Home > Children & Young People > Urgent Care >

Assessment of acutely unwell children

Checked: 17-09-2024 by Vicky Ryan Next Review: 17-11-2026

Assessment in Primary Care

See Common Urgent Care Conditions page for traffic light score table and presentation-specific advice.

Recommended equipment

It is advised that clinicians in primary care have access to equipment in order to obtain observations in children of all ages which is stored in an agreed place in the surgery. This should include:

Paediatric and neonatal pulse oximeters (1,2)
Baby scales
Axillary thermometer (for use in children <6 months)

Observations

Normal values for infants and children
Age	<6 months	6 months	1 year	2 years	5 years
Heart rate	110-180	120-160	100-150	95-140	80-120
Respiratory rate	30-60	30-50	20-40	20-30	20-25

Ardens Templates

Most BNSSG practices have access to Ardens templates and these can be a useful guide when assessing an unwell child. There are a range of templates depending on presenting complaint including:

Fever in a child < 5years
Fever and temperature in child under 18
Abdominal pain in children
Croup
Bronchiolitis
Cough and breathlessness

EMIS alerts

In addition EMIS also has pop up alerts when observations are coded and indicate possible sepsis/ escalation required.

PEWS - Paediatric Early Warning System

PEWS chart have been collaboratively developed by clinical teams across England to standardise the approach of tracking the deterioration of children in hospital and are to be used on general children’s wards (3). They have not yet been validated for use in the community.

Referral

See the Urgent Care Referrals page for further information on how to refer to the BRHC Emergency Department and use of the advice line.

Resources

Paediatric pulse oximeters

(1) An example is the Rad G Masimo pulse oximeter, which can be used with a child probe and an infant reusable wraparound attachment: (https://professional.masimo.co.uk/siteassets/uk/documents/pdf/plm-12399d-product-information-rad-g-british.pdf).

(2) Tips on how to effectively use a paediatric pulse oximeter: https://www.childrenscolorado.org/globalassets/departments/heart/cchd-screening-providers.pdf

PEWS

(3) National paediatric early warning system (PEWS) observation and escalation charts

Further guidelines and educational resources for GPs/healthcare professionals:

CYP education including webinars, podcasts and newsletters: https://www.bnssgtraininghub.com/cyp-education/
Brisdoc’s ‘Tips and Tripwires in Urgent Paediatric Primary Care’: https://remedy.bnssg.icb.nhs.uk/media/6694/tips-and-tripwires-in-urgent-paediatric-primary-care-digital.pdf
BCH guidelines: https://www.uhbristol.nhs.uk/for-clinicians/clinical-guidelines/
Dorset, Hampshire and IOW Healthier Together clinical resources: https://www.what0-18.nhs.uk/professionals
Spotting the Sick Child online learning tool: https://spottingthesickchild.com/

Resources for parents:

Handi App for advice on common childhood conditions: https://bnssg.icb.nhs.uk/health-and-care/health-advice-and-support/handi-app/
Dorset, Hampshire and IOW Healthier Together for advice for parents and young people (including translated information): https://www.what0-18.nhs.uk/

AccuRx templates:

Please follow link for locally developed AccuRx templates for children and young people’s health

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.