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Cough - acute with chest signs in children - Management
How do I assess a child with a respiratory tract infection and chest signs on examination?

  • A child is considered to be at high risk if any of the following features are present:
    • Respiratory rate (RR) > 60/minute, apnoea or grunting, moderate or severe chest indrawing
    • Oxygen saturations < 90% on air
    • No response to social cues, they are unable to be roused, or if rousable they do not stay awake
    • Appears ill to healthcare professional
    • Reduced skin turgor
    • Age < 3 months and temperature > 38°C, or age 3–6 months and temperature > 39°C
  • A child is considered to be at intermediate risk if they have no high risk features and have any of the following features:
    • Age < 12 months and RR > 50/minute, or age > 12 months and RR > 40/minute, nasal flaring, crackles (pneumonia or bronchiolitis)
    • Oxygen saturation < 95% on air
    • Pallor reported by parent/carer
    • No response to normal social cues, awakes only with prolonged stimulation, decreased activity
    • Poor feeding in infants (less than 50% of normal fluid intake in preceding 24 hours), dry mucous membrane, reduced urine output
    • Capillary refill time > 3 seconds
    • Fever > 5 days duration
  • A child is considered to be at low risk if no features of intermediate or high risk are present.
  • Note: risk is higher in young infants, infants with syndromes or who were premature, and in children with any significant medical history, such as chronic lung disease or congenital heart disease. These additional factors should be considered before deciding on the level of risk.
  • Assess the ability of the child's carers to cope with the ill child.

In depth

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