Acute assessment of unwell children under 5 years

A medical consult is recommended where there is no specific protocol for a condition
  • Always consider sepsis — signs and symptoms can include
    • High or low temperature
    • Fast breathing
    • Fast pulse
    • Low BP or dizziness
    • Confusion and/or agitation
  • Small babies can get sick very quickly
  • Behaviour and appearance are the best indicators of serious illness

Look

Appearance — TICLS

  • Tone — child active, moving around or listless
  • Interactivity/mental status — alert, interacting with care giver
  • Consolability — can child be comforted by caregiver
  • Look/gaze — is child fixing gaze on a face or is there a glassy-eyed stare
  • Speech/cry — child’s speech or cry weak, high pitched or hoarse

Work of breathing — see Table 1.3

  • Assess body position, visible movements of chest/abdomen and breathing pattern
  • Listen for abnormal airway sounds — snoring, hoarse speech, grunting, wheezing or gasping
  • Look for sniffing posture, tripod positioning, head bobbing, sternal or intercostal retractions, nasal flaring, tachypnoea
  • Shortness of breath

Circulation

  • Skin colour — pallor, mottling, cyanosis
  • Capillary refill time, warmth of peripheries
  • Non-blanching rash

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • If  REWS score 3 or more or if any danger signs — urgent medical consult
    • If doctor not available within 30 minutes — contact paediatrician
  • If REWS score 2 or less see — Table 1.8 to assist with differential diagnosis 
    • if unsure medical consult
  • If available POC Test — WBC, electrolytes
  • History and immunisation status
  • Head-to-toe exam

Table 1.8 Serious causes of fever in babies and children under 5 years