{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:56:43Z","timestamp":1785401803841,"version":"3.56.0"},"reference-count":32,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>A child with fever presenting with concerned caregivers is a common occurrence in primary healthcare in South Africa. Many fevers are self-limiting. However, serious and possibly fatal diseases must be excluded before discharging the child. This article is a guideline for primary care practitioners, which needs to be read in conjunction with the management guidelines for specific diseases.<\/jats:p>","DOI":"10.4102\/safp.v68i1.6199","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T06:36:45Z","timestamp":1771396605000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A primary healthcare approach to children with fever"],"prefix":"10.4102","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0126-8087","authenticated-orcid":false,"given":"Indiran","family":"Govender","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02svzjn28","id-type":"ROR","asserted-by":"publisher"}],"name":"Walter Sisulu University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6094-3797","authenticated-orcid":false,"given":"Henry","family":"Okonta","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/003hsr719","id-type":"ROR","asserted-by":"publisher"}],"name":"Sefako Makgatho Health Sciences University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Green R, Webb D, Jeena PM, et al. 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Available from: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/104772\/9789241506823_Module-5_eng.pdf;jsessionid=1348F4D8E65CFFE9CD02AACCA6FF1050?sequence=7"},{"key":"ref4","unstructured":"Esenwa O, Jiang A, Rasouli R, et al. Fever: Paediatrics in Toronto notes. Toronto: The Toronto Notes for Medical Students Inc; 2023."},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Green R, Jeena P, Kotze S, et al. Management of acute fever in children: Guideline for community healthcare providers and pharmacists. S Afr Med J. 2013;103(12):948\u2013954. https:\/\/doi.org\/10.7196\/SAMJ.7207","DOI":"10.7196\/SAMJ.7207"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Surong N, Joseph D. Clinicoetiological profile of pyrexia of unknown origin in children 1\u201312 years of age in a tertiary care centre. Int J Contemp Pediatr. 2023;10(6):813\u2013818. https:\/\/doi.org\/10.18203\/2349-3291.ijcp20231483","DOI":"10.18203\/2349-3291.ijcp20231483"},{"key":"ref7","unstructured":"Noor A. Fever in the infant and toddler [homepage on the Internet]. Medscape. 2024 [cited 2025 Jul 08]. Available from: https:\/\/emedicine.medscape.com\/article\/1834870-treatment?form=fpf"},{"key":"ref8","unstructured":"Consolini DM. Fever in infants and children [homepage on the Internet]. 2025 [cited 2025 Jul 08]. Available from: https:\/\/www.msdmanuals.com\/home\/children-s-health-issues\/symptoms-in-infants-and-children\/fever-in-infants-and-children"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Corsello A, Alberti I, Farhanghi S, et al. Effectiveness and safety of interventions for fever-associated discomfort in children: A systematic review. Br J Clin Pharmacol. 2025;91(12):3323\u20133329. https:\/\/doi.org\/10.1002\/bcp.70203","DOI":"10.1002\/bcp.70203"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Dinarello CA. Infection, fever, and exogenous and endogenous pyrogens: Some concepts have changed. J Endotoxin Res. 2004;10(4):201\u2013222. https:\/\/doi.org\/10.1179\/096805104225006129","DOI":"10.1179\/096805104225006129"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Barbi E, Marzuillo P, Neri E et al. Fever in children: Pearls and pitfall. Children (Basel). 2017;4(9):81. https:\/\/doi.org\/10.3390\/children4090081","DOI":"10.3390\/children4090081"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Nijman RG, Thompson M, Van Veen M, Perera R, Moll HA, Oostenbrink R. Derivation and validation of age and temperature specific reference values and centile charts to predict lower respiratory tract infection in children with fever: Prospective observational study. Br Med J. 2012;344:e4224. https:\/\/doi.org\/10.1136\/bmj.e4224","DOI":"10.1136\/bmj.e4224"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Brent AJ, Lakhanpaul M, Ninis N, Levin M, MacFaul R, Thompson M. Evaluation of temperature-pulse centile charts in identifying serious bacterial illness: Observational cohort study. Arch Dis Child. 