In primary care, children with fever should be assessed using the NICE traffic light system to evaluate their risk of serious illness NICE CKS.
Assessment includes checking the child's general appearance, temperature, heart rate, respiratory rate, capillary refill time (CRT), and fluid status during face-to-face consultations NICE CKS.
Measure the child's blood pressure if abnormal vital signs are present or if equipment is available NICE CKS.
Ask about the duration and height of the fever, and the method of temperature measurement, considering parental perception as valid NICE CKS.
Identify any symptoms or signs of specific illnesses, such as cough, rash, or neck stiffness, and check for features of Kawasaki disease if fever lasts 5 days or more NICE CKS.
Assess for signs of dehydration, including prolonged CRT, abnormal skin turgor, weak pulse, cool extremities, and abnormal respiratory pattern NICE CKS.
Evaluate for red, amber, or green features to determine urgency: red features require emergency referral, amber features need urgent assessment, and green features can be managed at home with advice NICE CKS,NICE NG143.
In children under 4 weeks, measure temperature with an electronic thermometer in the axilla; for 4 weeks to 5 years, use an electronic, chemical dot, or infra-red tympanic thermometer NICE CKS.
Consider additional investigations such as urine testing for UTI in infants under 3 months with suspected infection, and perform lumbar puncture in infants under 1 month or unwell infants aged 1-3 months NICE CKS.