Feverish Child

Question 1

List 3 reasons why parents may be reluctant to let their child have their vaccinations (total of 5)

Answer 1

1. Fear of ‘damage’ from the vaccine or allergies - MMR widespread media scaremongering (autism)
2. Not feeling their child is at risk
3. Not knowing about the vaccinations or not being invited
4. Concern that vaccinations can ‘overload’ or weaken the baby’s immune system
5. Not liking seeing their baby in pain

Question 2

When a baby/child is not brought for their vaccinations, what must we consider?

Answer 2

Is the baby being cared for properly? Is this a safeguarding concern?

Question 3

What is a normal temperature?

Answer 3

36.5-37.5

Question 4

When categorising children and their risk of sepsis, what 6 categories do we look at?

Answer 4

1. Behaviour
2. Respiratory; resp rate, O2 sats
3. Circulation and hydration; HR, CRT
4. Temperature
5. Skin; appearance
6. Other

Question 5

What are the symptoms and signs of meningococcal disease in a child?

Answer 5

• Fever
• Non-blanching rash, 1< of the following;
  1. ill-looking child
  2. lesions >2mm diameter
  3. CRT >3 seconds
  4. Neck stiffness

Question 6

What are the signs and symptoms of bacterial meningitis in a child?

Answer 6

• Fever
• Neck stiffness
• Bulging fontanelle
• Decreased level of consciousness
• Convulsive status epilepticus

Question 7

What are the signs and symptoms of Herpes Simplex Virus (HSV) in a child?

Answer 7

• Fever
• Focal neurological signs
• Decreased level of consciousness

Question 8

What are the signs and symptoms of Pneumonia in a child?

Answer 8

• Fever
• Tachypnoea
• Chest crackles
• Nasal flaring
• Chest indrawing
• Cyanosis
• O2 sats 95% and below

Question 9

What are the signs and symptoms of UTI in a child?

Answer 9

• Fever (any infant <3/12 particularly)
• Vomiting
• Poor feeding
• Lethargy
• Irritability
• Abdo pain/tenderness
• Urinary frequency or dysuria

Question 10

What are the signs and symptoms of Septic arthritis in a child?

Answer 10

• Fever
• Swelling of a limb or joint
• Not using an extremity
• Non-weight bearing

Question 11

What are the signs and symptoms of Kawasaki disease in a child?

Answer 11

• Fever for >5 days and at least 4 of the following;
  1. Bilateral conjunctival infection
  2. Change in mucous membranes (tongue)
  3. Change in the extremities
  4. Polymorphous rash
  5. Cervical lymphadenopathy

Question 12

What 5 signs in a child might indicate increased work of breathing?

Answer 12

1. Increased resp rate
2. Cyanosis
3. Abdominal breathing
4. Recession
5. Tracheal tug

Question 13

What is the main organism that causes tonsillitis?

Answer 13

Viruses

Question 14

What is the FeverPAIN score?

Answer 14

This is a scoring system used to determine the likelihood of streptococcal infection of the tonsils (and therefore the likelihood of the need for abx)

Question 15

Define the points of the FeverPAIN criteria

Answer 15

Fever; >38
Purulence; tonsillar/pharyngeal exudate 
Attend rapidly (<3days)
severely Inflamed tonsils
No cough or coryza

Question 16

What is the maximum FeverPAIN score?

Answer 16

5. You score a point for each category that is true.

Question 17

How do the scores from the FeverPAIN criteria correlate with the relative risk for having pharyngeal/tonsillar streptococcal infection?

Answer 17

0-1 = 13-18% likelihood of strep infection
2-3 = 34-40% likelihood of strep infection
4-5 = 62-65% likelihood of strep infection

Question 18

What is the ‘centor criteria’?

Answer 18

Another scoring criteria that allows healthcare professionals to predict the likelihood of strep infection.

Question 19

What are the 4 points of the Centor criteria?

Answer 19

1. Tonsillar exudate
2. Tender anterior cervical lymphadenopathy
3. Hx of fever (>38)
4. Absence of cough