Question 1

What is the NICE NG143 traffic light system for fever in children?

Accepted Answer

NICE NG143 uses a traffic light system: Green (low risk) — normal colour, responds normally, moist mucous membranes, normal capillary refill — manage at home with safety netting. Amber (intermediate risk) — pallor, not responding normally, dry mucous membranes, reduced urine output, fever >5 days — same-day medical review. Red (high risk) — pale/mottled/ashen/blue, unresponsive, bulging fontanelle, non-blanching rash, temperature >38°C in under 3 months, signs of meningism, capillary refill >3 seconds — immediate emergency referral.

Question 2

What is the correct paracetamol dose for children by weight?

Accepted Answer

Paracetamol dose for children: 15 mg/kg per dose, maximum 4 doses in 24 hours (every 6 hours). Maximum single dose 1 g. Maximum daily dose 60 mg/kg/day or 4 g/day, whichever is lower. For 10 kg child: 150 mg per dose. For 20 kg child: 300 mg per dose. For 30 kg child: 450 mg per dose. Oral suspension 250 mg/5 mL is standard. Reduce dose by 50% in hepatic impairment. Do not use in neonates without specialist guidance.

Question 3

When should a GP refer a febrile child under 3 months?

Accepted Answer

All febrile infants under 3 months (temperature ≥38°C rectal or ≥37.5°C axillary) should be referred to hospital immediately. They are at high risk of serious bacterial infection (sepsis, meningitis, UTI, pneumonia) and cannot reliably demonstrate focal signs. A full septic workup (blood culture, FBC, CRP, urine, lumbar puncture if no contraindication) and IV antibiotics are required. Never send home without hospital assessment. Under 1 month — any temperature abnormality requires emergency referral.

Question 4

What are the key safeguarding red flags for non-accidental injury in children?

Accepted Answer

Key NAI (non-accidental injury) red flags: TEN-4 bruising rule — bruises on Torso, Ears, or Neck in any child under 4 years, or any bruise in a child under 4 months; Inconsistent or changing history; Bruises in non-ambulatory children; Posterior rib fractures, metaphyseal corner fractures, or multiple fractures of different ages on X-ray; Retinal haemorrhages suggesting abusive head trauma; Unexplained or delayed presentation; Pattern of repeated minor injuries. Always document carefully, refer to children's social care (MASH), and do not share concerns with the alleged perpetrator.

Paediatrics

Fever & Sepsis

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