1. 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 > 50/min Age > 12 months RR > 40/min Oxygen sats < 96 in air crackles

10. 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

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 won’t stay awake Weak high pitched continuous cry – Respiratory Grunting Tachypnoea > 60 Moderate or severe chest indrawing

12. 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

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 > 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 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%

23. 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

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 > 5 days  Bilateral conjunctival injection  Dry cracked lips, strawberry tongue, injected pharynx  Change in extremities – oedema, erythema, desquamation  Polymorphous rash  Cervical lymphadenopathy