Dawaa Reference

emergency

Fever in an infant under 3 months

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Fever in under 5s: assessment and initial management - NICE Guideline NG143 (NCBI Bookshelf NBK552086) - https://www.ncbi.nlm.nih.gov/books/NBK552086/ · Fever in an infant under 3 months - disease-level clinical article (fever-in-infant-under-3-months-full.txt) · Fever in an infant under 3 months - disease-level clinical article (fever-in-infant-under-3-months-clinical.txt)

Verified against3 documents
  • Fever in under 5s: assessment and initial management - NICE Guideline NG143 (NCBI Bookshelf NBK552086) - https://www.ncbi.nlm.nih.gov/books/NBK552086/
  • Fever in an infant under 3 months - disease-level clinical article (fever-in-infant-under-3-months-full.txt)
  • Fever in an infant under 3 months - disease-level clinical article (fever-in-infant-under-3-months-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Take the parent seriously when they say the baby has been hot, even if the reading is normal by the time you see them
  • Under three months a temperature of 38 degrees or more places the baby in the high-risk group on its own
  • A recent vaccination can produce the fever itself at this age [fever]
  • How long the fever has run does not predict how ill the baby is, but five days or more prompts a look for Kawasaki disease [fever]
  • Amber features the parent can report: dry mouth, feeding less than usual, fewer wet nappies, and shivering attacks [dry mouth · reduced wet nappies · rigors]

Signs — what you find (9)

  • High-risk colour: skin, lips or tongue that is pale, mottled, ashen or blue [pallor]
  • No response to social cues, or not waking, or not staying awake once roused
  • The cry is wrong: feeble, high pitched, or going on without stopping
  • Grunting, breathing faster than 60 a minute, or indrawing of the chest that is more than mild [chest recession]
  • Skin that stays pinched, or a fontanelle that bulges
  • Capillary refill of three seconds or longer is an amber marker
  • A fast heart rate puts the baby at least in the amber band [tachycardia]
  • The classic meningitis signs are often missing in a baby - stiff neck, bulging fontanelle and a high pitched cry may all be absent [bulging fontanelle · excessive crying · neck stiffness]
  • For dehydration look at refill, turgor, the breathing pattern, the pulse and how warm the hands and feet are [dehydration]

Tests (8)

  • Measure and write down the temperature, the heart rate and the breathing rate in every febrile baby of this age
  • The work-up under three months is a blood count, a blood culture, CRP and a urine test
  • Chest film only where there are respiratory signs, and stool culture only where there is diarrhoea
  • Lumbar puncture for every baby under one month, and for any one to three month old who looks unwell
  • Tap a one to three month old whose white cell count sits below 5 or above 15
  • Do the tap before antibiotics wherever that can be managed, and do not put it off
  • Think of urine infection in any febrile baby under three months
  • Blood pressure if the pulse or the refill time is abnormal and a cuff is to hand

If not this — what else fits (8)

  • Meningococcal disease, where there is a rash that does not blanch
  • Spots wider than 2 mm, slow refill or a stiff neck make that far more likely
  • Bacterial meningitis: stiff neck, bulging fontanelle, drowsiness, or a fit that will not stop
  • Herpes encephalitis, where there are focal signs, focal fits or reduced consciousness
  • Pneumonia, with breathing over 60 a minute in the first five months of life
  • Crackles, flaring of the nostrils, indrawing, blue colour, or saturations at or below 95 percent
  • Urine infection - past three months the pointers are vomiting, feeding poorly, lethargy or irritability
  • Sepsis itself, where the reaction to an infection begins to damage the organs

Scores

  • WHO Emergency Triage (sick child) — Is this sick child safe to wait?

SourceFever in an infant under 3 months - disease-level clinical article (fever-in-infant-under-3-months-full.txt)

Presentation findings are traced to the source above.

1

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Fever in under 5s: assessment and initial management - NICE Guideline NG143 (NCBI Bookshelf NBK552086) - https://www.ncbi.nlm.nih.gov/books/NBK552086/

Why

Age alone decides the answer here. NG143 puts every infant under 3 months with a temperature of 38°C or higher into the highest-risk group before anything else about the baby has been assessed, so the destination is hospital and no medicine given in the clinic changes that. No drug is offered below for that reason.

