Childhood Illnesses

Sepsis

What is sepsis?

The body’s response to an infection causes injury to its own tissues and organs through widespread inflammation

Sepsis

What can sepsis cause?

• Septic shock

• Organ failure

• Death

Sepsis

What is septic shock?

The most severe stage of sepsis, defined by:

• Persistently low blood pressure

• Poor blood flow to organs

• Cellular and metabolic dysfunction

Sepsis

Which patients is sepsis especially hard to spot in?

• Babies

• Young children

Sepsis

What can you do to help prevent infections that can lead to sepsis?

• Keep up to date with vaccines

• Clean and care for any wounds

• Take antibiotics correctly

• Wash hands regularly

• Do not ignore symptoms

Sepsis

Why may treatment for sepsis in children be delayed?

Children often exhibit unclear signs and symptoms

Sepsis

When should you call 111 or 999 for a child with suspected sepsis?

Call 111 or see your GP

If a child under 5:

• Is not feeding

• Is vomiting repeatedly

• Has not passed urine for 12 hours

Call 999 or go to A&E

If a child:

• Is breathing very fast

• Has a fit or convulsion

• Looks mottled, bluish or pale

• Has a rash that does not fade when you press it

• Is very lethargic or difficult to wake

• Feels abnormally cold to touch

Sepsis

NICE Sepsis Risk Stratification

Who is it for?

children aged 5 - 11

Sepsis

NICE Sepsis Risk Stratification

High Risk

What action should be taken if ANY high-risk criterion is present?

urgent referral to emergency care

Sepsis

NICE Sepsis Risk Stratification

High Risk

High-risk behavioural signs

• Altered mental state

• Appears ill

• Not waking or staying awake

Sepsis

NICE Sepsis Risk Stratification

High Risk

High-risk respiratory rates and oxygen saturation

Age 5: RR >= 29

Ages 6 - 7: RR >= 27

Ages 8 - 11: RR >= 25

Oxygen saturation < 90%

Sepsis

NICE Sepsis Risk Stratification

High Risk

High-risk heart rates

Age 5: >= 130 bpm

Ages 6 - 7: >= 120 bpm

Ages 8 - 11: >= 115 bpm

Sepsis

NICE Sepsis Risk Stratification

High Risk

High-risk skin signs

• Mottled or ashen skin

• Cyanosis (bluish discolouration of skin, lips, tongue)

• Non-blanching rash

Sepsis

NICE Sepsis Risk Stratification

Moderate-high risk

Features

• Not behaving normally

• Decreased activity

• Moderate tachycardia or tachypnoea

• Capillary refill >= 3 seconds

• Reduced urine output

• Temperature < 36^oC

Sepsis

NICE Sepsis Risk Stratification

Moderate-high risk

Management

• If child has an impaired immune system = refer to A&E

• If a clear alternative diagnosis = treat and give safety advice

• If no clear diagnosis = refer to A&E

Sepsis

NICE Sepsis Risk Stratification

Low-risk

Features

• Child is behaving normally

• No moderate or high-risk criteria

Sepsis

NICE Sepsis Risk Stratification

Low-risk

Management

• Advise parents on what symptoms to monitor

• Explain when/how to seek medical help

Sepsis

NICE Sepsis Risk Stratification

Key point

ONE RED FLAG = IMMEDIATE REFERRAL TO A&E

Meningitis

What is meningitis

Inflammation of the 2 inner meninges (the pia and arachnoid mater) of the brain and spinal cored

Meningitis

Meningitis can either be…

infection or non-infective

Meningitis

What is the difference between bacterial meningitis and meningococcal disease?

Bacterial meningitis: any bacterial infection of the meninges

Meningococcal disease: a type of bacterial meningitis, infection of the meninges by N. meningitidis

Both are notifiable diseases » healthcare professionals are legally required to report suspected or confirmed cases to public health authorities

Meningitis

Causes of meningitis in:

• Children 3 months+ and adults

• Neonates (<1 month)

Children 3 months+ and adults

• Neisseria meningitidis (meningicoccus)

• Streptococcus pneumoniae (pneumococcus)

• Haemophilus influenza type b (Hib)

Neonates (<1 month)

• Streptococcus agalactiae

• Escherichia coli

• S. pneumoniae

• Listeria monocytogenes

Meningitis

How are bacterial meningitis and meningococcal disease transmitted?

