Initial Assessment


The priorities in the initial assessment include:

  1. Could something else be causing these symptoms?
  2. Does this child have risk factors for a more serious clinical course?
  3. Are there any red flags that this child is very unwell / needs resuscitation?
  4. How dehydrated is this child?

In your history and examination, any of the following features should prompt you to consider an alternative diagnosis [1]:

  • fever:
    • temperature of 38°C or higher in children younger than 3 months
    • temperature of 39°C or higher in children aged 3 months or older
  • shortness of breath or tachypnoea
  • altered consciousness
  • neck stiffness
  • bulging fontanelle in infants
  • non-blanching rash
  • blood and/or mucus in stool
  • bilious (green) vomit
  • severe or localised abdominal pain
  • abdominal distension or rebound tenderness
  • vomiting lasting more than 24 hours without diarrhoea
  • persistent diarrhoea (more than 10 days)

These alternative causes include:

  • Other infections: meningitis, septicaemia, urinary tract infection, pneumonia
  • Acute surgical abdominal conditions: appendicitis, volvulus, intussusception
  • Non-infective gastroenterological conditions: inflammatory bowel, coeliac disease, malabsorption, overflow constipation
  • Antibiotic associated diarrhoea: including Clostridium Difficile