Pediatric fever/rash triage + safety-net

Scope

Use for

Pediatric office triage for fever/rash with parent counseling and safety-net instructions.

Not for

• Toxic-appearing or rapidly deteriorating child requiring ED escalation.
• Definitive management of febrile infants aged 90 days or younger; arrange age-specific urgent evaluation.

Immediate actions

• Record age, temperature and measurement method, vital signs, appearance, hydration and urine output; assess rash, mucosa, immunization and exposure history.
• For suspected measles, use airborne precautions, keep the child out of shared waiting areas, and contact public health without waiting for test results.

Red flags: escalate now

If any of these are present, stop routine steps and follow the urgency stated. Activate emergency care for instability or findings that need immediate transfer.

• Any infant aged 90 days or younger with a rectal temperature of 38.0 C or higher, including a fever measured at home, needs prompt assessment in a setting equipped for the age-specific febrile-infant workup even if appearing well. Hypothermia below 36.0 C also requires urgent evaluation.
• Emergency transfer for impaired consciousness, breathing difficulty, poor perfusion, seizure, or fever with a non-blanching rash, especially purpura or rapid progression.
• Arrange urgent reassessment for poor intake, reduced urine output, worsening appearance or inability to monitor safely.

First-line plan

• In older, clinically well children, select testing by the suspected cause and clinical risk. Improvement after antipyretics does not exclude serious illness.
• Offer fluids and weight-appropriate symptom relief for discomfort; verify product concentration and avoid duplicate ingredients.
• Give caregivers written return precautions and a named reassessment route.

Follow-up and monitoring

• Reassess sooner for deterioration and if fever persists beyond 48-72 hours. Infants younger than 6 months with fever need clinician assessment.
• Fever lasting 5 days or longer warrants assessment for Kawasaki disease, particularly with mucosal, conjunctival or extremity changes; do not wait until day 5 if the child is unwell.

Before the patient leaves

Return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

• Point to the red flags above that apply to this patient.
• Confirm follow-up timing and where to go after hours.
• Attach a relevant handout to reinforce the plan.
• Document disposition, rationale, unresolved uncertainty, and that precautions were understood.

About this workflow

Clinical owner

Family Medicine Editorial Team

Risk tier

High

Review cadence

Every 3 months

Last reviewed

September 4, 2026AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.

Review status

Evidence current. Next review due December 4, 2026.

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)