There is growing concern that the National Health Service (NHS) policy changes may be making the problem of recognizing serious illness in feverish young children more difficult, according to an Editorial in this week's issue of the British Medical Journal. According to Anthony Harndern, Lecturer in General Practice, University of Oxford, medical professionals should be offering less telephone advice and more opportunities for prompt assessment by an experienced doctor.

Harndern writes that the diagnosis and management of feverish children is a significant part of primary care. Half of children with meningococcal disease are sent home after their first visit, even though GPs have extensive clinical experience of assessing febrile children. "How can this be so?" asks Harndern. He stresses that we should be focusing on what we can do to improve our assessment of febrile children.

Harndern states that there are several factors that make the recognizing of serious illness in feverish children more difficult. Among those is the increasing rarity of serious bacterial infection, plus the time point in the illness that the child is examined. NHS policy changes have meant that an increasing number of febrile children are seen outside primary care hours by a wide array of professional groups with varying levels of experience and skills.

To recognize clinical severity in febrile children a full assessment by an experienced clinician is needed, says Harndern. The child's history needs to be known, the clinician needs to carry out a careful observation of signs, including alertness, activity, color and respiratory effort. This is part of the reason why NICE (National Institute for Health and Clinical Excellence) issued guidelines for the assessment and initial management of young children with feverish illness.

Harndern believes the 'traffic light' system, as well as the guidelines are over-reliant on the measuring of vital signs. This may be inappropriate, resulting in a large number of children who develop serious illness being sent away. It is vital, he writes, that GPs do not disregard their intuition.

"We should recognise that we are seeing only a brief snapshot of a dynamic illness and should always empower and make it easy for parents to consult again - even a few hours later - if symptoms deteriorate. We should trust our clinical intuition and refer and re-refer if concerned," Harndern concludes.

"Editorial: Recognising serious illness in feverish young children in primary care"
BMJ Volume 335 pp 409-10
bmj