[The practice guideline 'Children with fever' (second revision) from the Dutch College of General Practitioners; a response from the perspective of paediatricians].

The new version of the practice guideline 'Children with fever' was recently published by the Dutch College of General Practitioners and is commented on from the perspective of paediatricians. Whether or not general practitioners should refer feverish children to the paediatrician depends on the age of the patient and the severity of the illness. All children younger than 1 month and children with warning symptoms should be referred to a paediatrician at once. One of the warning symptoms is that the child gives the impression of being seriously ill at the physical examination. As it can be difficult to ascertain the severity of the illness and to distinguish which children will develop a serious bacterial infection, observation scales can be of use, as can the general practitioner's intuitive feeling that 'something is wrong'. Emphasis is put on the fact that infections are dynamic processes and therefore good follow-up is important. Children under the age of 2 years with a fever with no apparent cause should be re-examined after 24-48 h. Parents should be properly instructed to come back for re-examination of their child if the clinical picture changes or worsens.