Transcript Feverish Illness in Children

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
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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
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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