How to assess febrile children in primary care?

In primary care, children with fever should be assessed using the NICE traffic light system to evaluate their risk of serious illness ¹.

Assessment includes checking the child's general appearance, temperature, heart rate, respiratory rate, capillary refill time (CRT), and fluid status during face-to-face consultations ¹.

Measure the child's blood pressure if abnormal vital signs are present or if equipment is available ¹.

Ask about the duration and height of the fever, and the method of temperature measurement, considering parental perception as valid ¹.

Identify any symptoms or signs of specific illnesses, such as cough, rash, or neck stiffness, and check for features of Kawasaki disease if fever lasts 5 days or more ¹.

Assess for signs of dehydration, including prolonged CRT, abnormal skin turgor, weak pulse, cool extremities, and abnormal respiratory pattern ¹.

Evaluate for red, amber, or green features to determine urgency: red features require emergency referral, amber features need urgent assessment, and green features can be managed at home with advice ¹,².

In children under 4 weeks, measure temperature with an electronic thermometer in the axilla; for 4 weeks to 5 years, use an electronic, chemical dot, or infra-red tympanic thermometer ¹.

Consider additional investigations such as urine testing for UTI in infants under 3 months with suspected infection, and perform lumbar puncture in infants under 1 month or unwell infants aged 1-3 months ¹.