Cautions
  • AGE IS THE RED FLAG, ON ITS OWN - an infant below 3 months whose temperature reaches 38°C belongs, by age alone, to the group at high risk of serious illness. Nothing else about the baby has to be abnormal. A well-looking, feeding, smiling six-week-old with 38°C goes to hospital.
  • AND A HIGH-RISK INFANT IS A REFERRAL, NOT A PRESCRIPTION - a child showing any 'red' feature, who is nonetheless not judged to be in immediate danger of death, is referred urgently into the care of a paediatric specialist.
  • IF THE BABY LOOKS LIFE-THREATENINGLY ILL, DO NOT REFER - SEND - where the symptoms, or the symptoms and signs taken together, point to an illness that is immediately life-threatening (NG143 cross-refers here to its own recommendation on spotting those features), the child is referred at once for emergency care, by whatever transport suits best - normally a 999 ambulance.
  • PARACETAMOL AND IBUPROFEN ARE FOR DISTRESS, AND NEITHER IS A REASON TO STAY HOME. NG143 permits them on that narrow ground only - either one may be considered for a feverish child who appears distressed - and says in the next breath that an antipyretic must NOT be used in a feverish child for the sole purpose of bringing the temperature down. Giving one to an infant under 3 months does not cancel the referral above.
  • A TEMPERATURE THAT COMES DOWN PROVES NOTHING - once an antipyretic has been given, whether or not the temperature falls must NOT be used to tell serious illness from illness that is not serious. A septic baby who settles for two hours after syrup is still a septic baby.
  • NEVER BOTH AT ONCE - NG143 1.6.6 puts four conditions on the use of paracetamol or ibuprofen in a feverish child: keep going only while the child still appears distressed; think about switching to the other one if the distress is not relieved; do NOT give the two together; and only consider alternating them if the distress carries on, or returns, before the next dose falls due.
  • ANTIPYRETICS DO NOT STOP FITS - an antipyretic does NOT prevent a febrile convulsion, and must NOT be given for that purpose. Parents and clinics in Cairo dose hard on exactly that belief.
  • AND NEITHER DOES COOLING THE BABY DOWN - sponging with tepid water is advised against as a treatment for fever, and a feverish child must NOT be left underdressed, nor wrapped up too warmly.
  • DO NOT HAND OUT AN ANTIBIOTIC INSTEAD OF A REFERRAL - an oral antibiotic must NOT be prescribed to a feverish child in whom no source has been found.
  • THE ONE ANTIBIOTIC THAT IS GIVEN BEFORE TRANSPORT - where meningococcal disease is suspected, a parenteral antibiotic is given at the first opportunity there is: benzylpenicillin, or a third-generation cephalosporin.
  • TEST THE URINE - a feverish child has the urine tested, as NICE's own under-16s guideline on urinary tract infection directs, and urinary tract infection is to be considered in every feverish child below 3 months.
  • WHAT THE HOSPITAL WILL DO, SO THE FAMILY CAN BE TOLD - a set list of investigations is carried out in any feverish infant below 3 months; and where a parenteral antibiotic is indicated at that age, the combination is a third-generation cephalosporin - cefotaxime or ceftriaxone, say - together with an antibiotic that covers listeria, such as ampicillin or amoxicillin.
  • A RECENT VACCINATION IS NOT AN EXPLANATION TO REST ON - all NG143 says is that certain vaccinations have been found to bring on a fever below the age of 3 months, and it leaves the high-risk classification standing.
  • FEVER LASTING 5 DAYS OR LONGER CHANGES THE QUESTION - how long a fever has run must NOT be used to predict how likely serious illness is; but a child febrile for 5 days or more is assessed for Kawasaki disease. Be aware too that a child under 1 year may show fewer of the clinical features of Kawasaki disease besides the fever, while carrying a higher risk of coronary artery abnormality than an older child does.
  • SIGNS OF DEHYDRATION TO LOOK FOR WHILE ARRANGING TRANSFER - a capillary refill that takes too long; skin turgor that is abnormal; a breathing pattern that is abnormal; a pulse that is weak; hands and feet that are cool.
  • OLDER BABIES ARE NOT SAFE EITHER, ONLY LESS UNSAFE - a child of 3-6 months whose temperature reaches 39°C is, at the least, in the intermediate-risk group for serious illness.

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