• Aerosol

• Respiratory droplets

• Direct contact with upper respiratory secretions e.g. coughing, sneezing, kissing

Meningitis

Where do the infectious secretions that transmit meningicoccal disease originate from?

the upper respiratory tract

Meningitis

What is the usual relationship between Neisseria meningitidis and humans?

It is usually commensal - lives harmlessly in the human nasopharynx without causing disease

Meningitis

What is an incubation period?

What is the typical incubation period for meningitis?

• The time between exposure to an infectious organism and the appearance of symptoms

• 3 - 5 days

Meningitis

Which age group has the highest incidence of bacterial meningitis and meningococcal disease?

Children under 2

Meningitis

How does the incidence of meningitis change during childhood?

declines with age

Meningitis

Why is meningococcal disease considered particularly serious in paediatrics?

It is a leading infectious cause of death in children

Meningitis

Symptoms

• Fever

• Vomiting

• Irritability

• Upper respiratory tract symptoms

• Seizures

• Neck stiffness

• Bulging fontanelle (soft spot)

• High pitched cry

• RASH

Meningitis

Which classic signs of meningitis and are often absent in infants with bacterial meningitis?

• Neck stiffness

• Bulging fontanelle (soft spot)

• High pitched cry

Meningitis

Features of the rash

Usually starts as small, red pinpricks before spreading quickly and turning into red and purple blotches

Meningitis

What feature of meningitis indicates sepsis?

The rash does not fade if you press the side of a clear glass firmly against the skin » CALL 999

Meningitis

Treatment for bacterial meningitis

• Tests in hospital to confirm diagnosis

• Treated in hospital for at least a week

Treatments include:

• IV Antibiotics

• IV Fluids

• Oxygen through a face mask

Meningitis

Treatment of viral meningitis

Tends to self-resolve within 7 to 10 days:

• Get plenty of rest

• Take painkillers and anti-sickness medication

Meningitis

Which vaccinations offer protection against meningitis?

• MebB vaccine

• The 6-in-1 vaccine

• Pneumococcal vaccine

• Hib/MenC vaccine

• MMR vaccine

From when will routine MMRV vaccination be introduced in the UK?

1 January 2026

What infections does the MMRV vaccine protect against?

Measles, mumps, rubella, and varicella (chickenpox)

At what ages will routine MMRV doses be given?

• 12 months

And

• 18 months

What vaccine does MMRV replace in the childhood schedule?

The MMR vaccine in the routine 2-dose schedule.

Which children are affected by the wider schedule changes from January 2026?

Children born on or after 1 July 2024

What change is made to the hexavalent (DTaP/IPV/Hib/HepB) vaccine schedule?

An additional 4th dose at 18 months

Why is the extra hexavalent dose at 18 months being introduced?

To provide longer-term protection against Hib infection

Measles

Measles is usually a self-limiting condition with symptoms usually resolving over the course of about a week. Which of these prodromal symptoms is least likely to be for measles.

A. Fever
B. Cough
C. Corzya
D. Conjunctivitis
E. Pain

E. Pain

Measles

The main complications of measles are of the respiratory tract or central nervous systems. Which complication is LEAST appropriate in a patient with measles
A. Otitis media
B. Pneumonia
C. Blindness
D. Convulsions
E. Deafness

E. Deafness

Measles

Measles is a highly contagious infection caused by a morbillivirus of the paramyxovirus family. Which statement is the MOST appropriate for a child with measles.

A. The person is infectious from when symptoms first appears (around 4 days before the rash) to 4 days after the onset of the rash.
B. Measles is spread by direct contact with infectious droplets or by airborne transmission from breathing, coughing or sneezing
C. The viruses can remain potentially infectious in the air for up to 4 hours after a person with measles has left.
D. Once infected the person usually develops lifelong immunity.

A. The person is infectious from when symptoms first appears (around 4 days before the rash) to 4 days after the onset of the rash.

