Pre-referral guidelines for primary care providers

Fever in children is extremely common and has many different causes, several of which are infective. There are many myths and misconceptions surrounding fever in the community, and parental concern regarding fever often leads to medical consultation.

Acute fever will not be discussed further here. For the management of acute fever, please refer to the Royal Children’s Hospital clinical practice guidelines.

Intermittent fever, occurring commonly in children at non-regular intervals, is generally indicative of simple recurrent viral infection. See recurrent infections for further detail.

Chronic fever, or pyrexia of unknown origin, which is defined as a fever persisting for more than 2 weeks, requires urgent paediatric assessment for further investigation.

Relapsing or periodic fever, which is uncommon, but seen in some children with reproducible periodicity, requires paediatric input for further investigation.

Practice points

  • Fever in its own right is not dangerous, nor are simple febrile convulsions.
  • The height of a fever, speed of onset or response to antipyretics are not indicators of type or severity of illness.
  • The use of antipyretics to reduce fever alone is not recommended.
  • Young children commonly have multiple febrile illnesses throughout winter and spring every year. Unless these are invasive or unusually severe, an underlying immune deficiency or other serious medical problem in a well grown child is unlikely, and further investigation is generally not indicated (see Recurrent infections)
  • For fever persisting 5 days or more in a younger child, consider the diagnosis of Kawasaki disease.

Referral pathways

  • Paediatrician
    • Referral to paediatric outpatient services is not appropriate in the management of acute fever or uncomplicated intermittent fever.
    • Pyrexia of unknown origin should be referred to the local Emergency Department for further evaluation.
    • Concern over true periodic fever can be referred for further evaluation to paediatric outpatient services.