatric Trainee and Academic Clinical Fellow at the Great North Children’s Hospital in Newcastle upon Tyne.