Seeing a Doctor about Fever

Authored by Dr Mary Lowth, 22 May 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Adrian Bonsall, 22 May 2017

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/amber/red symptoms in fever in children aged below 5 years
 Green - low riskAmber - medium riskRed - high risk
ColourNormal colourPaleVery pale, mottled or blue.
Activity

Responds normally to you.
Content/smiles.
Stays awake or awakens quickly.
Strong normal cry/not crying.

Not responding normally to you.
No smile.
Wakes only with a lot of stimulation.
Decreased activity, listless.

No response to you.
Does not wake or if roused does not stay awake.
Weak, high-pitched or continuous cry.

Breathing

 Increased breathing rate (>40 breaths per minute aged over 12 months, >50 breaths per minute aged 6-12 months).

Grunting.
Respiratory rate >60 breaths per minute.
Chest indrawing between ribs when breathing in.

CirculationMoist tongue and lips, normal eyes.

Dry tongue and lips.
Poor feeding (babies).
Not producing wet nappies/needing to pass urine.
Fast heart rate ('normal' varies with age, and rate is difficult to judge without a stethoscope: your doctor will check this).

Reduced skin elasticity.
OtherNo red or amber signs.Age 3-6 months, temperature ≥39°C.

Fever for ≥5 days.
Rigors (repeated episodes of alternating shivering bouts then sweating, as temperature repeatedly goes up and down).
Swelling of a limb or joint.
Non-weight-bearing limb/not using an extremity.

Age <3 months, temperature ≥38°C.

Non-blanching rash.
Bulging fontanelle.
Neck stiffness.
Unusual seizures or fits.

Further reading and references

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