Fever: management (red or amber features)
Children with red/amber features need admission. Those with red fea-tures have life-threatening illness and need urgent treatment.
• In hypoxic children or those in shock.
• If there is no apparent source of infection, despite fever, then the investigations should include the following:
• Blood—culture, FBC, CRP, electrolytes;
• Urine—test for UTI;
• lumbar puncture—consider if the clinical assessment dictates and there are no contraindications;
• CXR—consider if high white blood cell count.
Maximum dose third-generation cephalosporins (cefotaxime or ceftriax-one) should be given to children with fever and:
• signs of shock or coma
• signs of meningococcal disease
Consider giving high dose IV aciclovir if suspect herpes simplex encepha-litis or disseminated neonatal disease.
Consider giving IV corticosteroid if confirmed bacterial meningitis (but not in infants younger than 3mths
Give third-generation cephalosporin if any of the following are sus-pected
• Neisseria meningitidis
• Streptococcus pneumoniae
• Escherichia coli
• Staphylococcus aureus
• Haemophilus influenzae type b
Consider choice of antibiotics or route of administration carefully in the following instances:
• Child <3mths: add antibiotic against listeria (e.g. ampicillin)
• Child with decreased level of consciousness: give parenteral antibiotics.
• Significant rates of antibiotic resistance: follow local guidelines
Fever should be treated if the child is unwell with it:
• Do not use tepid sponging.
• Do not over- or underdress the child.
• Only use paracetamol or ibuprofen if the child is distressed with fever.