When should we go to the doctor?
The National Institute for Health and Care Excellence (NICE) has produced guidelines aimed to help healthcare professionals assess children with fever. These can also be useful to parents. They look at the symptoms seen in children with fever and allocate them to categories of 'green', 'amber' and 'red'. They are shown in the table below.
Green symptoms are reassuring. They mean that your child's symptoms suggest they are at low risk of serious illness.
Amber symptoms suggest that you need a doctor's advice. They suggest that your child might be at slightly increased risk of more serious illness.
Red symptoms suggest that you need urgent medical advice. They suggest that your child's symptoms could indicate a serious illness, needing emergency help.
Not all possible symptoms are included in the guidance - for instance, tummy (abdominal) pain is not mentioned and, unless it is mild, it usually does need assessing by a doctor.
Some of the guidance concerns the kind of symptoms which a trained healthcare professional is expected to assess but which you may feel uncomfortable trying to measure, such as number of breaths per minute (respiratory rate) and heart rate (which usually needs a stethoscope for accurate assessment in a small child). They are included here for completeness: if ANY red or amber signs are present you should seek help or advice; you do not need all of them to be present in order to do so.
|Green - low risk||Amber - medium risk||Red - high risk|
|Colour||Normal colour||Pale||Very pale, mottled or blue.|
Responds normally to you.
Not responding normally to you.
No response to you.
|Increased breathing rate (>40 breaths per minute aged over 12 months, >50 breaths per minute aged 6-12 months).|
|Circulation||Moist tongue and lips, normal eyes.|
Dry tongue and lips.
|Reduced skin elasticity.|
|Other||No red or amber signs.||Age 3-6 months, temperature ≥39°C.|
Fever for ≥5 days.
|Age <3 months, temperature ≥38°C.|
Further reading and references
Feverish illness in children - Assessment and initial management in children younger than 5 years; NICE Guideline (Updated August 2017)
Feverish child - risk assessment; NICE CKS, September 2013 (UK access only)
Thompson M, Van den Bruel A, Verbakel J, et al; Systematic review and validation of prediction rules for identifying children Health Technol Assess. 2012 Mar16(15):1-100.
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