e-learning – Fever in under 5s

This guideline has been updated in Nov 19. It was first published in 2007, then updated in 2013, when I first did this blog.

The main update this year is around Kawasaki disease. It used to be that Kawasaki disease was diagnosed if children had 4 out of 5 features. However it has now been realised that children diagnosed with Kawasaki disease often don't have 4 out of the 5 features. Features often come and go throughout the course of the disease as well. Children under one year of age often don't have as many additional features of Kawasaki disease.

So be aware of Kawasaki disease if children have a fever that lasts 5 days or more.

Additional features may include:

  • bilateral conjunctival injection without exudate.
  • erythema and cracking of the lips, strawberry tongue or erythema of the oral and pharyngeal mucosa.
  • oedema and erythema in the hands and feet.
  • polymorphous rash.
  • cervical lymphadenopathy.

The 'traffic-light' sheet with the red, amber and green features to look out for hasn't changed. Still a good one for the wall.

They have handy 'parent information sheets' that you can print out. The sections on 'Caring for your child at home' and 'Seeking further advice' are useful for safety-netting.

  • The following points were new, or useful to remember from the 2013 update.
  • Tachycardia has been defined and age specific ranges given (see the new 'traffic-light sheet'.
  • Duration of fever shouldn't be used as a risk factor, but remember Kawasaki disease if they've had fever for over 5 days.
  • Remote Assessment. If you are assessing a child over the phone, any red features should prompt a face to face review within 2 hrs.
  • Antipyretics. The advice before was 'only 1 at a time'. Did anyone do this? Anyway, they've now advised that parents can add in the second agent if the first alone isn't controlling symptoms.
  • Red Features. This is stated as being for secondary care, but probably applies to us too. If you have a child with 'red features' and give them antipyretics, don't judge severity of illness by a fall in temperature, or by the lack of a fall. All these kids need a full reassessment regardless.

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