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.