Measles

A 6-year-old child suffering from measles should stay away from nursery or school. What is the LEAST appropriate management option

A. To rest and drink adequate fluids
B. Take paracetamol or aspirin for the symptomatic relief
C. Stay away from nursery or school for at least 4 days after initial development of the rash
D. Should avoid contact with pregnant women.

B. Take paracetamol or aspirin for the symptomatic relief

Slapped Cheek Disease (Parovirus B19)

A child with her mother visits your pharmacy with suspected parvovirus B19 infection. How many days after the rash or symptoms developed is the child considered no more infectious?

A. 1 day
B. 2 days
C. 5 days
D. 7 days

C. 5 days

Slapped Cheek Disease (Parovirus B19)

If a child is suspected of fifth disease. Which of the following statement is LEAST appropriate?

A. Avoid contact with people at increased risk of complications
B. Symptom relief can be with analgesia
C. In a healthy child with fifth disease will need a laboratory investigation to confirm the diagnosis
D. Parovirus B19 infection can cause slapped cheek

C. In a healthy child with fifth disease will need a laboratory investigation to confirm the diagnosis

Slapped Cheek Disease (Parovirus B19)

Slapped cheek syndrome is common in children and should get better on its own within how many days

A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks

B. 2 weeks

Slapped Cheek Disease (Parovirus B19)

In order to reduce the risk of spreading the virus that causes fifth disease, which statement is LEAST appropriate for general advice

A. Wash your hands often with water and soap
B. Use tissues to trap germs when coughing or sneezing
C. Bin used tissues as quickly as possible
D. Give analgesic including aspirin to the child when required.

D. Give analgesic including aspirin to the child when required.

Scarlet Fever

Scarlet fever usually lasts for how many weeks

A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks

A. 1 week

Scarlet Fever

Which one of the following statement is LEAST appropriate for scarlet fever?

A. If a child has scarlet fever, stay away from school for 24 hours after you take the first dose of antibiotics
B. You can spread scarlet fever to other people until 48 hours after you take the first dose of antibiotics.
C. Don’t share cutlery, cups, towels, clothes, bedding or baths with who has symptoms of scarlet fever
D. Use calamine lotion or antihistamines to ease itching.

B. You can spread scarlet fever to other people until 48 hours after you take the first dose of antibiotics.

Scarlet Fever

A child shows a white coating on his tongue which peels leaving the tongue red, swollen and covered in little bumps. This appearance of the tongue is known as

A. Strawberry tongue
B. Scarlet fever tongue
C. Red tongue
D. Raspberry tongue

A. Strawberry tongue

Scarlet Fever

A child with symptoms of scarlet fever, shows first signs of this condition by showing flu like symptoms. How many hours later will a rash appear on this child.

A. 12 – 24 hours
B. 24 – 48 hours
C. 12 – 48 hours
D. 24 – 72 hours

C. 12 – 48 hours

Hand Foot and Mouth Disease

Hand foot and mouth disease usually gets better on its own. Within how many days does a child with the disease get better?

A. 7 – 10 days
B. 10 – 14 days
C. 7 – 14 days
D. 10 – 21 days

A. 7 – 10 days

Hand Foot and Mouth Disease

Which of the following statements about hand foot and mouth is LEAST appropriate when giving general advice to parents or carers of child with the condition

A. Keep the child off School or nursery while they’re feeling too unwell to go
B. Child needs to wait until all the blisters have healed before going back to School
C. Wash soiled bedding and clothing on a hot wash
D. Most likely to spread symptoms to others in the first 5 days after symptoms start.

B. Child needs to wait until all the blisters have healed before going back to School

Hand Foot and Mouth Disease

For a patient with symptoms of hand foot and mouth, which of the following statements is LEAST appropriate as an advice

A. Drink cool fluids such as fruit juice to sooth the mouth and prevent dehydration
B. Eat soft foods like yoghurt
C. Take paracetamol or ibuprofen to help ease a sore mouth or throat
D. Avoid hot, salty and spicy food

A. Drink cool fluids such as fruit juice to sooth the mouth and prevent dehydration