Table 1

 Diagnosis, treatment, and disposition of common childhood illnesses not requiring hospital admission

Common conditionsSubjective findingsObjective findings (only some may be present and only most common are listed)PlanDisposition
Fever• Hot and unwell• Depends on cause (must be sought and found)• Exclude serious cause• Care at home, refer for further investigations if cause cannot be identified and child significantly unwell or serious cause cannot be excluded
• Miserable• Symptomatic treatment
• May be off food/fluids• Cause must be sought (including urine culture if no other cause found)
• Do not give antibiotics if cause unknown
Vomiting• Frequency ? blood• Rule out:• Exclude abdominal or other serious pathology• Care at home unless very unwell/dehydrated or significant pathology cannot be excluded
• ?tolerating clear fluids • ?bile stained○ dehydration ○ other sign of infection ○ Surgical pathology• If tolerating clear fluids, encourage clear fluids till improving then solid diet
• Do not give antiemetics
Diarrhoea• Need description ?blood ?slime ?watery ?amount ? smell• Rule out: ○ abdominal abnormalities ○ signs of dehydration• Encourage clear/electrolyte replacement fluids to re-hydrate only• Care at home unless very unwell/dehydrated or history of bloody diarrhoea, or significant pathology cannot be excluded
• May be vomiting or anorexic○ other signs of infection• Exclude occult infection and dehydration
• Exclude other abdominal pathology
• Continue breastfeeding throughout. Recommence solids and formula feeds after re-hydrating
• Mild fever• Avoid foods high in fat or simple sugars
• Do not give antidiarrhoeal agents
Upper respiratory tract infection• Cough• Inflamed throat• Symptomatic treatment• Care at home
• “Cold”• Otitis media• No antibiotics
• Sore throat• Coryza,• Review if fluid intake poor
• Snuffly• Chest clear
• Hot and miserable• Fever
• May be off food
Croup (mild)• Barking cough• Barking cough• Nebulised budesonide or oral dexamethasone• Care at home unless systemically unwell or deteriorating
• Noisy breathing• May have mild stridor
• May be worse at night• Child not distressed
• Mild fever possible
Asthma (mild)• Wheeze • Cough• Bilateral wheeze • Good air entry• Adjustment of dose of bronchodilator• Care at home unless no response to treatment, deteriorating, or history of previous ITU admission
• May be URTI• May be tachypnoeic • Child not distressed• Check technique of administration using spacer
• Oral (soluble) prednisolone
Bronchiolitis (mild)• URT symptoms followed by lower respiratory symptoms• Not distressed• Symptomatic treatment• Care at home; consider need for follow up visit and encourage recall if condition deteriorates (especially reluctance to feed or breathing difficulty). Very low threshold for admission in babies under 2 months old
• Mild tachypnoea
• Mild fever possible
• Bilateral inspiratory fine crackles and wheeze
Conjunctivitis• Sore gritty eyes • Normal visual acuity• Mildly inflamed conjunctiva, often bilaterally• Regular cleaning with cooled boiled water• Care at home
• Sometimes purulent discharge• Antibiotic eye drops
Foreign body• History of witnessed insertion of object in nose, ear• Foreign body visible • Stridor • Wheeze• May be possible to remove—if not refer to appropriate specialist• Care at home if object removed, otherwise refer to A&E
• “Missing” object• Unequal air entry• Do not attempt to remove blindly if lodged in pharynx
• Sudden respiratory distress
Tonsillitis• Sore throat • Systemically unwell • Sore neck • Difficulty swallowing• Swollen inflamed tonsils • Exudate • Lymphadenopathy • Fever• Mild—symptomatic treatment, otherwise penicillin (unless allergic when use suitable alternative) for 10 days and symptomatic treatment• Care at home with advice to recall if swallowing becomes impossible or airway becomes noisy
Teething• Miserable• Teeth erupting• Symptomatic treatment• Care at home
Otitis media• Miserable• Inflamed ear drum +/− perforation• Symptomatic treatment • Consider antibiotics if• Care at home • If eardrum perforated, refer
• Fever possiblevery severe or if eardrum is perforatedto GP for review and keep ear dry
Skin and viral rashes
Chicken pox (uncomplicated—see fig 2)• Mild URTI symptoms • Rash• Blistering rash in crops, most severe on trunk• Symptomatic treatment• Care at home
• Mild fever
Scabies• Itchy rash• Itchy papules, may be more generalised than in adults, with some “tracks”• Non-urgent referral to GP• Care at home and non-urgent referral to GP
Impetigo• Crusting rash• Yellow/golden crusting spreading rash• Systemic antibiotics unless very tiny lesion when topical antibiotics may be tried• Care at home
• May occasionally be systemically unwell• Advise on reducing spread to other family members
• May be painful especially if secondary infection
Mumps (uncomplicated)• Swollen neck• Parotid swelling• Symptomatic treatment• Care at home
• Difficulty opening mouth and swallowing• Loss of palpable angle of mandible
• Mild fever/malaise
Rubella (see fig 5)• Fine pink rash• Fine macular rash• Symptomatic treatment• Care at home
• May be very slightly unwell• Posterior cervical lymphadenopathy• Check no contact with pregnant adult is likely
• Minimal systemic upset
Roseola infantum• High fever which settles when rash comes out• Discrete rash that may coalesce• Symptomatic treatment• Care at home
• May be oedema of eyelids
• Fever
Measles (uncomplicated—see fig 6)• Upper respiratory symptoms• Unwell child• Symptomatic treatment• Care at home
• Rash• Kopliks spots early in illness• Notifiable disease
• Typical rash
• Upper respiratory tract signs
• No sign of complications (for example, pneumonia)
Increase in seizures• In child known to have seizures• Infection or any obvious cause• Look for infection• Refer to GP if not currently seizing and otherwise well; refer to A&E if currently seizing or seizures very frequent (see article 5 on primary survey positive children)
• Recent change in medication dose; not taking medication or malabsorbing (for example, GI upset)
Head injury (mild)• No symptoms• May be bruising• Rule out significant mechanism of injury• Care at home in the absence of history of loss of consciousness and significant symptoms; advise recall if symptoms present.
• If no loss of consciousness, persistent vomiting, unusual drowsiness, or visual disturbance since injury, advise that treatment should be sought if these symptoms present• Provide written head injury instructions
Headache• Ask for type, when it occurs in day, associated features• Exclude serious infection• Look for signs of raised intra-cranial pressure and meningitis• If child well with no signs of meningitis, provide symptomatic treatment and refer to GP
• Past history investigations• Arrange urgent review if unwell or condition worsens
Febrile convulsions• Fever, child known to have febrile convulsions• Fever • Infection • Usual age range approx. 6 months to 6 years• Locate source of infection and treat, referring to hospital if serious cause found or if no cause found • Check blood sugar• Care at home for simple febrile convulsions, provided
○ This is not the first fit
○ It is a simple convulsion
○ The cause of the fever has been identified and is benign
○ No more than one fit in a 24 hour period
○ The parents are confident about caring for the child
Abdominal pain (colicky)• May be irritable• Rule out surgical problem abnormalities • Look for associated features• Exclude appendicitis, obstruction. or other pathology• If child is completely well, refer to GP. If child is unwell or parents are concerned, refer urgently to GP or hospital
(see above)• Symptomatic treatment
Dysuria• Complaining of pain when passing urine• Balanitis possible• Mild balanitis can be treated with salt baths• Care at home; refer for further investigations if no cause found
• Rule out renal tenderness• If balanitis is severe will require antibiotics
• Check otherwise well or minimum systemic upset• If no balanitis check urine culture and treat for urinary tract infection till results of culture available