fever

Question 1

why is fever most common in those <2 years

Answer 1

Immune system develops by age 2 years old

Question 2

Signs of serious infection

Answer 2

peripheral shutdown 
> CRT
pale and drowsy sign of decompensation 
RR increases to try to compensate 
lactic acid

Question 3

history and examination

Answer 3

rash
fever - we are more worried about fevers greater than 39.5 degrees centigrade. Except in babies 0-3 up to months old, when a fever of over 38 degrees should be considered significant.
duration of fever
general behaviour
drowsy
feeding
immunuisations
at risk: leukaemia, steroids, pre-term, CF
medications reduced fever? Ifstill unwell even with low temp even more worrying

Question 4

fever examination

Answer 4

Assess if the child is “unwell”

Check the child’s colour and responsiveness
drowsy? irritable? mottled?

Check the heart rate, respiratory rate and capillary refill time.
peripheral shutdown helpts to preserve BP until very late so give fluids when see shutdown.

If drowsy check BM

Question 5

pneumonia

Answer 5

Reliable signs of pneumonia in children are tachypnoea, respiratory distress and hypoxia

In children<3 y/o with signs of sepsis, CXR often done for penumonia.

Respiratory distress = grunting, “indrawing” of chest wall, other signs of increased work of breathing

Question 6

UTI

Answer 6

n younger children, their symptoms are more likely to be non-specific, such as fever, vomiting, poor feeding, abdominal pain or irritability. In children, especially those under 3, the infection can spread from the lower urinary tract to the upper urinary tract, and in some cases can cause lasting damage to the kidneys, which will show up later in life. In babies urine infections can rapidly turn into septicaemia.

Question 7

Bone or joint infection

Answer 7

Signs of bone or joint infection are; not using a limb, limping, or refusing to walk.

There may or may not be warmth and redness over the affected area in the early stages. Septic arthritis may need an operation to urgently open the joint and wash out the infection

Question 8

Kawasaki disease

Answer 8

Fever for 5 days? - consider Kawasaki disease

Kawasaki disease needs treating within the first 10 days of fever

Kawasaki disease is a disease of childhood most common in the under 2s which has serious complications with the heart and coronary arteries.

The high temperature goes on for several days, the child is usually very irritable, most cases have a rash which is quite non-specific but usually maculopapular. The fingers and toes are swollen and there are red eyes and a sore mouth. There is often a large lymph node on the side of the neck. Later on in the disease process this rash fades and peeling of the fingers and toes occurs.

Question 9

influenzae

Answer 9

Symptoms usually consist of headache, muscle ache, sore throat, fever and general tiredness. There may be a cough. Younger children will have less specific symptoms and may have vomiting or diarrhoea or a rash

Question 10

meningitis and meningococal sepsis

Answer 10

Immunisation has reduced serious bacterial infections

Early features of meningitis and septicaemia are non-specific – fever, lethargy, vomiting

Features of bacterial meningitis in a child:
- neck stiffness
- bulging fontanelle
- decreased level of 
  consciousness
- convulsive status 
  epilepticus

Features of meningococcal disease include fever and a non-blanching rash, particularly:

• an ill-looking child
• non-blanching lesions larger than 2 mm in diameter (purpura)
• a capillary refill time of 3 seconds or longer
• neck stiffness

Septicaemia is more fatal than meningititis.