Feverish Illness in Children

1
Feverish Illness in Children

• 2007

2
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

3
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

4
Detecting fever

• Take all reports seriously
• Do not measure temperature by oral or rectal
  route
• Do not use forehead chemical thermometers

5
Assessment

• Measure and record
• Temperature
• Heart rate
• Respiratory rate
• Capillary refill time

6
Assessment

• Assess for signs of dehydration
• Prolonged capillary refill time
• Abnormal skin turgor
• Abnormal respiratory pattern weak pulse
• Cool extremities

7
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

8
Traffic light system

• Green
• Activity responding normally
• Respiration normal
• Hydration normal skin and eyes, moist mucous
  membranes
• Other no amber or red signs

9
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
• Age 6-12 months RR gt 50/min
• Age gt 12 months RR gt 40/min
• Oxygen sats lt 96 in air
• crackles

10
Traffic light system

• Amber intermediate risk
• Hydration
• Dry mucous membranes
• Poor feeding in infants
• CRT gt 3 secs
• Reduced urine output
• Other
• Fever gt 5 days
• Swelling of joint or limb
• Non weight bearing/not using an extremity
• New lump gt 2cm

11
Traffic light system

• Red high risk
• Colour pale mottled or ashen blue
• Activity
• no response to social cues
• Appears ill
• Unable to rouse or wont stay awake
• Weak high pitched continuous cry
• Respiratory
• Grunting
• Tachypnoea gt 60
• Moderate or severe chest indrawing

12
Traffic light system

• Red high risk
• Hydration
• Reduced skin turgor
• Other
• Age 0-3/12 temp gt 38C
• Age 3-6/12 temp gt 39C
• Non blanching rash
• Bulging fontanelle
• Neck stiffness
• Status epilepticus
• Focal neurological signs or focal seizures
• Bile stained vomiting

13
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

14
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

15
Antipyretic interventions

• 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

16
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

17
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

18
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

19
Specific Diseases

• Meningococcal disease
• Non blanching rash
• Ill looking child
• Purpuric lesions gt 2cm
• CRT . 3 seconds
• Neck stiffness

20
Specific Diseases

• Meningitis
• Neck stiffness
• Bulging fontanelle
• Decreased level of consciousness
• Convulsive status epilepticus

21
Specific Diseases

• Herpes simplex encephalitis
• Focal neurological signs
• Focal seizures
• Decreased level of consciousness

22
Specific Diseases

• Pneumonia
• Tachypnoea
• 0-5 months RRgt 60/min
• 6-12 months RR gt 50/min
• gt 12 months RR gt 40/min
• Crackles in chest
• Nasal flaring
• Chest indrawing
• Cyanosis
• Oxygen saturation lt 96

23
Specific Diseases

• UTI age in children gt 3 months
• Vomiting
• Poor feeding
• Lethargy
• Irritability
• Abdominal pain or tenderness
• Urinary frequency or dysuria
• Offensive urine or haematuria

24
Specific Diseases

• Septic arthritis
• Swelling of a limb or joint
• Not using an extremity
• Non weight bearing

25
Specific Diseases

• Kawasaki disease
• Fever lasting gt 5 days
• Bilateral conjunctival injection
• Dry cracked lips, strawberry tongue, injected
  pharynx
• Change in extremities oedema, erythema,
  desquamation
• Polymorphous rash
• Cervical lymphadenopathy