RHC for Health Professionals
Red flag symptoms and signs that require urgent referral:
- Weight loss, night sweats
- Failure to thrive
- Severe chronic diarrhoea
- Extensive mucocutaneous candidiasis in infancy
Recurrent Fever in Children: Advice for Referrers
Warning
Fever is one of the most common presenting complaints in childhood and is most frequently due to infection. Young children experience, on average, three to six febrile episodes per year. Most have a self-limiting, presumed viral illness. Around 5 - 10% of those presenting to an A&E department have a serious bacterial infection (Craig et al., 2010). If fevers are prolonged, recurrent, or periodic, other differential diagnoses including immunodeficiency, malignancy and inflammatory conditions should be considered (Soon and Laxer, 2017).
Fever patterns:
- Prolonged fever – fever longer than expected for the clinical diagnosis e.g. viral syndrome lasting more than 10 days
- Fever of unknown origin – single episode lasting more than 3 weeks, during which fever is above 38.3°C on most days, uncertain diagnosis after 1 week of investigation
- Recurrent fever – single episode during which fever waxes and wanes, or repeated febrile episodes
- Periodic fever – recurring episodes lasting days to weeks in which fever is the main feature, well in-between episodes (Long, 2005)
Please include the following points from the history in the referral letter:
- Age of onset, frequency, peak of fevers
- Associated signs and symptoms
- Whether infections localise to the same organ system e.g. recurrent tonsillitis
- Whether associated symptoms are recurrent and predictable
- Interval between febrile episodes and whether the child is well
- Whether they are thriving
- Infections caused by unusual or opportunistic pathogens (if known)
- Previous treatments, including whether they have previously been treated with antibiotics
- History of chronic diarrhoea, and/or extensive mucocutaneous candidiasis in infancy
- History of atopy e.g. asthma, hay fever, food allergies
- History of delayed separation of the umbilical cord (>30 days)
- Immunisation status, including BCG
- Ethnicity, parental consanguinity and family history of primary immune deficiency, recurrent fever, or autoimmunity
- Contact with unwell persons, particularly household TB contacts, animals, ticks
- Travel history – if travelled whether followed travel health advice such as vaccines or antimalarial prophylaxis
Please include the following points from the examination in the referral letter:
- Weight and height (current and previous if available)
- Lymphadenopathy
- Hepatosplenomegaly
Websites:
Articles:
- Craig, J. C. et al. (2010) ‘The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses.’, BMJ (Clinical research ed.). British Medical Journal Publishing Group, 340, p. c1594. doi: 10.1136/bmj.c1594.
- Long, S. S. (2005) ‘Distinguishing Among Prolonged, Recurrent, and Periodic Fever Syndromes: Approach of a Pediatric Infectious Diseases Subspecialist’, Pediatric Clinics of North America. Elsevier, 52(3), pp. 811–835. doi: 10.1016/J.PCL.2005.02.007.
- Soon, G. S. and Laxer, R. M. (2017) ‘Approach to recurrent fever in childhood.’, Canadian family physician Medecin de famille canadien. College of Family Physicians of Canada, 63(10), pp. 756–762. Available at: (Accessed: 10 September 2021).