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Feverish child-Fever represents a regulated rise in body temperature. An…
Feverish child-Fever represents a regulated rise in body temperature. An infant or child is considered to have a fever if their temperature is 38°C or higher.
Prevalence & causes
Fever is very common in young children, with cough, cold, earache
Between 20–40% of parents presented to healthcare professionals for febrile illness in their children each year.
Assessment
onset, duration, and pattern of fever, and method of temperature measurement.
children < 4 weeks of age, use or recommend an electronic thermometer in the axilla
any compromise of the airway, breathing, circulation, or consciousness level if so 999
children aged 4 weeks to 5 years of age, use or recommend either an electronic thermometer or a chemical dot thermometer in the axilla, or an infra-red tympanic thermometer.
identify any rationale of fever, by any symptoms prior or during fever
Any perinatal complications such as maternal fever and/or premature delivery
PMHx - such as known immunosuppression or immunodeficiency,
DHx- any recent abx or antipyretic
immunization Hx
Travel Hx
Family health history
Parents ICE
Examination
Actvity- change in level of activity
Respiratory- RR, SpO2, chest examination- auscultate, look. Observe breathing and chest
Colour- skin, lips and tongue
Hydration and Circulation- skin and eyes- signs of dehydration. Mouth and peripheries- colour and character, Hx from parents, eating and drinking, passing urine and faecus, amount, frequency. Skin turgor. Pulse and capillary refill
Other- skin for non blanching rash, head for bulging fontanelle, neck stiffness, any rigors, swelling of limbs, inability to use limbs, seizures , focal neurological signs.
Traffic like system- risk of serious illness
Respiratory
Nasal flaring, Tachypnoea: 6–12 months of age RR
> 50 breaths per minute; > 12 months of age RR
> 40 breaths per minute, Oxygen saturation =< 95% in air, Crackles on chest auscultation
grunting, Tachypnoea: RR* 60 breaths per minute or more. Moderate or severe chest indrawing.
Respiratory rate, oxygen saturation, chest examination clear, breathing normal
Hydration and Circulation
Poor feeding in infants, Dry mucous membranes, Capillary refill time of 3 seconds or more, Reduced urine output (in infants ask about wet nappies), Tachycardia: >160 beats/minute under 1 year of age; >150 beats/minute 1–2 years of age; >140 beats/minute 2–5 years of age.
Reduced skin turgor
normal skin turgor and eyes. Moist mucous membranes
Activity
Not responding normally to social cues, waking only with prolonged stimulation, Decreased activity, Not smiling
No response to social cues. Appears ill to a healthcare professional. Unable to rouse, or if roused does not stay awake. Weak, high-pitched, or continuous crying.
responding to social clues, content and smiling. Stays awake or awakens quickly. Strong normal cry or no crying
Other
Fever for 5 days or more, Rigors, Temperature ≥ 39°C in children 3–6 months of age, Swelling of limb or joint. Non weight-bearing or not using a limb
Temperature ≥ 38°C in infants 0–3 months of age. Non-blanching rash. Bulging fontanelle. Neck stiffness. Focal neurological signs. Focal seizures. Status epilepticus
no rash, no bulging fontanelle, no rigors, swelling of limb or joint, able to move all limbs, non non blanching rash, no seizures, no neck stiffness or focal neurological signs,
Colour
Pallor of skin, lips, or tongue reported by parent or carer
Pale, mottled, ashen, or blue skin, lips, or tongue
normal colour of skin, lips and tongue
Management
Amber features no red features-arrange a face-to-face assessment if the infant or child was initially assessed by telephone, the urgency depending on clinical judgement, to help guide whether hospital admission is needed
Serious or life threatening cause (Sepsis, CNS infection, meningitis, encephalitis,pneumonia, severe dehydration)- 999 Ambulance to A&E
No amber or red features- child can usually be managed at home- assess for and manage cause of fever. Urine dipstick and MSU if unexplained fever. Advice to parent on using brufen or paracetamol to control fever. Information leaflet on fever in children. Advice on febrile seizures and prevention of dehydration. Safety netting if symptoms worsen or do not improve.
Non serious or life threatening cause-arrange an urgent (within 2 hours) face-to-face assessment if the infant or child was initially assessed by telephone, to help guide whether urgent hospital admission is needed
Consider arranging hospital admission if: An infant < 3 months with a suspected urinary tract infection (UTI) and no alternative focus of infection, to obtain a reliable urine specimen and initiate treatment, The feverish illness has no obvious underlying cause, and the infant or child is unwell for longer than expected for a self-limiting illness, There is significant parental/carer anxiety and/or difficulty coping due to the family/social situation
If the child can be managed at home, provide the parents/carers with safety netting advice by one or more of the following methods, depending on clinical judgement: Advise on warning symptoms and signs and when urgent medical review is needed, Arrange a follow-up appointment in primary care for review, Liaise with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required.
Kawasaki disease
Erythema and cracking of lips; strawberry tongue; or erythema of oral and pharyngeal mucosa
Oedema and erythema in the hands and feet
Bilateral conjunctival injection without exudate.
Polymorphous rash.
fever lasts for more than 5 days
Cervical lymphadenopathy
Ask parents or carers about the presence of these features since the onset of fever, because they may have resolved by the time of assessment. Be aware that children under 1 year may present with fewer clinical features Kawasaki disease in addition to fever, but may be at higher risk of coronary artery abnormalities than older children.
Reference
https://cks.nice.org.uk/feverish-children-risk-assessment#!scenario