Feverish illness is very common in young children. It is probably the commonest reason for a child to be taken to the doctor and nearly half of all paediatric admissions to hospital are associated with fever.1 Most feverish illnesses are caused by self-limiting viral infections but a significant few are caused by serious bacterial infections. It is often difficult for healthcare professionals to distinguish between the two, especially in the younger child. In an attempt to help healthcare professionals in this area, the Department of Health instructed the National Institute for Health and Clinical Excellence (NICE) to commission an evidence-based guideline on the assessment and initial management of feverish illness in children aged 0–5 years. The guidance has recently been published in full and abbreviated forms.2 3 Another summary has also been published.4

The Department of Health considered that national guidance was needed for a number of reasons (MacFaul R, personal communication). Not least was the fact that infectious diseases remain a major cause of mortality in childhood. In recent decades, the infant mortality rate has not reduced significantly in the UK, and other European countries now have mortality rates up to 30% lower. It is possible that the infant mortality rates in this country could be brought in line with those in other countries if the proportion due to infectious diseases could be reduced. This possibility is supported by the fact that, in the absence of national guidance, there is evidence of variable management of infections in children. In some cases this has been associated with higher fatality rates. This is illustrated by recent studies of meningococcal disease, the leading cause of infectious death in childhood. One large national study reported an association between death from meningococcal disease and deficiencies in health care, and another found …