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Feverish illness in children Table 5.2 Traffic light system for identifying risk of serious illness.* [new 2013] 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 columns are at low risk. The management of children with fever should be directed by the level of risk. 138 Colour (of skin, lips or tongue) Green – low risk Amber – intermediate risk Red – high risk Normal colour Pallor reported by parent/carer Activity Responds normally to social cues Content/smiles Stays awake or awakens quickly Strong normal cry/not crying Not responding normally to social cues No smile Wakes only with prolonged stimulation Decreased activity 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 in the chest Circulation and hydration Normal skin and eyes Moist mucous membranes Other None of the amber or red symptoms or signs CRT capillary refill time; RR respiratory rate Tachycardia: > 160 beats/minute, age < 1 year > 150 beats/minute, age 1–2 years > 140 beats/minute, age 2–5 years CRT ≥ 3 seconds Dry mucous membranes Poor feeding in infants Reduced urine output Age 3–6 months, temperature ≥ 39°C Fever for ≥ 5 days Rigors Swelling of a limb or joint Non-weight bearing limb/not using an extremity Pale/mottled/ashen/blue No response to social cues Appears ill to a healthcare professional Does not wake or if roused does not stay awake Weak, high-pitched or continuous cry Grunting Tachypnoea: RR > 60 breaths/minute Moderate or severe chest indrawing Reduced skin turgor Age < 3 months, temperature ≥ 38°C Non-blanching rash Bulging fontanelle Neck stiffness Status epilepticus Focal neurological signs Focal seizures * This traffic light table should be used in conjunction with the recommendations in this guideline on investigations and initial management in children with fever.
Clinical assessment of the child with fever Table 5.66 Summary table for symptoms and signs suggestive of specific diseases [2013] Diagnosis to be considered Symptoms and signs in conjunction with fever Meningococcal disease Non-blanching rash, particularly with 1 or more of the following: Bacterial Meningitis Neck stiffness an ill-looking child lesions larger than 2 mm in diameter (purpura) capillary refill time of ≥ 3 seconds neck stiffness Bulging fontanelle Decreased level of consciousness Convulsive status epilepticus Herpes simplex encephalitis Focal neurological signs Focal seizures Decreased level of consciousness Pneumonia Tachypnoea (RR > 60 breaths/minute, age 0–5 months; RR > 50 breaths/minute, age 6–12 months; RR > 40 breaths/minute, age > 12 months) Crackles in the chest Nasal flaring Chest indrawing Cyanosis Urinary tract infection Vomiting Oxygen saturation ≤ 95% Poor feeding Lethargy Irritability Abdominal pain or tenderness Urinary frequency or dysuria Septic arthritis Swelling of a limb or joint Not using an extremity Non-weight bearing Kawasaki disease Fever for more than 5 days and at least 4 of the following: RR respiratory rate bilateral conjunctival injection change in mucous membranes change in the extremities polymorphous rash cervical lymphadenopathy 139
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Feverish illness in children<br />
Table 5.2 Traffic light system for identifying risk of serious illness.* [new 2013]<br />
Children with fever and any of the symptoms or signs in the red column should be recognised as being at high<br />
risk. Similarly, children with fever and any of the symptoms or signs in the amber column and none in the red<br />
column should be recognised as being at intermediate risk. Children with symptoms and signs in the green<br />
column and none in the amber or red columns are at low risk. The management of children with fever should be<br />
directed by the level of risk.<br />
138<br />
Colour (of<br />
skin, lips or<br />
tongue)<br />
Green – low risk Amber – intermediate risk Red – high risk<br />
Normal colour Pallor reported by<br />
parent/carer<br />
Activity Responds normally<br />
to social cues<br />
Content/smiles<br />
Stays awake or<br />
awakens quickly<br />
Strong normal<br />
cry/not crying<br />
Not responding normally<br />
to social cues<br />
No smile<br />
Wakes only with<br />
prolonged stimulation<br />
Decreased activity<br />
Respiratory Nasal flaring<br />
Tachypnoea:<br />
RR > 50 breaths/<br />
minute, age 6–12 months<br />
RR > 40 breaths/<br />
minute, age > 12 months<br />
Oxygen saturation ≤ 95%<br />
in air<br />
Crackles in the chest<br />
Circulation<br />
and hydration<br />
Normal skin and<br />
eyes<br />
Moist mucous<br />
membranes<br />
Other None of the amber<br />
or red symptoms or<br />
signs<br />
CRT capillary refill time; RR respiratory rate<br />
Tachycardia:<br />
> 160 beats/minute,<br />
age < 1 year<br />
> 150 beats/minute,<br />
age 1–2 years<br />
> 140 beats/minute,<br />
age 2–5 years<br />
CRT ≥ 3 seconds<br />
Dry mucous membranes<br />
Poor feeding in infants<br />
Reduced urine output<br />
Age 3–6 months,<br />
temperature ≥ 39°C<br />
Fever for ≥ 5 days<br />
Rigors<br />
Swelling of a limb or joint<br />
Non-weight bearing<br />
limb/not using an<br />
extremity<br />
Pale/mottled/ashen/blue<br />
No response to social cues<br />
Appears ill to a healthcare<br />
professional<br />
Does not wake or if roused<br />
does not stay awake<br />
Weak, high-pitched or<br />
continuous cry<br />
Grunting<br />
Tachypnoea:<br />
RR > 60 breaths/minute<br />
Moderate or severe chest<br />
indrawing<br />
Reduced skin turgor<br />
Age < 3 months, temperature<br />
≥ 38°C<br />
Non-blanching rash<br />
Bulging fontanelle<br />
Neck stiffness<br />
Status epilepticus<br />
Focal neurological signs<br />
Focal seizures<br />
* This traffic light table should be used in conjunction with the recommendations in this guideline on investigations and initial<br />
management in children with fever.