1. Unwell Child Vikki Odell GP VTS November 2009

2. Introduction Unwell child usually involves fever Average of 8 infectious episodes in first 18 months life in healthy children

3. Statistics from General Practice In a study of 1% child population – 3.7 consultations per child per year for fever and doubled in under 4’s Annual consultations for infection – 60% under 1s, 36% 1-4s, 20% 5-15s

4. NICE Summary Recommendations Detection – electronic/chemical dot axilla or tympanic thermometer Assessment via traffic light system Any RED signs need to be seen face to face within 2 hours AMBER features should be safety netted – written or verbal guidance to carer

5. Chemical Dot Thermometer Tympanic Thermometer

6. GreenAmberRed Colour Normal colour of skin, lips and tongue Pallor reported by parent or 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

7. GreenAmberRed Others None of the amber or red symptoms or signs Fever for ≥ 5 days Swelling of a limb or joint Non-weight bearing/not using an extremity A new lump > 2 cm Age 0–3 months, temperature ≥ 38°C Age 3–6 months, temperature ≥ 39°C Non- blanching rash Bulging fontanelle Neck stiffness Status epilepticus Focal neurological signs Focal seizures Bile-stained vomiting

8. Written or Verbal Guidance http://www.nice.org.uk/nicemedia/pdf/FIC WrittenDischargeAdviceSheet.doc

9. CSA Telephone Consultation You are in the middle of a busy surgery and receive a message to call a worried mum 6/12 old child vomiting 3 year old with a rash