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'Traffic light' tool to assess feverish children

By Lilian Anekwe

GPs have been urged to use a new 'traffic light' system to assess which children with feverish illness need urgent referral.

NICE guidance recommends GPs only refer children to a paediatric specialist if they have one of a series of 'red' high-risk symptoms, including mottled skin, focal seizures and unusually rapid breathing.

The traffic light tool was launched this week, designed to help GPs and out-of-hours staff to 'assess the symptoms of a child with fever and advise on how they should be cared for'.

Children with 'amber' or intermediate symptoms in whom no diagnosis can be reached should be cared for at home by parents with follow-up appointments arranged as necessary. If all symptoms are 'green', children should be managed at home with advice on care.

The guidelines discourage GPs from performing routine chest X-rays or prescribing antibiotics to children with fever, or routine prescribing of anti-pyretic drugs 'with the sole aim of reducing body temperature'. They also urge GPs to take parental perceptions of a child's illness seriously.

Dr Martin Richardson, a consultant paediatrician at Peterborough District Hospital who chaired the guideline development group, said: 'We're asking for a shift in emphasis in working out how likely a child is to become ill.'

Dr James Cave, the GP representative member of the group, has been using the tool at his surgery in Newbury, Berkshire. He said: 'Children with fever are 20-40% of consultations so it's clear we need some sort of tool.'

Red flags for urgent referral

Children with the following symptoms should be urgently referred to a paediatric consultant:

• Pale/mottled/ashen/blue skin tone or reduced skin firmness

• Listlessness or a weak, high-pitched or continuous cry

• Grunting or unusually rapid breathing

• Temp 38°C or higher in children aged up to three months or 39°C or higher in children aged three to six months

• Non-blanching rash

• Neck-stiffness

• Focal seizures or other focal neurological signs

• Bile-stained vomiting

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