Paediatric fever — assessing a 2-year-old

PLAB 2 & PRES 3 · paediatrics · medium · 8 minutes

Candidate brief

You are a doctor in a GP out-of-hours clinic. Mrs Aisling Walsh has brought her 2-year-old daughter, Mia, who has had a fever for 2 days and is drinking less than usual. Assess the child, explain your concerns and agree an appropriate management plan. Verbalise any examinations, observations or investigations you would perform.

What examiners look for

Assess the whole child, not only the temperature. Appearance, interaction, breathing, hydration, circulation and parental concern help identify serious illness. Use ABCDE, age-appropriate observations and the NICE traffic-light system or the applicable local PEWS and paediatric sepsis pathway. In a child older than 12 months, a respiratory rate above 40 is tachypnoea. Reduced activity, dry mucous membranes, reduced urine output, tachycardia and capillary refill of 3 seconds are concerning amber features. A fall in temperature after paracetamol or ibuprofen does not exclude serious infection. With fever and no clear source, assess for UTI and pneumonia and remain alert to meningitis, meningococcal disease, sepsis and septic arthritis. Give either paracetamol or ibuprofen when the child is distressed, using an age- and weight-appropriate dose. Do not give both simultaneously or use medicines solely to normalise the temperature. Do not recommend tepid sponging. Encourage fluids and monitor urine output. Fever lasting 5 days or longer requires assessment for Kawasaki disease, even when all typical features are not present. Provide clear verbal and written safety-netting and take parental concern seriously.

Guideline references

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