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Important conditions to be considered in a child with a fever (bacterial meningitis)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Diagnosis to be considered

Symptoms and signs in conjunction with fever in a child under 5 years of age

Meningococcal disease

Non-blanching rash, particularly with 1 or more of the following:

  • an ill-looking child
  • lesions larger than 2 mm in diameter (purpura)
  • capillary refill time of >=3 seconds
  • neck stiffness

Bacterial meningitis

Neck stiffness

Bulging fontanelle

Decreased level of consciousness

Convulsive status epilepticus

Herpes simplex encephalitis

Focal neurological signs

Focal seizures

Decreased level of consciousness


Tachypnoea (respiratory rate >60 breaths/minute, age 0-5 months; >50 breaths/minute, age 6-12 months; >40 breaths/minute, age >12 months)

Crackles in the chest

Nasal flaring

Chest indrawing


Oxygen saturation <=95%

Urinary tract infection


Poor feeding



Abdominal pain or tenderness

Urinary frequency or dysuria

Septic arthritis

Swelling of a limb or joint

Not using an extremity

Non-weight bearing

Kawasaki Disease

Fever for 5 days or longer and may have some of the following:

  • bilateral conjunctival injection without exudate
  • erythema and cracking of lips; strawberry tongue; or erythema of oral and pharyngeal mucosa
  • oedema and erythema in the hands and feet
  • polymorphous rash
  • cervical lymphadenopathy


Do not use duration of fever to predict the likelihood of serious illness. However, children with a fever lasting 5 days or longer should be assessed for Kawasaki disease


  • NICE (November 2019). Feverish illness in children Assessment and initial management in children younger than 5 years

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