What are signs of active infection or systemic illness in a 3 year old who is du

Posted: 10 January 2026 Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Signs of active infection or systemic illness in a three-year-old child scheduled for tonsillectomy include:

  • Fever: Elevated temperature, particularly 38°C or higher, is a key sign of infection or systemic illness.
  • Breathing difficulty: Signs such as tachypnoea (respiratory rate over 40 breaths per minute for children older than 12 months), nasal flaring, chest indrawing, cyanosis, or oxygen saturation ≤95% on air indicate respiratory involvement and systemic illness.
  • Marked systemic illness or sepsis signs: These include pallor of skin, lips or tongue; mottled or ashen appearance; cold hands or feet; capillary refill time ≥3 seconds; reduced urine output; and altered behaviour or decreased level of consciousness.
  • Difficulty swallowing saliva or liquids, or any difficulty in breathing: These symptoms suggest significant local or systemic infection requiring urgent reassessment.
  • One-sided neck or throat swelling: May indicate abscess formation or cellulitis, which are serious complications.
  • Signs of dehydration: Such as prolonged capillary refill time, abnormal skin turgor, weak pulse, or cool extremities.
  • Other systemic signs: Non-blanching rash (purpura), neck stiffness, bulging fontanelle, convulsions, or focal neurological signs suggest severe systemic infection like meningitis or sepsis.

In the context of tonsillectomy, if any of these signs are present, surgery should be deferred and urgent medical assessment arranged.

These signs are based on NICE guidelines for sore throat, feverish children, and suspected sepsis, which emphasize the importance of identifying systemic illness before elective procedures like tonsillectomy 1,3,4,5.

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This content was generated by iatroX. Always verify information and use clinical judgment.