Pediatric fever/rash triage

Office triage structure for pediatric fever/rash with disposition and safety-net focus.

Last reviewed February 7, 2026

Red flags

Toxic appearance, altered consciousness, respiratory distress, poor perfusion, or persistent lethargy.
Non-blanching rapidly progressive rash, neck stiffness, or severe headache.
Inability to maintain hydration or worsening symptoms despite first-line care.

Assess age, hydration, activity level, mental status, and caregiver-reported trajectory.
Clarify rash evolution, distribution, blanching status, and associated systemic symptoms.
Confirm immunization status and exposure history. Suspected measles requires airborne precautions and prompt public health notification; avoid a shared waiting area.

Record full vital signs and serial trend if concern for deterioration.
Infants aged 90 days or younger with rectal temperature at least 38.0 C, including a home measurement, need urgent age-specific evaluation in an appropriately equipped setting even when well appearing.
For older children, focus investigations on clinical risk rather than routine broad testing.
Reassess appearance and hydration after supportive care; a lower temperature after antipyretics does not exclude serious illness.

Provide clear home-care guidance with hydration targets and monitoring milestones.
Use shared plan with caregiver for reassessment window and return criteria.
Keep threshold low for escalation when reliable follow-up cannot be ensured.

Persistent fever/rash with uncertain diagnosis after first reassessment.
Concern for serious bacterial illness, inflammatory syndrome, or rapidly progressive disease.
Caregiver or systems barriers that make safe outpatient monitoring unreliable.

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