Ask questions about symptoms to ascertain if urgent care/A+E is needed. If so advise to call 999 or attend A+E. See sections below for more detail.
If problem not listed below book a red appointment for the child.
For all children consider SEPSIS. Please see relevant heading below for more details and when to consider calling 999.
Autism/ADHD
There are currently no NHS services accepting referrals for ADHD/ASD assessments for children under 5.
Parents/carers may choose to go private, but they will need to research suitable private providers themselves.
If the parent/carer does not wish to go private, they can be placed on an NHS waiting list (approximately 3–4 years).
Chest Infection
Face to Face Consultation
Book a red appointment for children under 2 with a suspected chest infection.
Book an amber appointment for children aged 2-5 years with a suspected chest infection.
Book a red appointment if:
- Shortness of breath/rapid breathing/sucking in between ribs/difficultly breathing
- Reduced wet nappies over 12 hours/urination
- More lethargic than usual/floppy/less responsive
- Underlying respiratory conditions e.g. asthma, cystic fibrosis
Always check for sepsis symptoms – see sepsis page/flow chart – Direct to A+E/Call 999
If none of the above refer to Cold, Coughs & Flu section
Chicken Pox
Community Pharmacy or Face to Face Consultation
Send to pharmacy for advice and product purchase.
More information on chicken pox can be found on Chickenpox – NHS.
Book a red face to face appointment if the child is reported to be very unwell or there are signs of infected lesions.
Cold, Coughs & Flu
Face to Face Consultation
If suspected cold or flu symptoms send an accurx with information. Most will resolve without treatment within 1-2 weeks. If symptoms are not improving in this time or reported as severe (see chest infection for more info) book a red appointment.
For all children aged 2 years or under book a red appointment.
Colic
Community Pharmacy/Health Visitor/Face to Face Consultation
Direct to pharmacy and/or health visitor for support and advice.
If ongoing concerns book a green appointment with a clinician.
Conjunctivitis
Community Pharmacy/Face to Face Consultation
Children aged > 2 years can be directed to the pharmacy.
Children < 2 years book a red face to face appointment.
Ear Infection
Pharmacy First Scheme or Face to Face Consultation
If aged 1 years and over refer to pharmacy first scheme (Excludes: recurrent ear infections ( 3 or more episodes in 6/12), systemically unwell, high risk of complications such as heart/lung/liver/renal conditions, children born prematurely).
For all children under 1 years old and excluded from pharmacy scheme book a red face to face appointment.
Eye problems
Conjunctivitis – See ‘Conjunctivitis’ above.
Eye trauma – Direct to A+E/urgent care.
Foreign body in eye – Direct to A+E/urgent care.
Light sensitivity (photophobia) – See ‘Meningitis,’ ‘Sepsis’ to screen for concerning features and direct to A+E if indicated. For all others book a red face to face appointment.
Red and or painful eye – Book a red face to face appointment.
Squint (eyes in different directions/lazy eye) – Book a green face to face appointment.
Sudden change in vision – If sudden loss/change in vision book a red face to face appointment.
Visual changes – If old enough direct to optician. If optician will not see book a green appointment with a clinician.
Watery eye – Book green face to face appointment.
Fever/High Temperature
A mild fever is between 37.5-37.9 degrees.
A high fever is a temperature of 38 degrees or higher.
Look for a possible underlying cause e.g. cough/UTI and see relevant heading for more information. Consider symptoms below to assess severity and act accordingly.
A&E/999
If the child has any of the following:
Has a rash that does not disappear with pressure (perform the glass test)
Breathing very fast, too breathless to talk, eat or drink
Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
Breathing that stops or pauses
Is pale, blue, mottled or feels unusually cold to touch
Difficult to wake up, very sleepy or confused
Has a fit (seizure)
RED Appointment
If the parent reports any of the following:
Getting worse and you are worried
Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
Temperature less than 36°C
Breathing a bit faster than normal or working a bit harder to breathe
Dry skin, lips or tongue
Not had a wee or wet nappy in last 8 hours
Not drinking
Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
Swelling of a limb or joint
Not using or putting weight on an arm, leg, hand or foot
Complaining of severe pain that is not improving with painkillers
Has had chickenpox in the past few days and is now getting worse with a high fever or spreading red rash
No clear cause for ongoing fever
Self Care
If no red flag features as above and cause noted for fever e.g. common cold, parents can be advised to continue to monitor the child at home or seek advice from the local pharmacy. If they have ongoing concerns book a red appointment.
Hand, Foot & Mouth
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice.
If child is reported to be very unwell book a red face to face appointment.
Headlice
Community Pharmacy or Face to Face Consultation
Children over 6 months of age – send to the pharmacy for product purchase.
