View / Download pdf
version of this article
- Identify any immediately life-threatening features including compromise of the airway, breathing or circulation
and decreased level of consciousness.
- Use the “traffic light system” to predict risk of serious illness
CLINICAL CONDITION
|
Low risk |
Intermediate risk |
High risk |
| Skin appearance |
Normal colour of skin, lips and tongue |
Pallor reported by parent/carer |
Pale, mottled, ashen, blue
|
| Responsiveness |
- Responds normally to social cues
- Content/smiles
- Stays awake or awakens quickly
- Strong normal cry or not crying
|
- Not responding normally to social cues
- Wakes only with prolonged stimulation
- Decreased activity
- No smile
|
- 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
|
| Respiratory |
Normal |
- Nasal flaring
- Tachypnoea:
- 6–12 months RR > 50 breaths/minute
- >12 months RR > 40 breaths/minute
- Oxygen saturation ≤ 95% in air
- Crackles/chest signs
|
- Grunting
- Tachypnoea:
- Moderate or severe chest indrawing
|
| Hydration |
- Normal skin and eyes
- Moist mucous membranes
|
- Dry mucous membranes
- Poor feeding in infants
- Capillary refill time (CRT) ≥ 3 seconds
- Reduced urine output
|
|
| Other |
- None of the amber or red symptoms or signs
|
- Fever for ≥ 5 days
- Swelling of a limb or joint
- Non-weight bearing, not using an extremity
- A new lump > 2 cm
- None of the red symptoms or signs
|
- Age 0 – 3 months, temperature ≥ 38°C
- Age 3 – 6 months, temperature ≥ 39°C
- Non-blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
- Focal seizures
- Bile-stained vomiting
|
| ACTION |
Reassure |
Review |
Refer |
- Refer: ANY of the symptoms or signs in the red column
- Immediately life-threatening illness – call ambulance
- All other situations – to be assessed in secondary care within two hours
Review: ANY of the symptoms or signs in the amber column, but NONE in the red column
- Diagnosis made – treat accordingly
- No diagnosis – provide parent/carer with verbal and written information on warning symptoms and ensure that they
know how to access further healthcare after hours. Arrange an appointment for follow-up.
Reassure: ANY of the symptoms and signs in the green column, but NONE in the amber or red columns
- Provide parent/carer with advice on symptomatic management and when to seek further attention from healthcare services.
- Advice for care at home:
| Managing child’s temperature |
Care at home |
When to seek further help |
DO
- Use paracetamol if the child appears distressed or unwell
- Use ibuprofen if there is no response to paracetamol
DO NOT
- Routinely use paracetamol and ibuprofen together
- Use paracetamol for the specific purpose of preventing febrile convulsion
- Under-dress or over-wrap the child
- Sponge the child (i.e. “tepid sponging”)
|
- Keep up regular fluids (breast milk if breast feeding)
- Look for signs of dehydration: sunken fontanelle, dry mouth, sunken eyes, absence of tears, decreased urine output,
overall unwell appearance
- Look for signs of a non-blanching rash
- Check the child regularly overnight
- Keep child away from day-care or school while the fever persists (notify them of illness)
|
- The child has a fit
- The child develops a non-blanching rash
- The fever is persistent
- The parent/carer feels that the child’s condition is worsening rather than improving
- The parent/carer is more worried than when they previously sought advice
- The parent/carer is distressed or concerned that they are unable to look after the child
|
Adapted from:
National Institute of Clinical Excellence (NICE). Feverish illness in children. NICE Clinical Guideline 47. NICE,
London, 2007. Available from: www.nice.org.uk (Accessed July, 2010).
For a News Update see BPJ62: Evidence that alternate dosing of paracetamol and
ibuprofen in children with fever may reduce temperature: other benefits uncertain