Fever in Children

Question 1

Low risk traffic light system for serious illness

Answer 1

-Normal skin colour
-Responds normally, smiles, awake, strong normal cry
-Moist mucous membranes
-Normal eyes and skin

Question 2

Intermediate risk for serious illness

Answer 2

-Pallor
-Not responding normally to social cues, no smiles, wakes only with prolonged stimulation, decreased activity
-Nasal flaring
-Tachypnoea (>50/ 40 over 1 yr)
-<95%
-Crackles in chest
-Tachycardia (>160)
-CRT >3
-Dry mucous membranes, poor feeding, reduced UO
-Age 3-6 months >39 degrees
-Fever for >5 days, rigors, welling, non-weight bearing limb

Question 3

High risk serious illness

Answer 3

-Pale/ mottled/ ashen blue
-No response to social cues, does not wake, weak/ high-pitched/ continuous cry
-Grunting, tachypnoea >60, chest indrawing
-Reduced skin turgor
-Non-blanching rash
-Bulging fontanelle
-Status epilepticus
-Focal neurological signs
-Focal seizures

Question 4

Symptoms and signs of meningococcal disease

Answer 4

Non-blanching rash, particularly with one or more of the following:

=An ill-looking child
=Lesions larger than 2 mm in diameter (purpura)
=A capillary refill time of greater than or equal to 3 seconds
=Neck stiffness.

Question 5

Symptoms and signs of meningitis

Answer 5

One or more of the following:

-Neck stiffness
-Bulging fontanelle
-Decreased level of consciousness
-Convulsive status epilepticus.

Question 6

Symptoms and signs of herpes simplex encephalitis

Answer 6

Herpes simplex encephalitis should be considered in children with fever and any of the following features:

-Focal neurological signs
-Focal seizures
-Decreased level of consciousness.

Question 7

Symptoms and signs of pneumonia

Answer 7

-Tachypnoea
=RR greater than 60 breaths per minute, age 0 to 5 months
=RR greater than 50 breaths per minute, age 6 to 12 months
=RR greater than 40 breaths per minute, age greater than 12 months
-Crackles in the chest
-Nasal flaring
-Chest indrawing
-Cyanosis
-Oxygen saturation less than or equal to 95% on air.

Question 8

Symptoms and signs of UTI

Answer 8

-Painful urination (dysuria)
-Urinary frequency
-Abdominal pain
-Loin tenderness or suprapubic tenderness
-New bedwetting
-Malodorous, darker or cloudy urine
-Haematuria
-Reduced fluid intake
-Capillary refill longer than 3 seconds
-Previous history of confirmed UTI.
-UTI is less likely if there is absence of dysuria, nappy rash, breathing difficulties, abnormal chest sounds or ear examination, or fever with a known alternative cause.

Question 9

Symptoms and signs of septic arthritis

Answer 9

-Septic arthritis/osteomyelitis should be considered in children with fever and any of the following signs:
-Swelling of a limb or joint
-Not using an extremity
-Non-weight bearing.

Question 10

Symptoms and signs of Kawasaki disease

Answer 10

-Fever lasting five days or longer. Features that increase the probability of a diagnosis are:
=Bilateral conjunctival injection
=Change in mucous membranes (eg injected pharynx, dry cracked lips, or strawberry tongue)
=Change in the extremities (eg oedema, erythema, or desquamation)
=Polymorphous rash
=Cervical lymphadenopathy.