Assessment of Febrile child Ravi Seyan

F2F encounter Consider ABC A- airways B- Breathing C- Circulation

F2F Airway, breathing: signs of respiratory distress include recession, grunting, accessory muscle use, flared nostrils

F2F Normal Respiration Neonates : Infant : 1 to 3 years : 4 to 10 years: Over 10 years: BE CONCERNED IF RR> 70 IN UNDER 1 YEAR OR > 50 IN OLDER CHILDREN PS rates are not reliable in crying infant 20 to 40 breaths /min 20 to 30 breaths/ min 30 to 60 breaths/ min 15 to 25 breaths/ min 15 to 20 breaths/ min

F2F Capillary refill time after five seconds' pressure on a finger or the sternum should be two seconds. Blotchy, cold peripheral skin suggests circulatory failure

Green – low riskAmber – intermediate risk Red – high risk Colour  Normal colour of skin, lips and tongue  Pallor reported by parent/carer  Pale/mottled/ashen/blue Activity  Responds normally to social cues  Content/smiles  Stays awake or awakens quickly  Strong normal cry/not crying  Not responding normally to social cues  Wakes only with prolonged stimulation  Decreased activity  No smile  No response to social cues  Appears ill to a healthcare professional  Unable to rouse or if roused does not stay awake  Weak, high-pitched or continuous cry Respiratory  Nasal flaring  Tachypnoea: RR > 50 breaths/minute age 6–12 months RR > 40 breaths /minute age > 12 months  Oxygen saturation ≤ 95% in air  Crackles  Grunting  Tachypnoea: RR > 60 breaths/minute  Moderate or severe chest indrawing Hydration  Normal skin and eyes  Moist mucous membranes  Dry mucous membrane  Poor feeding in infants  CRT ≥ 3 seconds  Reduced urine output  Reduced skin turgor Other  None of the amber or red symptoms or signs  Fever for ≥ 5 days  Age 0–3 months, temperature ≥ 38°C  Age 3–6 months, temperature ≥ 39°C  Swelling of a limb or joint  Non-weight bearing/not using an extremity  Non-blanching rash  Bulging fontanelle  Neck stiffness  Status epilepticus  Focal neurological signs  Focal seizures  A new lump > 2 cm  Bile-stained vomiting CRT, capillary refill time; RR, respiratory rate. Traffic light system for identifying risk of serious illness Children with fever and any of the symptoms or signs in the red column should be recognised as being at high risk. Similarly, children with fever and any of the symptoms or signs in the amber column and none in the red column should be recognised as being at intermediate risk. Children with symptoms and signs in the green column and none in the amber or red column are at low risk. The management of children with fever should be directed by the level of risk.

High temperature, fever, possibly with cold hands and feet Vomiting, or refusing feeds High pitched moaning, whimpering cry Blank, staring expression Pale, blotchy complexion Baby may be floppy, may dislike being handled, be fretful Difficult to wake or lethargic The fontanelle (soft spot on babies heads) may be tense or bulging. Red Alert signs