Febrile Child

Question 0

What are the criteria for tackycardia?

Answer 0

Recognise that children with tachycardia are in at least an intermediate-risk group for serious illness. Use the Advanced Paediatric Life Support (APLS)[1] criteria below to define tachycardia: [new 2013]

Age

Heart rate (bpm)

160

12–24 months

> 150

2–5 years

> 140

Question 1

What are the signs and symptoms of intermediate risk and high risk children with fever?

Answer 1

1.2.2.3 Recognise that children with any of the following symptoms or signs are in a high-risk group for serious illness:

pale/mottled/ashen/blue skin, lips or tongue

no response to social cues[3]

appearing ill to a healthcare professional

does not wake or if roused does not stay awake

weak, high-pitched or continuous cry

grunting

respiratory rate greater than 60 breaths per minute

moderate or severe chest indrawing

reduced skin turgor

bulging fontanelle. [new 2013]

1.2.2.4 Recognise that children with any of the following symptoms or signs are in at least an intermediate-risk group for serious illness:

pallor of skin, lips or tongue reported by parent or carer

not responding normally to social cues[3]

no smile

wakes only with prolonged stimulation

decreased activity

nasal flaring

dry mucous membranes

poor feeding in infants

reduced urine output

rigors. [new 2013]

Question 2

What febrile illness has:
Non-blanching rash, particularly with 1 or more of the following:

an ill-looking child

lesions larger than 2 mm in diameter (purpura)

capillary refill time of ≥3 seconds

neck stiffness

Answer 2

Meningococcal disease

Question 3

What illness should you consider in febrile child with:

Vomiting

Poor feeding

Lethargy

Irritability

Abdominal pain or tenderness

Urinary frequency or dysuria

Answer 3

Urinary Tract Infection

Question 4

What are signs of pneumonia?

Answer 4

Tackypnea 
1-12 months: normal median 38-40( up to 50)
12-18 months: median 35 (up to 40)
18-24 mos:      median31  (up to 40)
2 yr-4 yr: median 25-28  up to 35

Crackles in the chest

Nasal flaring

Chest indrawing

Cyanosis

Oxygen saturation ≤95%

Question 5

What illness presents with:
fever, pleomorphic rash, conjunctivitis, strawberry tongue, unilateral cervical lymphadenopathy, mucosal erythema and swelling of hands and feet(followed by desquamation)

Answer 5

Kawasaki’s Disease. 25% will develop coronary artery Anneuryisms if untreated. It’s a vasculitis of unknown cause.

Question 6

What are some of risk factors for UTI in children?

What are some of the “red flags” that should prompt consideration of UTI?

Answer 6

• White female
• Uncircumcised
• Fever
• Irritibility
• Failure to thrive
• Poor feeding
• Vomiting
• New onset urinary incontinence

Question 7

What is the presentation of children with influenza?

Answer 7

Most but not all children will have a temperature over 101. Upper respiratory symptoms like nasal congestion and cough and sore throat are often present but not always.**Headache and myalgia is distinctly less common in children then as adults as a matter fact less than 25% of children have these complaints. 10% of children will have gastrointestinal symptoms of nausea vomiting and or diarrhea. Approximately 10% of children will have associated otitis media and the smaller percentage conjunctivitis. **Some children will only have fever as the main sign and symptom of influenza without the other symptoms.