Pediatric Fever and Sepsis In Children Under 5 Years

Fever in children is the most common problem in pediatrics and our job is to distinguish the serious infections from the much more common self-limited viral infections. This post contains resources to help in this task.

The following is from Resource (4), link below:

Unexplained feverish illness is a concern for parents and carers and usually indicates an underlying infection. In most cases it is due to a self-limiting virus infection and recovery is quick without medical intervention. However, fever can be the presenting feature of serious bacterial illnesses such as meningitis, septicaemia, urinary tract infections and pneumonia.

Feverish illness is very common in young children (under 5), with between 20 and 40% of parents reporting such an illness each year. Fever is the most likely reason for a child to be taken to the doctor and the second most common reason for a child being admitted to hospital.

Feverish illness in infants and children can be hard to diagnose because it is often difficult to identify the cause. In some there will be symptoms and signs that suggest a particular infection, but many infants and children will have no obvious cause of fever despite careful assessment and investigation. These are a particular concern because it is especially difficult to distinguish between self-limiting virus infections and life-threatening bacterial infections in this group. The younger the child the more difficult it is to establish a diagnosis and assess the severity of illness.

The clinical picture can often change rapidly. The condition of an infant or child with a serious bacterial illness can deteriorate within hours of onset. On the other hand, those who appear ill with a virus infection can make a rapid recovery.

Here are the quality statements from Resource (4), link below:

Statement 1. Infants and children under 5 years with unexplained fever have their risk of serious illness assessed and recorded using the traffic light system.

Statement 2. Infants and children under 5 years who are seen in person by a healthcare professional have their temperature, heart rate, respiratory rate and capillary refill time measured and recorded if fever is suspected.

Statement 3. Infants and children presenting with unexplained fever of 38°C or higher have a urine sample tested within 24 hours. See statement 1 of NICE quality standard 36 on urinary tract infection in infants, children and young people for the quality measures, what the quality statement means, source guidance and definitions. Statement

Statement 4. Parents and carers who are advised that they can care for an infant or child under 5 years with unexplained fever at home are given safety net advice, including information on when to seek further help.

In addition to the Algorithm for the diagnosis of pediatric sepsis for children under 5 years old in this post, be sure and review the complete sepsis guideline (Resource 2), and the fever in the under 5s clinical guideline (Resource 3), the fever in under 5s  quality standard (Resource 4), and urinary tract infections in under 16s (Resource 5).

Reviewing all of the above resources will give every pediatric practioner an excellent review of pediatric fever. And these resources allow the practioner to recognize when the fever is potentially serious and how to take immediate appropriate action.


(1) Sepsis risk stratification tool: children aged under 5 years out of hospital [Link is to PDF] from NICE Guideline, NG51.

(2) Sepsis: recognition, diagnosis and early management [Link is to HTML] [Full Text PDF]. NICE guideline [NG51] Published date: July 2016 Last updated: September 2017. National Institute For Health And Care Excellence (NICE).

(3) Fever in under 5s: assessment and initial management [Link is to HTML] [Full Text PDF]. NICE Clinical guideline [CG160] Published date: May 2013 Last updated: August 2017. National Institute For Health And Care Excellence (NICE).

(4) Fever in under 5s [Link is to HTML] [Full Text PDF]. Quality standard [QS64] Published date: July 2014. National Institute For Health And Care Excellence (NICE).

(5) Urinary tract infection in under 16s: diagnosis and management [Link is to HTML] [Full Text PDF]. Clinical guideline [CG54]. National Institute For Health And Care Excellence (NICE)

(6) Urinary tract infection in children and young people [Link is to HTML] [Full Text PDF]
Quality standard [QS36] Published date: July 2013 Last updated: September 2017

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