Feverish Illness in a Child

Question 1

Under what age is the 2007 NICE Feverish illness in children meant for?

Answer 1

Under the age of 5 years.

Question 2

What should be vitals should be recorded in all febrile children?

Answer 2

• Temperature
• Heart rate
• Respiratory rate
• CRT

Question 3

What else should we assess for along side our vital recordings?

Answer 3

we should assess for dehydration. (reduced skin trugor, sucken eyes, cool extremeties, dry mucous membranes)

Question 4

How should we measure the temperature of a child < 4 weeks old?

Answer 4

With an electronic thermometer in the axilla or with a infra-red tympanic thermometer.

Question 5

Normal colour

Answer 5

Green-low risk

Question 6

Pallor reported by parent/carer

Answer 6

Amber-intermediate risk

Question 7

Pale/mottled/ashen or blue

Answer 7

Red-high risk

Question 8

Activity

• Responds normally to social clues.
• Content and smiles.
• Stays awake or awakens quickly.
• Strong normal cry or not crying.

Answer 8

Green-Low risk

Question 9

Activity

• Not responding normally to social cues
• No smile
• Wakes only with prolonged stimulation
• Decreased activity

Answer 9

Amber-intermediate risk

Question 10

Activity

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

Answer 10

Red-High Risk

Question 11

Respiratory

• Nasal flaring
• Tachypnoea
  
  • RR >50 breaths/minte aged 6-12 months
  • RR >40 breaths/minute age >12 months.
• Oxygen sats <+95% in air
• Crackles in the chest.

Answer 11

Amber-intermediate risk

Question 12

Respiratory

• Grunting
• Tachypnoea (RR >60 BPM)
• Moderate or severe chest indrawing

Answer 12

Red-high risk

Question 13

Circulation and hydration

• Normal skin and eyes.
• Moist mucous membranes

Answer 13

Green - low risk

Question 14

Circulation and hydration

• Tachycardia
  
  • >160bpm age <12 years.
  • >150bpm age 12-24 months.
  • >140bpm age 2-5 years.
  • CRT >=3 seconds
  • Dry mucous membranes
  • Poor feeding in infants
  • Reduced urine output

Answer 14

Amber-intermediate risk

Question 15

Circulation and hydration

• Reduced skin turgor

Answer 15

Red-highrisk

Question 16

Other

• None of the amber or red symptoms or signs

Answer 16

Green-low risk

Question 17

Other

• Age 3-6 months temperature >=39C
• Fever for >=5 days.
• Rigors
• Swelling of a limb or joint.
• Non-weight bearing limb/not using an extremity.

Answer 17

Amber-intermediate risk

Question 18

Other

• Age <3 months, temperature >=38C
• Non-blanching rash
• Bluging fontanelle
• Neck stiffness
• Status epilepticus
• Focal neurological signs
• Focal seizures.

Answer 18

Red-High Risk

Question 19

What is your management plan if green?

Answer 19

Child can be managed at home with appropriate care advice including when to seek further help.

Question 20

What is your management plan if amber?

Answer 20

• Provide parents with a safety net or refer to a paediatric specialist for further assessment
• A safety net includes verbal or written information on warning symptoms and how further healthcare can be accessed, a follow-up appointment, liaison with other healthcare professionals, e.g. out-of-hours providers, for further follow-up

Question 21

What is your management plan if red?

Answer 21

Refer child urgently to a paediatric specialist.