Paediatric specialist management of fever in children under 5 (NICE NG143 - with Resuscitation Council UK resuscitation principles)
Introduction
Fever in children under 5 is common and usually self‑limiting; a small minority have serious bacterial infection (SBI). The specialist emergency role is to identify the high‑risk child early, perform targeted investigations, start empiric therapy when indicated and provide safe observation or discharge with clear safety‑netting.
Use the NICE NG143 traffic‑light assessment together with age‑stratified thresholds for investigations, lumbar puncture (LP) and empiric antibiotics. For immediate resuscitation and shock management follow Resuscitation Council UK paediatric life‑support principles (see shock section).
NICE NG143 has been reviewed by exceptional surveillance (April 2025) and remains current.
Key principles
- Apply the traffic‑light system (green / amber / red) to stratify risk of serious illness; any red feature requires urgent paediatric review.
- Age determines thresholds for investigation and treatment: neonates (<1 month), young infants (1-3 months) and children ≥3 months have different triggers.
- Use a low threshold for investigations in infants <3 months: full blood count (FBC), blood culture, CRP, urine testing; perform site‑directed tests such as chest X‑ray (CXR) for respiratory signs or stool culture for diarrhoea.
- Perform lumbar puncture (LP) routinely in all febrile neonates; in 1-3 month infants perform LP if clinically unwell or consider LP when WBC <5 or >15 ×10^9/L.
- Start...
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