Fever in Children Under 5
Introduction
Fever in children under 5 is a very common ED presentation. Most cases are viral and self‑limiting, but a minority represent serious bacterial infection, sepsis or other time‑sensitive diagnoses (meningitis, pneumonia, occult UTI, septic arthritis/osteomyelitis, Kawasaki disease).
The aim of assessment is rapid identification of children with red‑flag features who need immediate resuscitation, sepsis management and paediatric review, while avoiding unnecessary investigation or admission for well children (NICE NG143; RCEM).
Thermometer use and documentation
Accurate and documented measurement reduces both false reassurance and unnecessary escalation.
- Do not routinely use oral or rectal temperature measurements in children aged 0-5 years because of discomfort and the risk of injury (NICE NG143).
- Infants younger than 4 weeks: measure temperature using an electronic axillary thermometer (recommended) (NICE NG143).
- Children aged 4 weeks to 5 years: acceptable methods are an electronic axillary thermometer, a chemical dot thermometer in the axilla, or an infra‑red tympanic thermometer.
- Avoid forehead chemical dot thermometers as they are unreliable in this age group (NICE NG143).
- Always document temperature, the measurement site and method, and record parental report of fever and any recent antipyretic use (NICE NG143).
Initial assessment and priorities
Use ABCDE and paediatric life‑support principles; recognise life‑threatening features immediately and commence resuscitation per Resuscitation Council UK / local paediatric basic life support (PBLS)...