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Febrile Illness in Children

Febrile Illness in Children. Aims of NICE?. Guidelines for individual conditions Generalized guideline for unwell child Patient centered Take on board parental concerns. Priorities. Fever detection Risk stratify with traffic light system <4/52 – axilla >4/52 to 5yrs – axilla or tympanic

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Febrile Illness in Children

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

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

  5. Non-Pediatrician

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

  7. 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

  8. 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

  9. Management GREEN MANAGE AT HOME

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

  11. Management RED URGENT REFERRAL Less than 2 hours

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

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

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