Patient Context
Enter age to load age-specific normal ranges and NICE/sepsis thresholds.
Paediatric Assessment Triangle (PAT)
Across-the-room "sick / not sick" screen — Appearance, Work of Breathing, Circulation to Skin. Do this before the detailed exam.
Age-Banded Vital Signs
Respiratory Rate
Enter age + RR
Oxygen Saturation
Enter SpO2
Heart Rate
Enter age + HR
Temperature
Enter age + temperature
DEFG — Don't Ever Forget Glucose
Enter blood glucose to interpret
A — Airway
B — Breathing
Auscultation — Quick Statement
Bilateral equal air entry, clear (normal)
Wheeze
Crackles / Crepitations
Reduced air entry
C — Circulation
D — Disability
ENT — Ear, Nose & Throat
T — Temperature
Temperature is captured on the Vital Signs card in A-E. This card covers the additional pattern/duration flags.
T — Tummy (Abdomen / Hydration / Exposure)
GREEN — LOW RISK
No Amber or Red features flagged yet — complete the assessment to update this.
Red features: 0 | Amber features: 0
Could This Be Sepsis? — Paediatric Sepsis Six
Think "Could this be sepsis?" for any child with possible infection, even without fever. Any high-risk (Red) criterion → treat as sepsis and escalate. Complete within 1 hour.
1. Senior/experienced clinician review
2. High-flow oxygen given
3. IV/IO access obtained, bloods taken (gas/glucose/lactate/cultures)
4. IV/IM antibiotics given
5. IV fluid resuscitation given/considered
6. Early senior/critical care involvement
00:00
Dehydration / Shock Ladder (NICE CG84)
Tap a stage above once assessed.
Reference — Clinical Dehydration Features
Appears unwell/deteriorating; altered responsiveness (irritable/lethargic); decreased urine output; sunken eyes; dry mucous membranes; tachycardia; tachypnoea; reduced skin turgor (red-flag features within this column — increased risk of progression to shock).
Reference — Clinical Shock Features
Pale/mottled skin; cold extremities; weak peripheral pulses; prolonged capillary refill; hypotension (late, decompensated sign). Increased-risk groups: <1 year (esp. <6 months), low birth weight, >5 diarrhoeal stools/24h, >2 vomits/24h, unable to tolerate supplementary fluids, stopped breastfeeding during illness, malnutrition.
Specific-Disease Red Flags (Reference)
Meningococcal Disease
Fever + non-blanching rash, especially if ill-looking; purpura >2mm; CRT ≥3s; neck stiffness. Give parenteral benzylpenicillin/3rd-gen cephalosporin at earliest opportunity per local guidance.
Bacterial Meningitis
Neck stiffness, bulging fontanelle, decreased consciousness, convulsive status epilepticus. Classic signs are often absent in infants — have a low threshold.
Herpes Simplex Encephalitis
Focal neurology, focal seizures, decreased consciousness.
Pneumonia
Age-banded tachypnoea, crackles, nasal flaring, chest indrawing, cyanosis, SpO2 ≤95%.
UTI
Consider in any <3 months with fever; ≥3 months with vomiting, poor feeding, lethargy, irritability, abdominal pain/tenderness, urinary frequency/dysuria.
Septic Arthritis / Osteomyelitis
Limb/joint swelling, not using an extremity, non-weight-bearing.
Kawasaki Disease
Fever ≥5 days + conjunctival injection, cracked lips/strawberry tongue, extremity oedema/erythema, polymorphous rash, cervical lymphadenopathy. Features may be fewer in <1 year, who carry higher coronary-aneurysm risk.
Surgical Abdomen
Appendicitis; intussusception — red-currant-jelly stool, pallor, intermittent screaming, bilious vomit.
Imported Infection
Always take a travel history — consider malaria, typhoid, dengue.
Background
Clinical Impression & Differentials
Safety Netting
Worsening symptoms advice given
Clear timeframe for reassessment given
Emergency contact number given (111/999)
Follow-up/referral arranged
Written/verbal information left with parent/carer
Overall Status
Generate documentation to see overall status
1 — Presenting Complaint
2 — History of Presenting Complaint
3 — Background
4 — Examination
5 — Impression, Risk Stratification & Disposition
Documentation Checklist
PCR fully completed
Safety netting advice documented
Follow-up/referral documented
Third party/parent-carer contact documented
Safeguarding considered and documented