6.2  Assess fever

Whether or not the mother says the child has fever, it is important that you assess all sick children for fever.

A child has the main symptom of fever if:

  • the child has a history of fever or
  • the child feels hot or
  • the child has an axillary temperature of 37.5°C or above.

ASK: Does the child have fever?

Check to see if the child has a history of fever, feels hot or has a temperature of 37.5°C or above.

The child has a history of fever if the child has had any fever with this illness. Use words for ‘fever’ that the mother understands. For example, ask the mother if the child’s body has felt hot. Feel the child’s abdomen or armpit and determine if the child feels hot.

If the child’s temperature has not been measured, and you have a thermometer, measure the child's temperature.

If the child has fever, assess the child for additional signs related to fever (if the child has no fever you should ask about the next main symptom, which is an ear problem. You will learn how to assess and classify ear problems in Study Session 13).

When a child presents with fever you should assess the child following the steps set out in Box 6.3 below. You will see that it lists the steps for assessing a child for fever and what the related illness may be.

The fontanelle is the ‘soft spot’ on top of an infant’s head where the skull bones have not yet fused. Meningitis is described in detail in Study Session 3 of Communicable Diseases, Part 1.

There are two parts to the box. The top section (above the broken line) describes how to assess the child for signs of malaria, measles, meningitis and other causes of fever. In meningitis there will be bulging fontanelle in infants and stiffness of the neck. The bottom section of the box describes how to assess the child for signs of measles complications if the child has measles now, or has had measles within the last three months.

Therefore, if your assessment is that the child does have fever, you should follow the steps in Box 6.3:

Box 6.3  Assessing for fever and possible related illnesses

Decide malaria risk: high or low or no.

If ‘low or no’ malaria risk, then ask:

  • Has the child travelled outside this area during the previous 15 days?
  • If yes, has the child been to a malarious area?

●  For how long has the child had fever?

●  If more than seven days, has the fever been present every day?

●  Has the child had measles within the last three months?

●  Look or feel for stiff neck

●  Look or feel for bulging fontanelles (under one year old)

●  Look for runny nose

●  Look for signs of MEASLES

●  Generalised rash and one of these: cough, runny nose, red eyes

If the child has measles now or within the last three months

●  Look for mouth ulcers Are they deep and extensive?

●  Look for pus draining from the eye

●  Look for clouding of the cornea

You are now going to look in more detail at how to classify illnesses associated with fever.

6.1  Assess and classify fever

6.2.1  Assessing for malaria