Paediatric vital signs
General well child:
| Age | RR | HR |
| 0-3 months | 30-60 | 110-160 |
| 3-12 months | 25-50 | 100-150 |
| 1-4 years | 20-40 | 90-120 |
| 4-12 years | 20-30 | 70-110 |
| >12 years | 12-16 | 60-100 |
Advanced Paediatric Life Support criteria:
| Age | Heart rate (bpm) |
| < 12 months | < 160 |
| 12-24 months | < 150 |
| 2-5 years | < 140 |
| Age | Respiratory Rate |
| 0-5 months | < 60 |
| 6-12 months | < 50 |
| > 12 months | < 40 |
Specific illness
- Meningococcal disease
- Non blanching rash, ill looking, purpura, CRT > 3s, neck stiffness, bulging fontanelle
- Herpes simplex encephalitis
- Focal neurological signs, focal seizures, reduced GCS
- Pneumonia
- Tachypnoea, nasal flaring, chest indrawing, cyanosis, crackles in chest, abdo/chest pain
- UTI (presentation depends on age)
- fever alone if under 3 months
- Vomiting, reduced feeding, lethargy, abdominal pain, urinary frequency, dysuria
- Septic arthritis
- Swelling of limb or joint, not using limb
- Kawasaki disease
- Fever >5d
- Bilateral conjunctivitis
- Mucous membranes – red throat, dry cracked lips, strawberry tongue
- Extremities – oedema, erythema, desquamation polymorphous rash, cervical lymphadenopathy
Data gathering
- Red flags – drowsy, <3 months + temp 38c, neck stiffness
- Others – E+D, PU, BO, rashes, travel
- Examine
- General: Colour, activity
- Observations: Temperature, sats, RR, HR
- Dehydration: CRT, mucous membranes, cool extremities
- Other: Fontanelle
- Systems: chest/CVS/abdo/ENT
Clinical management
- Investigations
- Treatment
- Advice for home care
- Regular fluids
- Signs of dehydration
- Identify a non-blanching rash
- Check on child during night
- Advice for home care
- Follow-up / Safety-net
- Fever > 5 days
- Child looks less well after review or carer is more worried since last review
- Difficulties breathing
- Non blanching rash
Lower respiratory tract infection in children
- First line: Amoxicillin (Clarithromycin for penicillin allergy)
- Consider adding Flucloxacillin for 14-21 days for suspected infection with staphylococci (in influenza or measles)
- Consider adding a macrolide if no response after 48 hours
- Consider mycoplasma if symptoms worse than signs suggest – add macrolide and continue both agents for 10 days