CBM - Red Flag Signs in Children

Question 1

NICE Traffic light system

&

Grunting Symptoms

Answer 1

GREEN Taking most feeds ok; normal colour (lips, tongue, skin); responds to social cues, alert or wakens quickly, lusty cry or playing. Breathing calmly.

AMBER Taking 50% of feeds; pale; not responding to social cues; hard to wake; decreased activity; no smiling; tachypnoea; O2 sats <95%; crepitations, nasal flaring; capillary refill time >3secs.

RED Pale; mottled; ashen; blue. Doesn’t stay awake when roused; decreased consciousness. GRUNTING signs.

Question 2

Grunting Signs

Answer 2

GRUNTING signs

Grunting – weak or continuous high-pitched cry; tachypnoea Rib recession – retraction of sternomastoid, nasal flaring; wheeze; stridor

Unequal or unresponsive pupils – focal CNS signs, fits, marked hypotonia

Not using limbs; odd or rigid posture

Temperature over 38

I have a bad feeling about this baby

Neck rigidity, non-blanching rash, meningism, bulging fontanelle

Green bile in vomit – bowel obstruction

Question 3

Causes of acutely sick child?

Meningitis?

Answer 3

• Meningitis is an inflammation of the leptomeninges and underlying subarachnoid cerebrospinal fluid (CSF).
• Viral meningitis is more common and usually more benign than bacterial meningitis but all cases of suspected meningitis should be managed as though having bacterial meningitis, until proven otherwise.
• Meningococcal disease is the leading infectious cause of death in early childhood. It presents as bacterial meningitis (15% of cases), septicaemia (25% of cases), or as a combination of the two presentations (60% of cases

Question 4

Causes of acutely sick child?

Meningitis?

Answer 4

Risk factors:

Neonates at higher risk

Splenectomy and sickle cell disease increase the risk of meningitis secondary to encapsulated organisms.

Crowding (eg school, summer camps, nursery) increases the risk of outbreaks of meningococcal meningitis

Patients having spinal procedures

Causative Organisms:

Neonates: group B streptococci, Listeria monocytogenes, Escherichia coli.

Infants and young children: H. influenzae type b: Neisseria meningitidis, Streptococcus pneumoniae

Symptoms:

• Non-blanching rash
• Fever, headache
• Stiff neck, back rigidity, bulging fontanelle (in infants), photophobia.
• Altered mental state, unconsciousness, toxic/moribund state.
• Signs of shock

One study found that 95% had at least two of the four symptoms of headache, fever, neck stiffness and altered mental status.

GP Management -

Intramuscular or intravenous benzylpenicillin should be given before urgent transfer to hospital only if there is suspected meningococcal septicaemia with a non-blanching rash. Septicaemia in children

• Neonates more and children under 1 year more prone
• Abnormally cold to touch
• Mottled and blue or with very pale skin
• Raised respiratory rate
• Very lethargic and difficult to wake

Question 5

Causes of acutely sick child?

Childhood Cancer Red Flags?

Answer 5

Lymphomas, leukaemias and brain tumours*

Neuroblastoma, retinoblastoma, Wilm’s tumour and acute lymphoblastic leukaemia are most common in under 5s.

Bone tumour is uncommon in very young children but incidence increases with age and peaks in adolescence.

Brain tumours claim more lives than any other childhood cancer

In general, cancer is more common in teenagers and young adults compared to children General red flags along:

Symptoms of bone marrow failure: anaemia, neutropenia, thrombocytopenia

Malaise – generally feeling unwell Fatigue

Weight loss and loss of appetite

Night sweats

Painless lymphadenopathy

Fever and chills that come and go

Itching all over the body that cannot be explained