Feverish illness in children

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Feverish illness in childrenImplementing NICE guidance May 2007NICE clinical guideline 47


Changing clinical practice NICE guidelines are based on the best available evidence The Department of Health asks NHS organisations to work towards implementing NICE guidelines Compliance with developmental standards will be monitored by the Healthcare Commission


What this presentation covers Background to the guideline Key recommendations Suggested actions Resources from NICE


Background: why this guideline mattersFeverish illness in children: is the most common reason for children to be taken to the doctor is a cause of concern for parents and carers can be a result of a simple self-limiting infection or a life-threatening infection can have no apparent source.


Key recommendations Traffic light system Detection of fever Clinical assessment Management by remote assessment Management by a non-paediatric practitioner Management by a paediatric specialist Antipyretics


The Traffic Light SystemTool for identifying the likelihood of serious illness Children with only symptoms and signs in the ‘green’ column are at low risk Children with one or more symptom or sign in the ‘amber’ column are at intermediate risk Children with one or more symptom or sign in the ‘red’ column are at high risk


Traffic light system: green


Traffic light system: amber


Traffic light system: red


Detection of feverIn children aged 4 weeks to 5 years measure body temperature by: electronic thermometer in the axilla or chemical dot thermometer in the axilla or infra-red tympanic thermometer. Use an electronic thermometer in the axilla for children younger than 4 weeks.


Clinical assessment Check for any immediately life-threatening features. Use traffic light system to check for symptoms and signs that predict the risk of serious illness. Look for a source of fever and check symptoms and signs associated with specific diseases. Measure and record temperature, heart rate, respiratory rate, capillary refill time and assess for dehydration.


Symptoms and signs of specific diseases


Symptoms and signs of specific diseases (2)


Management by remote assessment


Management by a non-paediatric practitioner


Management of children 3 months to 5 years by a paediatric specialist


The safety netThe safety net should be one or more of the following: verbal and/or written information on warning symptoms and how further healthcare can be accessed arranging further follow-up liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if required.


Management of children under 3 months by a paediatric specialist


AntipyreticsAntipyretics do not prevent febrile convulsions and should not be used specifically for this purpose. Do not routinely give antipyretic drugs to a child with fever with the sole aim of reducing body temperature Do not administer paracetamol and ibuprofen at the same time but consider using the alternative agent if the child does not respond to the first drug.


Implementation AdviceFeedback to NICE suggests that there are likely to be three key areas for successful implementation: Traffic light system Providing the safety net Training for non-specialist and non-clinical staff


Suggested actions: traffic light system Review clinical assessment tools to ensure that they include the features of the traffic light system. Review care pathways and protocols to ensure that they reflect the traffic light system. The ‘green’ section of the Traffic Light System could be used to help staff feel confident when making the decision to advise that a child is managed at home


Suggested actions: providing the safety net Review protocols to ensure that information is provided about the treatment and care of children with fever. Patient information is available from a variety of sources, including a booklet about this guideline for parents/carers, ‘Understanding NICE guidance’. When a child is discharged give the parents/carers an advice sheet about how to care for their child and potential warning signs. Develop protocols for staff on when children are safe to be cared for at home.


Suggested actions: trainingUse the traffic light system when developing training. Review training needs to identify whether training in body temperature measurement is required. Training should be available for healthcare professionals working with children in the potential diagnoses of fever and other symptoms in children.


Suggested actions: training Ensure that either electronic, chemical dot or infra-red tympanic thermometers are available for staff to use. Ensure that staff are confident in measuring body temperature using these thermometers.


Access tools onlineCosting tools costing report costing template Implementation advice Audit criteria Available from: www.nice.org.uk/CG47


Access the guideline onlineQuick reference guide – a summary http://guidance.nice.org.uk/CG47/quickrefguide/pdf/English NICE guideline – all of the recommendations http://guidance.nice.org.uk/CG47/niceguidance/pdf/English Full guideline – all of the evidence and rationale http://guidance.nice.org.uk/CG47/guidance/pdf/English ‘Understanding NICE guidance’ – a plain English version http://guidance.nice.org.uk/CG47/publicinfo/pdf/English

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Last Updated: 8th March 2018

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