1: Immunology - Fever in under 5's Flashcards
How should children under-5 with a fever first be assessed
Using the traffic light system to determine severity
Unless sepsis then activate sepsis protocol
What is a mnemonic to remember categories for Fever in under 5’s
CARHO
What are the 5 categories looked at in traffic light system
Colour
Activity
Respiration
Circulation and hydration
Other
What is ‘low-risk’ (green) for colour
Normal
What are 4 points ‘low-risk’ (green) for activity
- Smiles
- Stays awake
- Opens eyes
- Strong cry
What is one point for circulation and hydration in green ‘ low-risk’
Moist mucous membranes
What is other in ‘low-risk’ green
No red or amber features
How will a medium-risk (amber) child’s colour present
Pale
Describe 4 features of activity in a medium-risk child
- No smile
- No response to social cues
- Only stays awake with prolonged stimulation
- Decreased activity
Describe clinical features of respiration in a medium-risk (amber) child
- Nasal flaring
- Crackles
- Tachypnoea
- Decrease SpO2
How will RR present in medium-risk child who is 6-12 months
> 50
How will RR present in medium-risk child who is older than 12-months
> 40
How will SpO2 present in a child who is medium-risk
< 95%
What are 4 features of circulation in a medium-risk child
- Prolonged cap refill
- Poor Feeding
- Decrease Urine Output
- Dry mucous membranes
How will HR present if less than 12-months in medium-risk child
> 160
How will HR present if less than 12-24months in medium-risk child
> 150
How will HR present if 2-5 years in medium-risk child
> 140
What are 5 other features in a medium-risk child
- Fever >39 if 3-6 months
- Fever >5 days
- Rigors
- Swollen joint
- Not weight bearing
How will colour appear in high-risk (red)
Pale, mottled
What are four features of activity in high-risk children
- Decrease response to social cues
- Does not wake
- Looks ill to HCP
- Continuous high- pitch cry
What are 3 features of respiration in high-risk children
- Grunting
- Chest indrawing
- RR > 60
What is a feature of circulation in high-risk infants
Reduced skin turgor
What are 5 other features of fever in high-risk infants
- Blueing fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
- Focal seizures
- Non-blanching rash
What is first-line investigation for fever in under-5
Observations: HR, RR, T, Cap Refill
If capillary refill is abnormal, what should be measured
BP
How is temperature measured if child is under 4 weeks
Electrical thermometer in the armpit
How is temperature measured if 4W - 5 years
- Infrared tympanic thermometer
- Chemdot
- Electrical thermometer
What category is a 3-6m with T > 39
Amber
What category is a <3m with T > 38
Red
If a remote assessment and child is life-threatening status what should be done
Call 999
If a remote assessment and a child is red (high-risk) what is done
Urgent review by HCP in 2-hours
If remote assessment and child is amber (medium-risk) what is done
Review by HCP - urgency decided by HCP
If remote assessment and child is green (low-risk) what is done
Manage at home - with appropriate advice for patients
If non paediatric HCP see’s as life-threatening patient, what should be done
Call 999
If a non-paediatric HCP see’s a high-risk (red) infant what should be done
Refer to paediatric specialist
If non-paediatric HCP see’s a amber child what should be done
Safety-net patients:
- Arrange further follow-up
- Liaise with other HCP to ensure child can be assessed out-of-hours
If non-paediatric HCP see’s a green child what should be done
Manage at home
If suspected pneumonia, but patient is not admitted to hospital, what should NOT be done
Do not do a CXR
If suspect UTI and under 3-months what is done
- Refer to paediatrics
- Urine collection
If suspect UTI and 3-months to 3-years what is done
- Urinalysis
If suspect UTI and over 3-years what is done
- Urinalysis
Explain antibiotics in fever in child under 5 given by non-paediatric specialists
Do not give antibiotics if unable to identify source of fever
If non-paediatric specialist suspects meningococcal disease, what should they give
Start IV (or IM) benzylpenicillin asap
In a child under 3-months what investigations are performed by paediatric specialist
- Obs: T, RR, HR
- FBC, CRP, Blood Culture
- Urinalysis
- CXR
- Stool Culture
What are the two indications for lumbar puncture in children under 3-months
- ALL children under 1-month
- 1-3 months with WCC <5 or >15
In children older than 3-months with red-features what 4 investigations are ordered
- FBC
- CRP
- Urine testing
- Blood Culture
In high-risk children older than 3-months what 4 investigations may be ordered
- ABG
- U+E
- CXR
- LP
If children older than 3-moths with amber features what 3 investigations may be ordered
- FBC
- CRP
- Urine testing
When is LP indicated for amber children over-3
ALL children under 1-year
When is CXR ordered for amber children over-3
WCC >20 and T > 39
What investigations are indicated for low-risk children
Urine test
If a children over-3 have fever, without identifiable cause, what is done
Admit to hospital for period observation
If child is symptomatic with fever, what is first-line
Anti-pyretics (NSAIDs, Paracetamol)
What are indications for antibiotics in children under 3-months with fever
ALL children under 3-months
Children 1-3 months with:
- Fever
- WBC <5 or >15
What antibiotics are first-line for under 5’s with fever
Third generation cephalosporin
In addition to cephalosporin, what else are children given and why
ampicillin or amoxicillin = antibiotics effective against listeria
