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Cough - acute with chest signs in children - Management
Table: Risk assessment of child with a respiratory tract infection
Table 1. Assessment of risk in a child with a cough and signs in the chest on examination.
| Intermediate risk | High risk |
|---|
Respiratory rate (RR) | Age < 12 months and RR > 50/minute Age > 12 months and RR > 40/minute | RR > 60/minute |
Other respiratory features | Nasal flaring Crackles (pneumonia or bronchiolitis) Oxygen saturation < 95% on air* | Apnoea or grunting Moderate or severe chest indrawing Oxygen saturations < 90% on air* |
Colour | Pallor reported by parent/carer | Pale/mottled/ashen/blue |
Activity† | No response to normal social cues† Awakes only with prolonged stimulation† Decreased activity† | No response to social cues† Unable to be roused, or if rousable does not stay awake† Appears ill to healthcare professional† |
Hydration/feeding | 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 | Reduced skin turgor |
Temperature | Fever > 5 days duration | Age < 3 months and temperature > 38°C Age 3–6 months and temperature > 39°C |
* May not be available in primary care. † Activity and appearance are highly subjective and are considered poor markers of severity by some experts. |
- 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.
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