Fever (Age 2 months up to 5 years)

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Does the Child Have Fever?

By history, by feel, or axillary temp is 37.5° C or above

Ask

• For how long?

Look and Feel:

• Stiff neck
• Bulging fontanelle

If the child has a fever, decide the child's Malaria risk:

• Malaria Risk means: Lives in malaria zone or visited a malaria zone during the past 4 weeks. If in doubt, classify for malaria risk

If Malaria risk

• Do a rapid malaria test

If Malaria test not available

• Look for a cold with runny nose
• Look for another adequate cause of fever

Consider Measles if

• Generalized rash with any of the following:
• Runny nose, OR
• Red eyes, OR
• Cough

Use the Measles chart 

Classify the Fever

For Suspected Meningitis:

Suspected Meningitis
Any general danger sign OR Stiff neck or bulging fontanelle	Give first dose of ceftriaxone IM  Test for low blood sugar, then treat or prevent  Give one dose of paracetamol for fever 38°C or above  Refer URGENTLY
Fever Other Cause
None of the above signs	Give paracetamol for fever 38°C or above If fever present for more than 7 days, consider TB  Treat for other causes Advise caregiver when to return immediately  Follow-up in 2 days if fever persists

If Malaria risk:

Suspected Severe Malaria
Any general danger sign OR Stiff neck or bulging fontanelle	If Malaria test positive and child older then 12 months, treat for Malaria  Treat for suspected Meningitis Test for low blood sugar, then treat or prevent  Give one dose of paracetamol for fever 38°C or above  Refer URGENTLY
Malaria
Malaria test positive	If age less than 12 months, refer URGENTLY If older than 12 months, treat for malaria  Give paracetamol for fever 38°C or above  Advise caregiver when to return immediately  Notify confirmed malaria cases Follow-up in 2 days if fever persists
Suspected Malaria
Malaria test not done and pneumonia OR Malaria test not done and no other adequate cause of fever found	Refer child to facility where Malaria Rapid Test can be done Give paracetamol for fever 38°C or above  If fever present for more than 7 days, assess for TB
Fever Other Cause
Malaria test negative OR Malaria test not done and a cold with runny nose, or other adequate cause of fever found	Give paracetamol for fever 38°C or above  If fever present for more than 7 days, assess for TB  Treat for other causes Advise caregiver when to return immediately  Follow-up in 2 days if fever persists

 

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Integrated Management of Childhood Illness 2022; Child (Age 2 months up to 5 years); Assess, Classify and Identify Treatment; Fever

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Last checked for updates: June 2023