Nice has today (May 22) formalised its guidance on treating childhood fever, which recommends using paracetamol or ibuprofen in children aged under five years only if they appear distressed.

Nice recommended restricting paracetamol and ibuprofen to "rational, stepwise use" in children and to alternate the drugs only in cases of persistent distress. It also reiterated warnings against giving both drugs simultaneously to under-fives.

The guidance shows little change from its original draft, first published in November, but did include new recommendations to recognise children with a raised heart rate as being in at least an intermediate risk group for serious illness.

Nice recommends restricting paracetamol and ibuprofen to "rational, stepwise use" and to alternate the drugs only in cases of persistent distress	More from Nice 'Unnecessary and inappropriate' PGDs should be       stopped, urges Nice Final approval of omalizumab for severe asthma Nice recommends asthma drug Xolair in u-turn on       cost-effectiveness MORE NEWS
	Tachycardia is classed as more than 160 beats per minute for children aged younger than 12 months, 150 beats per minute in those aged 12 to 24 months and 140 beats per minute in children aged between two and five years old.

Nice continues to recommend its traffic light system as a way of assessing the seriousness of a child's symptoms. Children with symptoms including a high respiratory rate, lack of response to social cues and pale, mottled skin were classed in the red, high-risk category.

Nice director of the centre for clinical practice Mark Baker said the guidance would help indicate when a child needed urgent medical attention.

"Potentially serious cases of feverish illness are likely to be rare, so it is important that information is in place to help healthcare professionals distinguish these from mild cases," Professor Baker said.

Read the full Nice guidance.