Clinical quiz: Managing fever in children under 5

As winter approaches, nurses in primary care are challenged with the assessment of young children presenting with raised temperature that may be common colds or potentially more serious illnesses. To help refresh your skills in this area, our latest clinical quiz explores the appropriate management of fever in children under 5.

Work your way through the cases and questions to test your knowledge.

Click start below to begin the quiz.

<p><strong>Related Article: </strong> <a id="related_article_link_2" href="https://www.nursinginpractice.com/clinical/paediatrics/mythbuster-chickenpox-is-only-a-mild-childhood-illness-theres-no-need-to-vaccinate-children-against-it/">Mythbuster: ‘Chickenpox is only a mild childhood illness, there’s no need to vaccinate children against it’</a> <section data-block="MultipleChoice"> <h3>You are seeing Avyan, a 2-year-old boy who has been brought in because his mother says that he feels hot. Which of the following are appropriate ways to measure his temperature? Select all that apply</h3> <ul> <li>Electronic thermometer in the axilla.</li> <li>Oral thermometer.</li> <li>Infra-red tympanic thermometer.</li> <li>Forehead chemical thermometer.</li> </ul> </section> <section data-block="SingleChoice"> <h3>Avyan’s temperature is 39.5°C. His respiratory rate is 42 and his pulse is 150. On direct questioning, he has no obvious source for his fever – no cough or runny nose, he isn’t pulling his ears and he doesn’t have a rash. He is off his food but is drinking OK and he hasn’t travelled abroad or had any known contacts with people who have a fever or an infectious disease. You notice that his eyes are red. His throat is a little red, but he has no pus on his tonsils and no cervical lymph nodes. He has apparently had this temperature for five days. What would you do next?</h3> <ul> <li>Treat with penicillin for presumed tonsillitis.</li> <li>Refer to paediatrics for consideration as to whether he has Kawasaki disease.</li> <li>Reassure his mother that the fever is due to conjunctivitis and prescribe chloramphenicol ointment.</li> <li>Reassure his mother that he seems to have a cold and should improve over the next few days with regular paracetamol.</li> </ul> </section> <section data-block="SingleChoice"> <h3>Janna is a four-year-old girl who has been brought in because she has a temperature, which has been checked at home several times by her mother and found to be between 37.5°C and 38.5°C. She has a runny nose and dry cough and is complaining of a sore throat but has a normal appetite. She walks into your consultation room and starts fiddling with the couch roll and trying to press buttons on your phone, reluctantly allowing herself to be examined. She has a temperature of 37.8°C, a heart rate of 110, a respiratory rate of 26, a clear chest and a red throat with no pus or cervical lymph nodes. What is your impression and what do you do?</h3> <ul> <li>Likely chest infection – give amoxicillin.</li> <li>Coryzal illness with an intermediate risk of serious illness – refer to paediatrics for review.</li> <li>Coryzal illness with low risk of serious illness – advise fluids at home and antipyretics if distressed.</li> <li>Possible glandular fever – arrange a blood test.</li> </ul> </section> <section data-block="SingleChoice"> <h3>Your next patient is Rafael, a two-month-old baby – his mother is concerned that he feels hot but doesn’t have a thermometer at home. He is fully breastfed, and she thinks that he might be slightly off his feeds, but hasn’t noticed anything else worrying. On examination his temperature is 38.8°C and you can find nothing else abnormal. What do you do?</h3> <ul> <li>Reassure his mother that most of his vital signs are normal and he probably has a cold.</li> <li>Arrange a chest x-ray.</li> <li>Ask her to bring him back in two days for a review.</li> <li>Refer urgently to paediatrics.</li> </ul> </section> <section data-block="SingleChoice"> <h3>You are carrying out telephone triage in an out of hours setting, where video calls are not available, and are speaking to the mother of Isla, a three-year-old girl. Her mother tells you that she’s had a cough for a few days and doesn’t seem to be her usual self – she isn’t really interested in her toys and is miserable all of the time. She’s a bit off her food and feels hot but is otherwise well. It’s 4am, Mum has three other children at home and is a single parent – she really would rather not have to bring them all out to get Isla seen face to face and wonders if you could give her some advice over the phone. What do you do?</h3> <ul> <li>Advise that Isla should be seen face to face.</li> <li>Advise her that this sounds like a cold and it’s fine to manage at home with paracetamol and fluids.</li> <li>Prescribe amoxicillin over the phone for a presumed chest infection.</li> <li>Prescribe penicillin over the phone for presumed tonsillitis.</li> </ul> </section> <p>  <p>

Note all cases are hypothetical and created for illustrative purposes

Dr Toni Hazell is a GP in north London

Clinical quiz: Managing fever in children under 5

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