Assessment of
Febrile child
Ravi Seyan
F2F encounter
Consider ABC
• A- airways
• B- Breathing
• C- Circulation
F2F
• Airway, breathing: signs of respiratory
distress include recession, grunting,
accessory muscle use, flared nostrils
F2F
Normal Respiration
• Neonates : 30 to 60 breaths/ min
• Infant
: 20 to 40 breaths /min
20 to 30 breaths/ min
• 1 to 3 years :
• 4 to 10 years: 15 to 25 breaths/ min
15 to 20 breaths/ min
• Over 10 years:
BE CONCERNED IF RR> 70 IN UNDER 1 YEAR
OR > 50 IN OLDER CHILDREN
PS rates are not reliable in crying infant
F2F
• Capillary refill time after five seconds'
pressure on a finger or the sternum should
be two seconds. Blotchy, cold peripheral
skin suggests circulatory failure
Green – low risk
Amber – intermediate risk
Red – high risk
Colour
Normal colour of skin, lips
and tongue
Pallor reported by parent/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
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
Respiratory
Hydration
Normal skin and eyes
Moist mucous membranes
Dry mucous membrane
Poor feeding in infants
CRT ≥ 3 seconds
Reduced urine output
 Reduced skin turgor
Other
None of the amber or red
symptoms or signs
Fever for ≥ 5 days
Age 0–3 months, temperature
≥ 38°C
Age 3–6 months, temperature
≥ 39°C
Swelling of a limb or joint
Non-weight bearing/not using an
extremity
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Red Alert
signs
•High temperature, fever, possibly with cold hands and feet
•Vomiting, or refusing feeds
•High pitched moaning, whimpering cry
•Blank, staring expression
•Pale, blotchy complexion
•Baby may be floppy, may dislike being handled, be fretful
•Difficult to wake or lethargic
•The fontanelle (soft spot on babies heads) may be tense or bulging.