1. Febrile Illness in Children

2. Aims of NICE? Guidelines for individual conditions Generalized guideline for unwell child Patient centered Take on board parental concerns

3. Guidance Non-Medical Non-Pediatric Medical Pediatric Medical

4. Priorities Fever detection –Risk stratify with traffic light system –<4/52 – axilla –>4/52 to 5yrs – axilla or tympanic –Forehead thermometers unreliable

5. Priorities Other observations –Heart rate –Respiratory rate –Capillary refill time Red flag features –Assessment <2hrs by Pediatricians

6. Non-Pediatrician CHILD GREENAMBERRED

7. Green Strong cry / not crying Content / smiles Awake Normal colour - skin, lips & tongue Moist mucous membranes Normal response socially

8. Amber Wakes only with prolonged stimulation Decreased activity Poor feeding (infants) Absent social responses Dry mucous membranes Reduced urine output New lump larger than 2 cm Pallor Nasal flaring

9. Red Unable to rouse / does not stay awake Weak, high-pitched cry pale/mottled/blue/ashen Reduced skin turgor Bile-stained vomiting Chest recession RR > 60 bpm Grunting Bulging fontanelle Appears ill <3/12 + temp ≥38°C 3–6 months + temp ≥ 39°C

10. CHILD (Colour) Normal colour skin, lips and tongue Pallor Pale Mottled Ashen Blue

11. CHILD (Activity) Normally responses Content/smiles Awake or awakens Normal cry/not crying Poor response Stimulation to wake Decreased activity No smile No response Appears ill Unable to rouse Weak/high pitch cry

12. CHILD (Respiratory) Nasal flaring 6–12 months RR > 50 > 12 months RR > 40 O2 Sats ≤ 95% RA Crackles Grunting RR > 60 breaths/minute Mod/severe recession

13. CHILD (Hydration) Normal skin Moist mucous membranes Dry mucous membrane Poor feeding CRT ≥ 3 secs Reduced U/O Reduced Skin Turgor

14. CHILD (Other) Fever>5/7 New Lump >2cm Swelling of a limb / joint Non-weight bearing Not using limb 0–3/12 temp≥ 38°C 3–6/12 temp≥ 39°C Non-blanching rash Bulging fontanelle, Neck stiffness Status epilepticus, Focal neurology Focal seizure Bile Stained Vomit

17. Management GREEN MANAGE AT HOME

18. Management AMBER SAFTEY NET Written advice Follow up Hand over to OOH

19. Management RED URGENT REFERRAL Less than 2 hours

20. Other Recommendations Parent education –Hydration & assessment for dehydration –Adverse signs –Observation through night –What to do in emergency

21. Other Recommendations Don’t prescribe abx without source LRTI/suspected pneumonia ≠ CXR Separate UTI guidelines Meningococcal disease –Early abx