The febrile infant — history from an anxious mother

PLAB 2 & PRES 3 · paediatrics / history taking · medium · 8 minutes

Candidate brief

You are an FY2 doctor in a GP surgery. Mrs Laura Bennett has brought her son Noah, 8 months old, because he has had a fever since yesterday. She measured 38.7 °C at home this morning. Observations (taken by the practice nurse): temperature 38.4 °C, heart rate 148, respiratory rate 34, capillary refill <2 seconds. Noah is alert, has smiled at the nurse, and is currently asleep in his mother's arms after a feed. Please take a full history from Mrs Bennett, explain your assessment and agree a plan with her.

What examiners look for

The febrile infant consultation is a risk-stratification exercise wearing a conversation's clothes. NICE NG143's traffic light system is the skeleton: colour, activity, respiratory, circulation/hydration, and the "other" features — and it runs on the HISTORY as much as the examination (pallor reported by a parent is an amber feature on their word alone). Work the system, say the system, and the mother can see the machine that produced your calm. Age rewrites every threshold: 38.7 °C at 8 months in a smiling baby is a GP consultation; the same number under 3 months is a same-day paediatric referral (red by age and temperature alone). Know which features are age-banded (respiratory and heart rate cut-offs, the 3–6 month ≥39 °C rule) and say them precisely — examiners listen for them. The fever has no focus until you've looked for one: ears, throat, chest, urine, skin, fontanelle, behaviour. In under-5s with fever and no apparent source, the urine is not optional garnish — occult UTI is the bacterial diagnosis that hides behind a "viral" shrug, and it is the one this mother has already watched a service miss once. Testing it is good medicine AND good trust repair. Treat the child's distress, not the thermometer: antipyretics make miserable children comfortable; they do not prevent febrile seizures and they do not shorten illness. Parents who understand that stop waking a sleeping, comfortable baby to chase a decimal — which is most of tonight's anxiety dissolved. And safety-net like you mean it: specific signs, named routes (surgery, 111, ED), explicit permission ("your worry counts"), and a time horizon (5 days of fever = review). A safety net is a clinical intervention with a measurable failure mode — every "sent home and deteriorated" inquiry finds a vague one at the scene.

Guideline references

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