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CLINICAL: CHILDREN’S HEALTH


2. Purssell E, While A, Coomber B. Tympanic thermometry-normal temperature and reliability. Paediatric Nursing 2009;21(6):40-3.


3. El-Radhi AS, Patel S. An evaluation of tympanic thermometry in a paediatric emergency department. Emergency Medicine Journal 2006;23(1):40-1.


4. Dixon G, Deehan D, Dickson R, et al. Clinical and consumer guidelines related to the management of childhood fever. Journal of Research in Nursing 2006;11(3):263-78.


5. National Institue for Health and Clinical Excellence. Feverish Illness in children, assessment and initial management in children younger than 5 years. London: National Collaborating Centre for Women’s and Children’s Health; 2007.


6. Van den Bruel A, Aertgeerts B, Bruyninckx R, et al. Signs and symptoms for diagnosis of serious infections in children: a prospec- tive study in primary care. British Journal of General Practice 2007;57:538-46.


7. Health Protection Agency. Vaccination of Individuals with Uncertain or Incomplete Immunisation Status. London: HPA; 2010. Available at: www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947406156


8. Prymula R, Siegrist C-A, Chlibek R, et al. Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials. The Lancet 2009;374(9698):1339-50.


9. Department of Health. Immunisation against infectious diseases.


London: DH; 2006. Available at: www.dh.gov.uk/en/Publicationsand- statistics/Publications/PublicationsPolicyAndGuidance/DH_079917


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TABLE 1. NICE’S TRAFFIC LIGHT SYSTEM FOR IDENTIFYING LIKELIHOOD OF SERIOUS ILLNESS5 Green: low risk


Amber: intermediate risk Colour Activity


Normal colour of skin, lips and tongue.


Responds normally to social cues. Content/smiles. Stays awake or awakens quickly. Strong normal cry/not crying.


Pallor reported by parent/carer.


Not responding normally to social cues. Wakes only with prolonged stimulation. Decreased activity. No smile.


Respiratory


Nasal flaring. Tachypnoea: – RR > 50 breaths/minute age 6-12 months;


– RR > 40 breaths/minute age > 12 months.


Oxygen saturation ≤ 95% in air. Crackles.


Hydration


Normal skin and eyes. Moist mucous membranes.


Dry mucous membrane. • Poor feeding in infants. CRT ≥ 3 seconds. Reduced urine output.


Reduced skin turgor. Red: high risk Pale/mottled/ashen/blue.


No response to social cues. Appears ill to a healthcare professional. Unable to rouse or if roused does not stay awake. Weak, high-pitched or continuous cry.


Grunting. Tachypnoea: – RR > 60 breaths/minute. Moderate or severe chest indrawing.


Other


None of the amber or red symptoms or signs.


Fever for ≥ 5 days Swelling of a limb or joint. Non-weight bearing/ not using an extremity. A new lump > 2cm


Age 0–3 months, temperature ≥ 38°C. Age 3–6 months, temperature ≥ 39°C. Non-blanching rash. Bulging fontanelle. Neck stiffness. Status epilepticus. Focal neurological signs. Focal seizures. Bile-stained vomiting.


CRT = capillary refill time; RR = respiratory rate.


58 Nursing in Practice March/April 2012


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