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2007 FEVERISH ILLNESS IN CHILDREN Detection of fever Children aged 4 weeks to 5 years Measure temperature by Electronic thermometer in axilla Chemical dot thermometer in axilla Infra red tympanic thermometer Assessment of child with fever Check Airway Breathing Circulation Decreased level of consciousness Use traffic light system to predict risk of serios illness Look for source of fever Detecting fever Take all reports seriously Do not measure temperature by oral or rectal route Do not use forehead chemical thermometers Assessment Measure and record Temperature Heart rate Respiratory rate Capillary refill time Assessment Assess for signs of dehydration Prolonged capillary refill time Abnormal skin turgor Abnormal respiratory pattern weak pulse Cool extremities Safety netting Provide carer with verbal and/or written information on warning symptoms and how to access further health care Arrange follow up appointment Liase with other healthcare professionals, includin gout of hours providers to ensure the carer has direct access to a further assessment Traffic light system Green Activity – responding normally Respiration – normal Hydration – normal skin and eyes, moist mucous membranes Other – no amber or red signs Traffic light system • Amber intermediate risk – Pallor reported by carers – Activity not responding normally to social cues, wakes only with prolonged stimulation, no smile – Respiratory - nasal flaring, tachypnoea • • • • Age 6-12 months RR > 50/min Age > 12 months RR > 40/min Oxygen sats < 96 in air crackles Traffic light system • Amber intermediate risk – Hydration • Dry mucous membranes • Poor feeding in infants • CRT > 3 secs • Reduced urine output – Other • Fever > 5 days • Swelling of joint or limb • Non weight bearing/not using an extremity • New lump > 2cm Traffic light system • Red high risk – Colour – pale mottled or ashen blue – Activity – • no response to social cues • Appears ill • Unable to rouse or won’t stay awake • Weak high pitched continuous cry – Respiratory • Grunting • Tachypnoea > 60 • Moderate or severe chest indrawing Traffic light system • Red high risk – Hydration • Reduced skin turgor – Other • Age 0-3/12 temp > 38’C • Age 3-6/12 temp > 39’C • Non blanching rash • Bulging fontanelle • Neck stiffness • Status epilepticus • Focal neurological signs or focal seizures • Bile stained vomiting Management • All green features – Child can be managed at home • If any amber feature and no diagnosis reached – Refer to paediatrician or give safety net instructions • If any red feature – Refer urgently to paediatrician Admission to hospital • Consider – Social and family circumstances – Other illnesses child or family have – Carers anxiety – Contact with serious infectious diseases – Recent travel abroad – Previous family experience of serious illness – If fever has no obvious cause and is lasting longer than expected Antipyretic interventions • • • • • Tepid sponging Do not over dress or under dress child Consider paracetamol or ibuprofen Take views of parents into account Do not administer paracetamol and ibuprofen at same time • Do not routinely give antipyretics with sole aim just to reduce fever or prevent febrile convulsion Care at home Advise carers Of antipyretic interventions To offer regular fluids Look for signs of dehydration Sunken fontanelle Dry mouth Sunken eyes Absence of tears Poor overall appearance Care at home Advise carers Seek advise if they see signs of dehydration How to identify a non blanching rash Check child during the night Keep away form school or nursery Notify school or nursery of the illness Care at home Advise carers to seek further help if Child has a fit Develops non blanching rash Feel child's health getting worse Fever lasts more than 5 days They are distressed or concerned or unable to look after their child Specific Diseases Meningococcal disease Non blanching rash Ill looking child Purpuric lesions > 2cm CRT . 3 seconds Neck stiffness Specific Diseases Meningitis Neck stiffness Bulging fontanelle Decreased level of consciousness Convulsive status epilepticus Specific Diseases Herpes simplex encephalitis Focal neurological signs Focal seizures Decreased level of consciousness Specific Diseases Pneumonia Tachypnoea 0-5 months RR> 60/min 6-12 months RR > 50/min > 12 months RR > 40/min Crackles in chest Nasal flaring Chest indrawing Cyanosis Oxygen saturation < 96% Specific Diseases UTI age in children > 3 months Vomiting Poor feeding Lethargy Irritability Abdominal pain or tenderness Urinary frequency or dysuria Offensive urine or haematuria Specific Diseases Septic arthritis Swelling of a limb or joint Not using an extremity Non weight bearing Specific Diseases Kawasaki disease Fever lasting > 5 days Bilateral conjunctival injection Dry cracked lips, strawberry tongue, injected pharynx Change in extremities – oedema, erythema, desquamation Polymorphous rash Cervical lymphadenopathy