Initial assessment of any febrile child

For all febrile children the following should be undertaken:

• Fully undress and examine systematically. Make a thorough search for a focus of infection: think about the 'hidden sites' such as meninges, urinary tract and bloodstream (septicaemia). Mildly pink tympanic membranes or throat do not constitute a focus.
  
  
  
• If a rash is found, it is important to decide whether it is non-blanching. All febrile children with haemorrhagic rashes must be taken very seriously. Although many children with fever and petechiae will have viral illnesses ^{17 28 29} there is no room for complacency when assessing these children. They must all have their vital signs measured, a decision made as to whether they have signs of meningitis or septicaemia and given intravenous antibiotics. A senior paediatrician should be informed immediately. Some hospitals in the UK may have local protocols on action to take when a haemorrhagic rash if found, depending on whether the rash is petechial or purpuric, and there is work underway to consolidate this⁴⁸.
  
  
  
• Children without a rash or with a blanching rash can still have MD. The rash may appear later or not at all if the child has pure meningitis and occasionally with septicaemia. Thorough clinical assessment should ascertain whether there are physical signs of serious systemic illness.
  
  
  
• If initial assessment of airway, breathing and circulation reveals that you are dealing with a seriously ill child, ABC should be rectified in line with APLS guidelines³⁰ before proceeding with the detailed examination.