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important conditions to be considered in a child with a fever

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Diagnosis to be considered Symptoms and signs in conjunction with fever in a child under 5 years of age
Meningococcal disease

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
Bacterial meningitis

Neck stiffness

Bulging fontanelle

Decreased level of consciousness

Convulsive status epilepticus

Herpes simplex encephalitis

Focal neurological signs

Focal seizures

Decreased level of consciousness

Pneumonia

Tachypnoea (respiratory rate >60 breaths/minute, age 0-5 months; >50 breaths/minute, age 6-12 months; >40 breaths/minute, age >12 months)

Crackles in the chest

Nasal flaring

Chest indrawing

Cyanosis

Oxygen saturation <=95%

Urinary tract infection

Vomiting

Poor feeding

Lethargy

Irritability

Abdominal pain or tenderness

Urinary frequency or dysuria

Septic arthritis

Swelling of a limb or joint

Not using an extremity

Non-weight bearing

Kawasaki Disease

Fever for 5 days or longer and may have some of the following:

  • bilateral conjunctival injection without exudate
  • erythema and cracking of lips; strawberry tongue; or erythema of oral and pharyngeal mucosa
  • oedema and erythema in the hands and feet
  • polymorphous rash
  • cervical lymphadenopathy

 

Do not use duration of fever to predict the likelihood of serious illness. However, children with a fever lasting 5 days or longer should be assessed for Kawasaki disease

Reference:

  • NICE (November 2019). Feverish illness in children Assessment and initial management in children younger than 5 years

Last edited 11/2019

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