Questionnaire/history: History from? Date of birth verified? Fever since? Maximal temperature? °C Temperature now? °C - T < 36° C? Temperature objectified with fever thermometer? - Infra-red tympanic thermometer? - Electronic thermometer in the axilla? - Chemical dot thermometers in the axilla (not recommended for healthcare professional)? - Forehead thermometer? - Oral route? - Rectal route? Associated symptoms suggesting an underlying cause of fever? Past medical history? Vaccination history? Current medication? Drug allergies? Examination: Behaviour: Normal behaviour? Alert? Active? Responding to social cues? Content/smiling? Not responding normally to social cues? Decreased activity? Behaving differently from usual? Objective evidence of altered behaviour or mental state? Appears ill to a healthcare professional? Does not wake or if roused does not stay awake? Colour of skin, lips and tongue: Normal? Cold hand and feet? Mottled or ashen appearance? Blueish skin, lips or tongue? Temperature: - T < 36°C? Breathing: Dyspnoea? RR normal? RR 24-28 bpm (5 years), 24-26 bpm (6-7 years), 22-24 bpm (8-11)? RR ≥ 29 bpm (5 years), ≥ 27 bpm (6-7 years), ≥ 25 bpm (8-11 years)? O2 saturation: Normal < 92%? < 90%? Heart rate: HR normal? HR 120-129 bpm (5 years), 110-119 bpm (6-7 years), 105-114 (8-11)? HR ≥ 130 bpm (5 years), ≥ 120 bpm (6-7 years), ≥ 115 bpm (8-11 years)? Regular? Cor: H1+2+0? Hydration and circulation Capillary refill time ≥ 3 seconds? Reduced urine output? Other: Ears? Throat? Cervical lymph node enlargement? Abdomen: - Soft? - Organomegaly? - Tenderness? - BS normal? Non-blanching rash? Signs of potential infection (eg redness, swelling, discharge at surgical site or breakdown of wound)? Neck stiffness? Brudzinski's sign? Kernig's sign? Urine dipstick? Management: According to clinical situation For home care: Advised: - To offer regular fluids - To encourage the child to drink more if signs of dehydration (sunken eyes, absence of tears, dry mouth, poor overall appearance) - To check the child during the night - Paracetamol (Calpol) 4-6 hourly (max 4 doses per 24 hours) if child appears distressed, max 4 doses per 24 hours, to alternate with ibuprofen (Nurofen) if no vomiting and distress persists or recurs before the next dose is due - To keep the child away from school while the child's fever persists but to notify the school of the illness - To call back if the child has a fit, develops a non-blanching rash, becomes less well or parents are more worried - Review own GP if no improvement or ongoing symptoms Resource(s): NICE Guideline 51: Sepsis: recognition, diagnosis and early management