Presentation on theme: "Fever in paediatrics Dr Ehsan Ahmed (Consultant Paediatrician"— Presentation transcript:
1Fever in paediatrics Dr Ehsan Ahmed (Consultant Paediatrician Walsall Manor Hospital)Dr Sasan Iraji GPVTS1
2Fever Indicates infection in child<5yr in most cases Parental perceptions of fever are accurate
3Fever definitionA fever is a high temperature. As a general rule, in children, a temperature of over 37.5°C (99.5°F) is a fever
4Thermometers and the detection of fever Do not routinely use the oral and rectal routes to measure the body temperature of children aged 0–5 years.In infants <4 weeks use electronic thermometer in the axilla.In children 4wk- 5yrs use one of the following:electronic thermometer in the axillachemical dot thermometer in the axillainfra-red tympanic thermometer- Forehead chemical thermometers are unreliable- Reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals
8Traffic light systemRed : Face-to-face assessment by a healthcare professional within 2 hours. Amber : Face-to-face assessment by a healthcare professional- The urgency of this assessment should be determined by the clinical judgement of the healthcare professional carrying out the remote assessment Green : Suitable for home care
9Identify life-threatening features Airway, breathing or circulation compromise and decreased level of consciousness (A,B,C,D approach)
10Face to face assessment; Use the traffic light system to assess risk of serious illness Routinely check T, HR, RR and capillary refill time, BPChildren <3 months with T 38°C or higher → high-risk groupChildren 3-6 months with T 39°C or higher, CRT>3 sec and Children with tachycardia → At least Amber groupFever >5 days assess for Kawasaki dxDo not forget travel history
11(APLS) criteria for tachycardia Can be an initial and subtle sign of sepsis AgeHeart rate (bpm)<12 months>16012–24 months>1502–5 years>140
12Signs of dehydration Prolonged capillary refill time Abnormal skin turgorAbnormal respiratory patternWeak pulseCool extremitiesOliguria
13Other signs and symptoms in high risk group (Red light) → Urgent referral pale/mottled/ashen/blue skin, lips or tongueno response to social cuesappearing ill to a healthcare professionaldoes not wake or if roused does not stay awakeweak, high-pitched or continuous crygruntingrespiratory rate greater than 60 breaths per minutemoderate or severe chest indrawingreduced skin turgorbulging fontanelle.Petechial rash
14Other signs and symptoms in intermediate risk group (amber light) → face-to-face assessment pallor of skin, lips or tongue reported by parent or carernot responding normally to social cuesno smilewakes only with prolonged stimulationdecreased activitynasal flaringdry mucous membranespoor feeding in infantsreduced urine outputrigors
15Symptoms and signs of specific illnesses after initial traffic light- face to face assessment
16Meningoccocal disease and bacterial meningitis Consider meningococcal disease in any child with fever and a non-blanching rash (petechiae or purpura), particularly if any of the following features are present: - an ill-looking child - lesions larger than 2 mm in diameter (purpura) - a capillary refill time of 3 seconds or longer - neck stiffness.
17Meningoccocal disease and bacterial meningitis Consider bacterial meningitis in a child with fever and any of the following features:- neck stiffness- bulging fontanelle- decreased level of consciousness- convulsive status epilepticus.
18Herpes simplex encephalitis Consider in a child with fever and any of the following:focal neurological signsfocal seizuresdecreased level of consciousness.
19Pneumonia Fever and any of the following signs tachypnoea crackles nasal flaringRecessioncyanosisoxygen saturation ≤95% in room air
20Urinary tract infection - Consider in any child <3 months with fever- Consider UTI in >3 months with fever and any of the followingvomitingpoor feedinglethargyirritabilityabdominal pain or tendernessurinary frequency or dysuria
21Septic arthritis or osteomyelitis - Fever and any of the following signs:swelling of a limb or jointnot using an extremityLimping non-weight bearing
22Kawasaki disease Fever for 5 days and 4 of the following 5 features WARM CREAM (non-purulent Conjunctivitis, Rash, palmar Erythema/swelling, cervical Adenopathy, dry and red Mucous membranes, strawberry tongue )
23Bacterial meningitis and meningococcal septicaemia overview
24Pre- hospital management of suspected meningitis
25Management a child with fever by non-paediatric practitioners Three stages assessment:1- Identify life-threatening features (A,B,C,D)2- Traffic light system for assessment3- Attempt to identify source of infection/featureRed features: urgent referral to paediatric specialist
26Management a child with fever by non-paediatric practitioners Amber features: If any 'amber' features but no diagnosisa) safety nets to parents (verbal and/or written information on warning symptoms, arranging further follow-up or access to OOH providers)------OR------b) referral to paediatric teamGreen features: home care with appropriate advice
27Antipyretic interventions Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purposeTepid sponging is not recommendedChildren with fever should not be underdressed or over-wrapped.Consider using either paracetamol or ibuprofen in children with fever who appear distressed.
28Antipyretic interventions When using paracetamol or ibuprofen in childrenwith fever:continue only as long as the child appears distresseddo not give both agents simultaneouslyonly consider alternating these agents if the distress persists or recurs before the next dose is due
29Advice for home care To encourage their child to drink more fluids How to detect signs of dehydrationHow to identify a non-blanching rashTo check their child during the nightTo keep their child away from nursery or school
30When to seek further help Any fitsNon-blanching rashChild is less well than when they previously sought adviceParents are more worried than when they previously sought adviceFever > 5 daysthe parent is distressed, or concerned that they are unable to look after their child.
31Take home messages Three stages assessment in a child with fever: 1- Identify life-threatening features (A,B,C,D)2- Traffic light system for assessment. Prompt action as per clinical assessment.3- Attempt to identify source of infection/feature and treat or act as necessary.
32Take home messages Children <3 months with fever → high-risk group Children 3-6 months with T 39°C or higher, CRT>3 sec and Children with tachycardia → At least Amber groupDo not give paracetamol and ibuprofen simultaneouslyParental education and safety nets