Children with a fever, who could be suffering from potentially life-threatening illnesses, are not being thoroughly checked over by GPs according to a new study.
The research found most under-fives with a high temperature are not examined for signs that could indicate sepsis, meningitis or pneumonia.
The National Institute for Health and Care Excellence (Nice) published guidelines in 2007 and again in 2013 urging GPs to carry out four simple tests for children with a fever - measure and record temperature, heart rate, respiratory rate and capillary refill time.
Capillary refill is when doctors press on a patient's nail bed and then count the seconds until it returns to its usual colour - normally under two seconds.
But evidence suggests they are still not being done and charities said lives are being needlessly lost as a result.
In the new study, Dr Alice Lee, from Pennine Acute Hospitals NHS Trust, looked at data for 47 children under five in a Stockport GP practice.
She found that just 13% of consultations included all four checks, with around one in three children receiving no tests at all or only one.
Despite the fact abnormal respiratory rate "is often the first sign of serious illness", Dr Lee said it was the lowest-recorded test, with only 30% of children being checked.
Almost half of youngsters also missed out on having their pulse taken, while a quarter did not have their temperature recorded.
Dr Ron Daniels, chief executive of the Sepsis Trust, said the failure of doctors to carry out all four checks had been implicated in several deaths, including those of three-year-old Sam Morrish from Devon and 12-month-old William Mead from Cornwall.
He said: "We are aware this is a problem and we are seeing this not only with children but with adults too.
"Basic observations are not being done routinely and, where observations are being done, they are not being done as a complete set."In the majority of cases, GPs will be able to make the right decision but it's clear we are still missing some cases."