Febrile Illness in Children

Aims of NICE?

• Guidelines for individual conditions

• Generalized guideline for unwell child

• Patient centered

• Take on board parental concerns

Guidance

Non-MedicalNon-Pediatric

MedicalPediatric Medical

Priorities

• Fever detection– Risk stratify with traffic light system– <4/52 – axilla– >4/52 to 5yrs – axilla or tympanic– Forehead thermometers unreliable

Priorities

• Other observations– Heart rate– Respiratory rate – Capillary refill time

• Red flag features– Assessment <2hrs by Pediatricians

Non-Pediatrician

CHILD

GREEN AMBER RED

Green

• Strong cry / not crying

• Content / smiles

• Awake

• Normal colour - skin, lips & tongue

• Moist mucous membranes

• Normal response socially

Amber

• Wakes only with prolonged stimulation • Decreased activity • Poor feeding (infants)• Absent social responses• Dry mucous membranes • Reduced urine output • New lump larger than 2 cm • Pallor • Nasal flaring

Red

• Unable to rouse / does not stay awake • Weak, high-pitched cry• pale/mottled/blue/ashen • Reduced skin turgor • Bile-stained vomiting • Chest recession• RR > 60 bpm• Grunting • Bulging fontanelle • Appears ill • <3/12 + temp ≥38°C• 3–6 months + temp ≥ 39°C

CHILD(Colour)

Normal colour skin, lips and tongue

Pallor

PaleMottledAshenBlue

CHILD(Activity)

Normally responsesContent/smiles

Awake or awakensNormal cry/not crying

Poor responseStimulation to wakeDecreased activity

No smile

No responseAppears ill

Unable to rouseWeak/high pitch cry

CHILD(Respiratory)

Nasal flaring 6–12 months RR > 50> 12 months RR > 40

O2 Sats ≤ 95% RACrackles

Grunting RR > 60 breaths/minute Mod/severe recession

CHILD(Hydration)

Normal skin Moist mucous

membranes

Dry mucous membrane

Poor feedingCRT ≥ 3 secs Reduced U/O

Reduced Skin Turgor

CHILD(Other)

Fever>5/7New Lump >2cm

Swelling of a limb / joint Non-weight bearing

Not using limb

0–3/12 temp≥ 38°C 3–6/12 temp≥ 39°C Non-blanching rash

Bulging fontanelle, Neck stiffness Status epilepticus, Focal neurology

Focal seizureBile Stained Vomit

Management

GREEN

MANAGE ATHOME

Management

AMBER

SAFTEY NET

Written advice

Follow up

Hand over to OOH

Management

RED

URGENTREFERRAL

Less than 2 hours

Other Recommendations

• Parent education– Hydration & assessment for dehydration– Adverse signs– Observation through night– What to do in emergency

Other Recommendations

• Don’t prescribe abx without source

• LRTI/suspected pneumonia ≠ CXR

• Separate UTI guidelines

• Meningococcal disease– Early abx