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Cough - acute with chest signs in children - Management
When should I refer a child with viral-induced wheeze, bronchiolitis, or community-acquired pneumonia?

  • Arrange admission for a child with any high risk features from the assessment. Arrange urgent admission if there are episodes of apnoea or if it is judged that the child is in severe respiratory distress.
  • For a child with any intermediate risk features, the need for hospital assessment will depend on clinical judgement, but the threshold for arranging this should be low. Arrange hospital assessment if:
    • The carers are unable to cope well with the ill child.
    • There is uncertainty about the diagnosis.
    • A complication is suspected, such as a secondary bacterial infection in a child with viral wheeze.
    • The child is unresponsive to treatment, or there is any deterioration in the condition of the child after starting treatment.
Basis for recommendation
  • These referral recommendations are consistent with guidance given by the National Institute for Health and Clinical Excellence (NICE) for identifying the likelihood of serious illness in a feverish child [National Collaborating Centre for Women's and Children's Health, 2007].
  • These recommendations are based upon the evidence of risk to a child with fever and certain symptoms and signs, and expert opinion as to the level of risk that should be managed in secondary care.

[NICE, 2007]

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