Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key signs and symptoms of common childhood infections warranting further investigation or referral include:
- Meningococcal disease: fever with a non-blanching rash, especially if the child appears ill, has purpura (lesions >2 mm), prolonged capillary refill (≥3 seconds), or neck stiffness NICE NG143.
- Bacterial meningitis: fever with neck stiffness, bulging fontanelle, decreased level of consciousness, or convulsive status epilepticus NICE NG143.
- Herpes simplex encephalitis: fever with focal neurological signs, focal seizures, or decreased level of consciousness NICE NG143.
- Pneumonia: fever with tachypnoea (age-specific thresholds: >60 breaths/min for 0–5 months, >50 for 6–12 months, >40 for >12 months), chest crackles, nasal flaring, chest indrawing, cyanosis, or oxygen saturation ≤95% on air NICE CKS,NICE NG143.
- Urinary tract infection (UTI): fever in children under 5, especially with dysuria, increased frequency, new bedwetting, malodorous or cloudy urine, abdominal or loin tenderness, or capillary refill >3 seconds NICE CKS,NICE NG143.
- Septic arthritis or osteomyelitis: fever with swelling of a limb or joint, refusal to use an extremity, or non-weight bearing NICE CKS,NICE NG143.
- Kawasaki disease: fever lasting 5 days or more with bilateral conjunctival injection (without exudate), erythema/cracking of lips, strawberry tongue, erythema of oral/pharyngeal mucosa, oedema/erythema of hands and feet, polymorphous rash, or cervical lymphadenopathy NICE CKS,NICE NG143.
- Signs of severe illness requiring urgent referral: compromised airway, breathing, circulation, or consciousness; shock; unrousable state; or signs of meningococcal disease NICE CKS.
Children with these signs should be urgently assessed face-to-face or referred to paediatric specialists as appropriate NICE CKS,NICE NG143. Safety-netting advice and follow-up should be provided if immediate referral is not required but amber features are present NICE CKS.