Febrile
Child
JRCALC · NICE CG160 · Paediatric Fever Assessment
🚨 Always carry out PRIMARY SURVEY first. Time-critical features = immediate transfer.
⚠️ Serious infections often mimic minor illness. Improvement after antipyretics does NOT rule out serious infection.
⚠️ Small children rarely have classical meningococcal signs. Early features: fever, cold hands/feet, abnormal skin colour, muscle pains.
Patient Age
<1 month
Auto Red Flag
1–3 months
High risk
3–6 months
6m–1 year
1–5 years
5–12 years
Over 12
Temperature
°C
Enter temp
Special Circumstances
Primary Survey — Time-Critical Features
If ANY present — start correcting ABCDE and immediate transfer. ATMIST pre-alert.

Time-Critical — Transfer Immediately

Immediate Observations

Tachycardia Calculator

Heart rate increases 10 bpm per 1°C rise in temperature. Disproportionate tachycardia = early sepsis.

Actual HR
Temp °C
Expected max for age
Select age
NICE Traffic Light System
Tap the description that best fits for each category. The tool will calculate your overall risk level.
🟢 GREEN
🟡 AMBER
🔴 RED
Colour
Normal colour of skin, lips and tongue
Pallor reported by parent/carer
Pale / cyanotic / mottled / ashen. (Note: mottling harder to see in dark skin)
Activity
Responds normally to social cues. Content/smiles. Stays awake. Strong normal cry.
Not responding normally to social cues. No smile. Wakes only with prolonged stimulation. Decreased activity.
No response to social cues. Appears ill to HCP. Does not wake or if roused does not stay awake. Weak, high-pitched or continuous cry.
Respiratory
Normal
Nasal flaring. Tachypnoea: >50/min (6–12m), >40/min (>12m). SpO₂ ≤95%. Crackles.
Grunting. Tachypnoea >60/min. Moderate/severe chest indrawing.
Circulation
Normal skin and eyes. Moist mucous membranes.
Tachycardia: >160 (<1yr), >150 (1–2yr), >140 (2–5yr). CRT ≥3 sec. Dry mucous membranes. Poor feeding. Reduced urine. Reduced skin turgor.
— (see Other for red flags)
Other
None of the amber or red symptoms or signs
Age 3–6 months, temp ≥39°C. Fever ≥5 days. Rigors. Swelling of limb/joint. Non-weight-bearing.
Age <3 months, temp ≥38°C. Non-blanching rash. Bulging fontanelle. Neck stiffness. Status epilepticus. Focal neuro signs. Focal seizures.
0
Green
0
Amber
0
Red
⚠️ Non-blanching rash — assess in NATURAL light if possible. Consider moistening unbroken skin to enhance visibility.
History Taking

Key History Points

⚠️ In children with learning disabilities — adjust interpretation of traffic light system accordingly.
Specific Disease Suspicion — Tap to Expand
🔴 Meningococcal
🧠 Meningitis
💧 UTI
🫁 Pneumonia
⚡ Herpes Encephalitis
🦴 Septic Arthritis
❤️ Kawasaki Disease

🔴 Meningococcal Disease

Often does NOT present acutely. May mimic URTI or gastroenteritis especially in small children.

Classical signs (neck stiffness, photophobia, non-blanching rash) more likely in older children and teenagers. In younger children look for:

  • Fever
  • Cold hands and feet
  • Abnormal skin colour
  • Muscle pains or confusion
  • Non-blanching rash — particularly with ill-looking child, lesions >2mm (purpura), CRT ≥3 sec, neck stiffness
Document evidence that you sought to RULE OUT meningococcal disease in any febrile child.

🧠 Bacterial Meningitis

  • Neck stiffness (rare in pre-school children)
  • Bulging fontanelle
  • Decreased level of consciousness
  • Convulsive status epilepticus
Pre-school children RARELY have neck stiffness. Do not use absence of neck stiffness to exclude meningitis.
Antibiotics should NOT be given blindly — can delay diagnosis of serious infection / partially treat meningitis masking signs.

💧 Urinary Tract Infection

UTIs very common in babies and young children. Can cause permanent kidney damage. Can progress to life-threatening septicaemia.

Symptoms are often non-specific:

  • Poor feeding / lethargy
  • Abdominal pain
  • Vomiting
  • Urinary frequency or dysuria
  • Irritability
In hospital practice — clean catch urine on EVERY febrile child to exclude UTI. Arrange urine sample within 24 hours for unexplained fever ≥38°C.

🫁 Pneumonia

Typical chest signs may be ABSENT in children with pneumonia.
  • Tachypnoea: >60 bpm (0–5m), >50 bpm (6–12m), >40 bpm (>12m)
  • Crackles in chest
  • Nasal flaring
  • Chest indrawing
  • Cyanosis
  • SpO₂ ≤95%

⚡ Herpes Simplex Encephalitis

  • Focal neurological signs
  • Focal seizures
  • Decreased level of consciousness
Time-critical transfer. Classical pointers are focal neurological signs and focal seizures in febrile child.

🦴 Septic Arthritis / Osteomyelitis

  • Fever
  • Very tender swollen joint(s) or bone(s)
  • Refusal to weight-bear
  • Not using an extremity
  • Swelling of a limb or joint
Cannot diagnose otitis media on history alone — direct visualisation of tympanic membrane required. A positive sign must be SEEN, not assumed.

❤️ Kawasaki Disease

Fever for >5 days AND at least FOUR of the following:
  • Bilateral conjunctival infection
  • Change in mucous membranes (redness, cracked lips, strawberry tongue)
  • Change in extremities (oedema, peeling skin)
  • Polymorphous rash (blanching, measles-like)
  • Cervical lymphadenopathy
Rare but important. Hospital assessment required.
Absolute Red Flags — Transport Required
ANY of these = transport to hospital. No exceptions.

Red Flag Criteria

Normal Paediatric Physiological Values

Your patient's age group is highlighted

AgeRR (bpm)HR (bpm)
<1 year40–60110–160
1–2 years25–35110–150
2–5 years25–3095–140
5–12 years20–2580–120
Over 1215–2060–100
Disposition
Febrile Child
Summary
JRCALC · Aide-memoire only — complete full PCR separately
⚠️ Aide-memoire only. Complete full PCR separately. GP must be informed of all consultations.
Plain Text Output — for PCR / Handover