Children under 6 months – will need a red appointment as pharmacy can’t supply products in this age group.
Impetigo
Pharmacy First Scheme or Face to Face Consultation
Children ages 1 and above direct to community pharmacy scheme (Excludes: Bullous impetigo, recurrent impetigo (2 or more episodes in 1 year))
Children under 1 or excluded from the pharmacy scheme book a red face to face appointment.
Measles
Face to Face Consultation
Book a red appointment.
Nappy Rash
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase.
If rash looks infected, causing severe pain or OTC products have not been helping book a red face to face appointment.
Rash
Community Pharmacy or Face to Face Consultation
RED FLAG SYMPTOMS
- A stiff neck
- Bothered by light/light sensitivity
- Confusion
- A high temperature
- The rash does not fade when you press a glass against it (advise glass test for meningitis)
- Difficulty breathing (you may noticed grunting noises or their tummy sucking under their ribs)
- Breathlessness or they are breathing very fast
- Their skin, lips or tongue looks pale, blue, grey or blotchy
These can be signs of meningitis. If a child has ANY of these symptoms advise to call 999 immediately.
If the patient does not have any red flag symptoms:
Age >2 years: Send to pharmacy for advice and product purchase.
Age <2 years, advised by pharmacist to see GP or are reported to be unwell (but no red flags) book a red face to face appointment.
Reflux
Face to Face Consultation
Book a green appointment.
Book an amber appointment if:
- No weight gain/weight loss
- Not taking feeds (baby <1 years)
- Persistent vomiting
Scabies
Face to Face Consulation
< 2 years old: Book a red appointment with a clinician.
2-5 years: Send to pharmacy for review and product purchase. Book an amber appointment with a clinician if directed back by pharmacy or uncertainty of diagnosis of scabies.
Scabies is contagious. Patients should be advised to avoid close physical contact with others and avoid sharing towels/cutlery etc
Scarlett Fever
Face to Face Consultation
Book an amber appointment.
Screen for sepsis for red flags (see sepsis heading)
Scarlett fever typically starts with flu like symptoms including a high temperature, sore throat and swollen glands in the neck. A rash appears 12-48 hours later (this feels rough like sandpaper). They can also develop a white coating on the tongue or strawberry appearance of the tongue. See NHS link for more details.
Sepsis
CALL 999
Symptoms of sepsis include:
- Blue, pale or blotchy skin, lips or tongue
- A rash that does not fade when you roll a glass over it
- Difficulty breathing (you may notice grunting noises, their stomach sucking under their ribcage, sucking in between their ribs), breathlessness or breathing very fast
- A weak, high pitched cry that’s not like their normal cry
- Not responding like they normally do or not interested in feeding or normal activities
- Being sleepier than normal or difficult to wake
- Not had a wee or wet nappy in 12 hours or more
More information on Sepsis with a checklist can be found at ‘SEPSIS’
Patients may not have all these symptoms, consider sepsis if any symptom is reported and advise the parent/guardian to ring 999 immediately.
Slapped Cheek Syndrome
Community Pharmacy or Face to Face Consultation
Direct to pharmacy/ NHS website for advice. Most cases will improve without treatment within 3 weeks.
Book a red face to face appointment if:
- Immunocompromised e.g. on chemotherapy, immunosuppressant medications
- Has a blood disorder e.g. sickle cell disease, Thalassaemia
- Reported to be very unwell
Nursery/school exclusion advice: Once the rash develops the child should no longer be infectious and it is not necessary for the child to stay off school or nursery
Sore Throat/Tonsillitis
Face to Face Consultation
Book an amber appointment.
Book a red appointment if:
- High temperature (>38)
- Struggling to eat/drink or reduced feeds
- Reduced urine output/fewer wet nappies to normal
- Immunocompromised e.g. cancer, on chemotherapy, organ transplant
Teething
Community Pharmacy or Face to Face Consultation
Direct to pharmacy for advice and product purchase.
In children who are reported to be very unwell, unable to swallow or have sores inside mouth book a red face to face appointment.
Threadworms/Pinworms
Community Pharmacy or Face to Face Consultation
Threadworms are common in children and spread easily. They appear as white thread in the poo. Other symptoms include extreme itching around the anus or vagina which is worse at night.
ALL members of the household require treatment even if they don’t have symptoms.
2 years and older: Send to pharmacy for advice and product purchase
<2 years: Book a green appointment (pharmacy can not issue medication)
Book a green appointment if treatment has failed or there is doubt over the diagnosis.
Urine Infection
Face to Face Consultation
Book a red appointment.
Ask the parent/guardian if possible to bring a urine sample to the appointment.