Pediatric fever/rash escalation referral checklist

Urgency tier

• Emergency transfer for toxic appearance, altered consciousness, respiratory distress or poor perfusion.
• Urgent age-specific assessment for an infant 90 days or younger with rectal temperature at least 38.0 C, even when well appearing; do not await a routine referral.
• Non-blanching/purpuric rash, rapidly progressive rash, or concern for invasive infection.
• Inability to maintain hydration, reduced urine output, or persistent vomiting.
• Clinical deterioration, caregiver inability to monitor safely, or unreliable follow-up access.

Minimum pre-referral workup

• Full symptom timeline including fever duration, rash progression, and exposure history.
• Vital signs, hydration status, mental status, and documented serial clinical trajectory.
• Immunization status, medication history, and recent travel/contact risk details.
• Focused exam documentation (skin morphology/distribution, mucosal findings, respiratory status).

Referral packet checklist

• Working differential and reason escalation is needed now versus routine follow-up.
• Key exam findings, vitals trend, and objective deterioration or persistence markers.
• Completed tests/treatments and response to date.
• Explicit safety-net instructions already provided to caregivers.

Pre-referral optimization tasks

• Do not delay emergency transfer to complete tests or fever-care counseling; provide supportive care while arranging handoff.
• Confirm caregivers can recognize warning signs and know where to seek urgent care.
• Arrange short-interval reassessment while referral is pending.

References

• CPS Febrile infants aged 90 days or younger (updated May 2026) (opens in a new tab)
• CPS Fever and temperature taking (opens in a new tab)
• PHAC Measles for health professionals (opens in a new tab)
• NICE NG143 Fever in under 5s (opens in a new tab)

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