Fever is one of the most common reasons for paediatric presentation in primary care, urgent care, and emergency departments. In the UK, NICE provides a traffic-light, risk-based assessment for fever in under 5s, while the Royal College of Paediatrics and Child Health (RCPCH) supports this framework and adds contextual paediatric judgement and parental guidance. This comparison highlights how to use both in practice.
See how this translates to practice: Explore our Clinical governance features, visit the Patient Safety Hub, or review Clinical Safety & Assurance for enterprise rollout.
Audience: GPs, paediatric ED clinicians, urgent care, and community paediatric teams.
Assessment: structure vs context
NICE
- Traffic-light system (green/amber/red) for risk stratification in under 5s.
- Focus on clinical features (colour, activity, respiratory, hydration, circulation, red flags).
- Discourages over-reliance on single markers; promotes combined clinical assessment.
RCPCH
- Supports NICE traffic lights, adds paediatric clinical judgement for ambiguous presentations.
- Emphasises context (e.g., immunisation status, underlying conditions, social factors).
- Highlights parental communication, safety-netting, and when to re-evaluate.
Key difference: NICE provides structured risk; RCPCH contextualises with paediatric nuance and family guidance.
Management and treatment
Both guidelines discourage unnecessary antibiotics and promote supportive care unless bacterial infection is suspected.
- Antibiotics: Avoid unless clear bacterial features or high-risk criteria; obtain cultures where appropriate.
- Fluids/antipyretics: Encourage oral fluids; consider paracetamol/ibuprofen for distress, not solely to normalise temperature.
- Observation: Reassess if amber/red features evolve; low threshold for senior review when concerned.
RCPCH places additional emphasis on parental guidance: clear safety-netting, when to return, and how to monitor symptoms at home.
Escalation
NICE ties escalation to traffic-light categories: red features → urgent referral/emergency care; amber → consider observation or referral based on clinical judgement and access.
RCPCH aligns but underscores early senior paediatric input when uncertainty persists, and tailored advice for parents to reduce risk of delayed presentation.
Practical flow you can apply
- Risk-stratify: Apply NICE traffic lights (green/amber/red).
- Act on red/amber: Red → urgent referral; Amber → observe/refer based on clinical judgement and resources.
- Avoid unnecessary antibiotics: Use when bacterial infection suspected; otherwise supportive care.
- Safety-net: Give clear parental advice on red flags and when to re-attend.
- Review: Reassess if symptoms change; seek senior paediatric input for ambiguity.
FAQs: quick answers
Is the traffic-light system still recommended? Yes—core to NICE; RCPCH supports it with clinical judgement.
Should we give antibiotics for all fevers? No. Avoid unless bacterial features are present or high-risk criteria met.
What should parents be told? Clear safety-netting: red flags (lethargy, poor perfusion, respiratory distress, non-blanching rash), when to seek urgent care, and how to monitor.
When to escalate? Any red features; concerning amber features with clinical judgement; persistent uncertainty warrants senior review.
Do both guidelines align? Yes—NICE provides structure; RCPCH reinforces clinical nuance and parental guidance.
Source links (official)
Why this matters
Fever is ubiquitous in childhood, but the stakes are high when serious infection is missed. NICE delivers a clear risk-structured approach; RCPCH adds the paediatric context and family guidance that make the system work in real life. Using both keeps care safe, consistent, and family-centred.