2011;96:368\u2013373. https:\/\/doi.org\/10.1136\/adc.2010.183129","DOI":"10.1136\/adc.2010.183129"},{"key":"ref14","unstructured":"Ye F, Hatahet M, Youniss MA, Toklu HZ, Mazza JJ, Yale S. The clinical significance of relative bradycardia. WJM. 2018;117(2):73\u201378."},{"key":"ref15","unstructured":"NICE guidline 143. Fever in under 5 s: Assessment and initial management [homepage on the Internet]. 2019 [cited 2024 Mar 5]. Available from: http:\/\/www.nice.org.uk\/guidance\/ng143"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Mohan K, Omar BJ, Chacham S. Malaria in newborn: A missed entity for primary care physician. J Family Med Prim Care. 2023;12(8):1511\u20131515. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_2332_22","DOI":"10.4103\/jfmpc.jfmpc_2332_22"},{"key":"ref17","unstructured":"Hamilton JL, Evans SG, Bakshi M. Management of fever in infants and young children. Am Fam Physician. 2020;101(12):721\u2013729."},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Jaskiewicz JA, McCarthy CA, Richardson AC, et al. Febrile infants at low risk for serious bacterial infection \u2013 An appraisal of the Rochester criteria and implications for management. Pediatrics. 1994;94(3):390\u2013396. https:\/\/doi.org\/10.1542\/peds.94.3.390","DOI":"10.1542\/peds.94.3.390"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Bachur RG, Harper MB. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics. 2001;108(2):311\u2013316. https:\/\/doi.org\/10.1542\/peds.108.2.311","DOI":"10.1542\/peds.108.2.311"},{"key":"ref20","unstructured":"Waseem M. Fever without a focus treatment & management [homepage on the Internet]. Medscape. 2023 [cited 2025 Jul 08]. Available from: https:\/\/emedicine.medscape.com\/article\/970788-treatment"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Cioffredi LA, Jhaveri R. Evaluation and management of febrile children: A review. JAMA Pediatr. 2016;170(8):794\u2013800. https:\/\/doi.org\/10.1001\/jamapediatrics.2016.0596","DOI":"10.1001\/jamapediatrics.2016.0596"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Ouchenir L, Renaud C, Khan S, et al. The epidemiology, management, and outcomes of bacterial meningitis in infants. Pediatrics. 2017;140(1):e20170476. https:\/\/doi.org\/10.1542\/peds.2017-0476","DOI":"10.1542\/peds.2017-0476"},{"key":"ref23","unstructured":"Standard treatment guidelines and essential medicine list for South Africa [homepage on the Internet]. Primary Health Care ed. Department of Health. [cited 2026 Jan 15]. Available from: https:\/\/share.google\/dnuIrhNC4necHrtud"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Offringa M, Newton R, Cozijnsen MA, Nevitt SJ. Prophylactic drug management for febrile seizures in children. Cochrane Database Syst Rev. 2017;2:CD003031. https:\/\/doi.org\/10.1002\/14651858.CD003031.pub3","DOI":"10.1002\/14651858.CD003031.pub3"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Paul SP, Kirkham EN, Shirt B. Recognition and management of febrile convulsion in children. Nurs Stand. 2015;29(52):36\u201343. https:\/\/doi.org\/10.7748\/ns.29.52.36.e9927","DOI":"10.7748\/ns.29.52.36.e9927"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Sullivan JE. Farrar and the section on clinical pharmacology and therapeutics, and committee on drugs. Clinical report \u2013 Fever and antipyretic use in children. Pediatrics. 2011;127(3):580\u2013584. https:\/\/doi.org\/10.1542\/peds.2010-3852","DOI":"10.1542\/peds.2010-3852"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Plaisance K.L. Toxicities of drugs used in the management of fever. Clin Infect Dis. 2000;31(suppl 5):S219\u2013S223. https:\/\/doi.org\/10.1086\/317518","DOI":"10.1086\/317518"},{"key":"ref28","unstructured":"Royal Children\u2019s Hospital Melbourne Febrile child [homepage on the Internet]. [cited 2016 Sep 17]. Available from: https:\/\/www.rch.org.au\/clinicalguide\/guideline_index\/Febrile_Child"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Yeh YC, Reddy P. Clinical and economic evidence for intravenous acetaminophen. Pharmacotherapy. 2012;32(6):559\u2013579. https:\/\/doi.org\/10.1002\/j.1875-9114.2011.01085.x","DOI":"10.1002\/j.1875-9114.2011.01085.x"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Agbolosu NB, Cuevas LE, Milligan P, et al. 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