Feverish Child

Question 1

What are the amber (intermediate risk) signs for a feverish child in the child’s activity?

Answer 1

1. Not responding normally to social cues
2. No smile
3. Wakes only with prolonged stimulation
4. Decreased activity

Question 2

What are the amber (intermediate risk) signs for a feverish child in the child’s respiration?

Answer 2

1. Nasal flaring
2. Tachypnoea (as per age range)
3. Sats <95% on room air
4. Crackles in the chest

Question 3

What are the amber (intermediate risk) signs for a feverish child in the child’s circulation and hydration?

Answer 3

1. Tachycardia (as per age range)
2. CRT >3 seconds
3. Dry mucous membranes
4. Poor feeding in infants
5. Reduced urine output

Question 4

What are the amber (intermediate risk) signs for a feverish child in the child’s other features? (not colour, activity, respiration, circulation, or hydration)

Answer 4

1. Age 3-6 months, temperature >39
2. Fever for >5 days
3. Rigors
4. Swelling of limb or joint
5. Non weight bearing limb or not using an extremity

Question 5

What is the amber (intermediate risk) sign for a feverish child in the child’s colour (skin, lips, tongue)?

Answer 5

Pallor reported by parent/carer

Question 6

What are the red (high risk) signs for a feverish child in the child’s colour (skin, lips, tongue)?

Answer 6

Pale, mottled, ashen, blue

Question 7

What are the red (high risk) signs for a feverish child in the child’s activity?

Answer 7

1. No response to social cues
2. Appears ill to a healthcare professional
3. Does not wake or if roused does not stay awake
4. Weak, high-pitched or continuous cry

Question 8

What are the red (high risk) signs for a feverish child in the child’s respiration?

Answer 8

1. Grunting
2. Tachypnoea >60
3. Moderate/severe chest indrawing

Question 9

What is the red (high risk) sign for a feverish child in the child’s circulation and hydration?

Answer 9

Reduced skin turgor

Question 10

What are the red (high risk) signs for a feverish child in the child’s other features? (not colour, activity, respiration, circulation, or hydration)

Answer 10

1. Age <3 months, temperature >38
2. Non-blanching rash
3. Bulging fontanelle
4. Neck stiffness
5. Status epilepticus
6. Focal neurological signs
7. Focal seizures

Question 11

How do you measure temperature in a child below 4 weeks and 5 weeks and above?

Answer 11

1. <4 weeks - electronic thermometer in axilla

2. 5 weeks or more - axilla, chemical dot, or tympanic membrane

Question 12

What are the steps for safety netting in a feverish child?

Answer 12

1. Check on child during the night
2. Offer regular drinks - if refusing seek medical help
3. Look for non-blanching rash by rolling a glass over it
4. If well but fever continues >5 days then go to A&E

Question 13

How do you investigate a fever in children under 3 months old?

Answer 13

1. FBC, U&Es, CRP, blood culture, urine dip, CXR, stool culture
2. LP in all <1 months and 1-3 months if unwell/WCC <5 or >15

Question 14

How do you investigate a fever in low risk (green) children over 3 months old?

Answer 14

1. Urine for UTI
2. No bloods or CXR
3. Observe

Question 15

How do you investigate a fever in intermediate risk (amber) children over 3 months old?

Answer 15

1. Urine for UTI
2. FBC, CRP, blood culture
3. CXR if >39 degrees/WCC >20
4. Consider LP if <1 years

Question 16

How do you investigate a fever in high risk (red) children over 3 months old?

Answer 16

1. Urine for UTI
2. FBC, CRP, blood cultures, U&Es, blood gas, CXR
3. Consider LP

Question 17

What should you think if paracetamol/NSAIDs do not bring a fever down in a child?

Answer 17

Sepsis

Question 18

How do you investigate sepsis in a child?

Answer 18

1. Serial observations
2. FBC, U&Es, CRP, blood gas
3. Blood film, bone profile, ESR, glucose, clotting
4. Listen to chest, ENT exam
5. Blood culture, urine MCS, nasopharyngeal aspirate for RSV, LP
6. CXR
7. Examine for rash