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- Fever in a child (looks well)
Fever in a child (looks well)
Traffic-light them, find the source, and safety-net the parents properly.
| If you find… | …then |
|---|---|
| Any red feature (pale/mottled/blue, no response, weak high-pitched cry, grunting, RR > 60, reduced skin turgor, non-blanching rash, bulging fontanelle, neck stiffness, focal signs, seizure) | Urgent paediatric assessment |
| Age under 3 months with temp ≥ 38 °C | Red — paediatric assessment |
| Age 3–6 months with temp ≥ 39 °C | Red — paediatric assessment |
| Fever ≥ 5 days | Consider Kawasaki and other causes |
| Non-blanching rash | Meningococcal until proven otherwise — antibiotics, paediatrics |
- Duration and height of fever
- Feeding, wet nappies, vomiting
- Activity, alertness, crying
- Rash, breathing, cough, ear, urine smell
- Immunisations; unwell contacts; travel
- Parental concern (take it seriously)
- Temperature, HR, RR, CRT, SpO₂
- Colour, activity, hydration
- ENT, chest, abdomen, skin (glass test any rash)
- Fontanelle, neck stiffness, limbs/joints
Assess from the doorway
Before touching the child, watch them on the parent’s lap. Colour, activity, breathing effort, interaction. This is the most valuable part of the traffic light.
The glass test
Press a clear glass firmly on any rash. If the spots don’t fade, it’s a non-blanching rash: meningococcal disease until proven otherwise.
NICE traffic light
- Pale, mottled or blue
- No response to social cues / appears ill / weak high-pitched cry
- Grunting, RR > 60 or chest indrawing
- Reduced skin turgor
- Age < 3 months with temperature ≥ 38 °C
- Non-blanching rash, bulging fontanelle, neck stiffness, seizure or focal signs
- Reduced activity / not responding normally
- Nasal flaring, tachypnoea, SpO₂ ≤ 95% or crackles
- Tachycardia, CRT ≥ 3 s, dry mucous membranes, poor feeding or reduced urine
- Age 3–6 months with temperature ≥ 39 °C
- Fever ≥ 5 days, rigors, or limb/joint swelling
RED — urgent paediatric assessment · AMBER — paediatric assessment / senior review per local pathway · GREEN — manage at home with safety-netting
NICE traffic light (NG143)
- Red: pale/mottled/blue; no response, appears ill, not waking, weak/high-pitched cry; grunting, RR > 60, chest indrawing; reduced skin turgor; age < 3 m and ≥ 38 °C; non-blanching rash, bulging fontanelle, neck stiffness, status, focal signs
- Amber: pallor reported; reduced activity, not responding normally; nasal flaring, RR > 50 (6–12 m) or > 40 (> 12 m), SpO₂ ≤ 95%, crackles; tachycardia, CRT ≥ 3 s, dry mucous membranes, poor feeding, reduced urine; age 3–6 m and ≥ 39 °C, fever ≥ 5 days, rigors, limb/joint swelling
- Green: normal colour, responds normally, content/smiles, stays awake, strong normal cry, normal skin and eyes, moist mucous membranes
Any red → urgent paediatric assessment. Amber without a source → safety-net carefully or refer per local pathway. All green → home with safety-netting.
| Investigation | Only if… |
|---|---|
| Urine dip / culture | Fever without a source (especially under 3) |
| No routine bloods | Green features with clear viral source |
Management & advice
- Antipyretics only if the child is distressed — not just to bring the temperature down
- Don’t give both together; consider switching only if distress persists or recurs before the next dose
- Fluids; check on the child during the night
- Keep off nursery while febrile
- Don’t underdress or sponge
Refer / follow-up
- Red features → urgent paediatrics
- Amber with no source / parental concern → paediatric assessment per local pathway
| Drug | Dose | Duration / notes |
|---|---|---|
| Paracetamol BNFc ↗ | 15 mg/kg (or dose by age on the packet / BNFc), every 4–6 h, max 4 doses in 24 h | For distress |
| Ibuprofen (if over 3 months and > 5 kg) BNFc ↗ | 5–10 mg/kg (or by age per BNFc), three times a day | For distress; avoid if dehydrated, asthma worsened by NSAIDs, or chickenpox |
Your child has a temperature from a viral infection, and they look well. Fever itself isn’t harmful; it’s the body fighting the infection. Give paracetamol or ibuprofen only if they’re uncomfortable, and keep them drinking. Check on them during the night. Call 999 or come straight back if there’s a rash that doesn’t fade when you press a glass on it, they have a fit, become floppy or hard to wake, breathe fast, or stop having wet nappies. If you’re worried, trust your instinct and come back.
Come back / call 111 — or 999 if severe — if:
- A rash that doesn’t fade under a glass
- Fits, very drowsy or floppy, or hard to wake
- Breathing fast or hard, grunting
- Not feeding, fewer wet nappies, dry mouth
- Fever lasting 5 days or more
- You are worried — trust your instinct
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
- Using antipyretic response to judge illness severity
- Not checking urine in febrile infants with no source
- Weak safety-netting
- Dismissing parental concern
Revision practice. Work through a real or imagined case to rehearse the reasoning. It builds a model note to learn from. It doesn’t replace your judgement, your seniors or local guidance.
✎Blank clinic note template
Fever in a child (looks well) — clinic note
Doses are typical doses drawn from the guidance above. Always confirm in the current BNF/BNFc and your local antimicrobial policy.