Febrile Child

In the febrile child under 5yrs where the underlying cause for the fever is unknown NICE have recommended a “traffic light system” for risk stratification.

Febrile kids should have the following recorded:

  • temp
  • heart rate
  • resp rate
  • cap refill time
  • evidence of dehydration

Temp should be recorded with in the axilla if the child is under 4 weeks,

Traffic Light System:

Green – Low risk

Colour

– Normal 

Activity

– Responds normall to social cues

– content / smiles

– stays awake or awakens quickly

– strong normal cry / not crying

Respiratory

Circulation and hydratoin

– normal skin and eyes

– moist mucous membranes

Other

– no amber or red signs

 

Amber – Intermediate Risk

Colour 

Pallor reported by carer

 

Activity 

– Not responding normally to social cues

– No smile 

Wakes only with prolonged stimulation

Decreased activity

 

Respiratory

Nasal Flaring

Tachypnoea

Respiratory Rate

  • >50 breath/min age 6-12months
  • >40 breaths/min age >12months

Oxygen sats less than or equal to 95% in air

Crackles in the chest

 

Circulation

Tachycardia

  • >160 beats / minute age <12months
  • >150 beats/minute age 12 – 24months
  • >140 beats /minute age 2-5years

Capillary refill time more than or equal to 3 seconds

Dry Mucous membranes

Poor feeding in infants

Reduced urine output

 

Other

Age 3- 6months Temp of greater or equal to 38C

Fever for > 5 days

Rigors

Swelling of limb or joint

Non-weight bearing limb / not using an extremity

(AGE / DURATION / RIGORS / SWELLING / USE “duras”)

 

Red – High Risk 

Colour

Pale / mottled / ashen / blue

 

Activity 

No response to social cues

Appears ill to healthcare professional

Does not wake or if roused does not stay awake

Weak / high-pitched or continuous cry

 

Respiratory

Grunting

Tachypnoea Resps > 60 per minute

Moderate or severe chest indrawing

Circulation and Hydration

Reduced skin turgor

 

Other

Age < 3months and temp > or = 38C

Non-blanching rash 

Bulging fontanelle

Neck Stiffness

Status epilepticus

Focal Neurological signs

Focal Seizures

 

Mangement

Green – low risk

  • Child can be managed at home
  • Appropriate advice  – including when to seek further help

Amber – intermediate risk

  • provide patient with a safety net or refer to a paediatric specialist for further assessment
  • a safety net includes verbal or written infomation on warning symptoms and how to access further heatlhcare, a follow-up appointment, liason with other heatlhcare professionasl, eg out-of-hours provides for further follow up.

Red – High Risk

  • refer child urgently to paediatric specialist

NB: Don’t prescribe oral antibiotics where source is not known

If a pneumonia is suspected but the child is not going to be referred to hospital then a chest x-ray does not need to be performed routinely.