Acute Paediatric ISCE station – FEVER and unwell child.
Designed by Dr. Shamim Choudhury FY3 Doctor.
Disclaimer: This document is intended for educational use only and reflects guidance for exam preparation (e.g. OSCE/ISCE practice). It is not conclusive and should not be used as a substitute for clinical judgement, local guidelines, or senior advice. Always follow your local trust policies and escalate concerns appropriately.
Note: Mneumonics such as ICE, PDFS and BINDS will help save you from losing out marks in a timed station!
Basic History Structure: Intro > ICE > Symptoms analysis and Systems review > PDFS > BINDS > Summarise history and Closing
Introduction
- Your name, role.
- Confirm patient details and who is accompanying them (guardian/parent)
- Open question: What’s brought you in today? … Pause after patient carer answers … Can you tell me more about that?
ICE the patient here to avoid forgetting: Ideas concerns and expectations!
Symptoms analysis and Systems review: Head to toe approach
- FEVER: Highest temperature recorded? Explore Red Flags immediately.
- Pain? SOCRATES: Site, Onset, Character, Radiation, Associated symptoms *See systems review*, Timing and Triggers, Exacerbating/relieving factors, Severity.
- General: Lethargy? change in behaviour? Pale than usual? Rashes?
- Neurological: Headaches, neck stiffness, photophobia, altered consciousness, abnormal movements, siezures, LOC.
- ENT: Ear ache, discharge, hearing loss, coryzal symptoms
- Eyes: Pain? conjunctivitis, serous or purulent discharge, stickiness In the morning
- Respiratory symptoms: cough/SOB/sputum/wheeze
- GI: abdo pain? Vomiting? Diarrhoea? If diarrhoea – don’t forget to ask about blood/mucous; Bowels last opened?
- GU: Urinary symptoms? *Don’t miss Nutrition and Hydration questions
- MSK – Joint: pains/erythema/reduced mobility?
NEVER MISS RED FLAGS in fever: Rash? Blanching? Reduced feeds? Reduced urine output? Lethargy / Drowsiness? Siezures? Breathing difficulties
PDFS: Past Medical History, Drug History and Allergies, Family History, Social history (Social History is Covered in BINDS) > PDFS is a useful mnemonic for Adult histories!
- PMHx: Any Past Medical History?
- DHx: Any regular medications? Any allergies?
- FHx: Any conditions that run in the family?
- SHx: See BINDS
B – Birth history
- Pregnancy complications
- Delivery (term? C-section?)
- Neonatal issues (NICU, jaundice, infections)
For Short OSCE stations: Was birth full term? Any complications during birth?
I – Immunisations: Important for infections (e.g. measles, meningococcal)
- Up to date? à Only ask this in OSCEs
N – Nutrition and hydration
- Feeding (reduced intake = red flag )
- Fluids / hydration
- Wet nappies being produced
D – Development
- Development milestones upto date
S1 – Social
- Who lives at home
- Sick contacts – siblings unwell – do they have any medical conditions?
- Smoking exposure
- Nursery/playgroup
S2: Safeguarding: Known to social services?
Exam Tip: You don’t always need all of BINDSS — but mentioning at least one for each area = easy marks
Investigations and Management plans: Think B-Boxes:
- Bedside– A-E examination including respiratory/gastro/cardio/neuro, observations
- Bloods- FBC to look for anaemia and infection, CRP to look for inflammation, U&Es and LFTs as a baseline for management and if suitable for contrast, clotting screen to look for deranged clotting, Blood cultures. ?Procalcitonin
- Orifices – Urine MC+S for septic screen
- X-rays/Imaging– may be needed but not acutely
- ECG to look at rhythm as acutely unwell
- Special tests – may need LP but would be senior decision
Management ideas relevant to the Paediatric Mock ISCE Acute station:
- ABCDE approach
- Within A-E: 2 wide bore IV cannulae. Initiate paediatric sepsis 6: Oxygen, IV ABx, fluid resuscitation (10-20ml/kg). Blood cultures, lactate. Catheter is up for debate but less common.
- Inform seniors!! Your registrar and paediatric team. Maybe even in ICU
- May need inotropic support
- Regular observations + continuous monitoring
- Likely will need to go to paediatric ICU
- Analgesia
- Nutritional support – NG feeding
- Long term management: informing public health, chemo-prophylactic antibiotics for close contracts, support for parents
… Don’t forget to mention SEPSIS 6 components to look slick in the exams.
Additional Reading:
- NICE Traffic light system for identifying risk of serious illness in under 5s https://www.nice.org.uk/guidance/ng143/resources/support-for-education-and-learning-educational-resource-traffic-light-table-pdf-6960664333
- NICE Fever in under 5s: assessment and initial management https://www.nice.org.uk/guidance/NG143
- NICE Guidance on fever children https://cks.nice.org.uk/topics/feverish-children-risk-assessment-management/
- Geeky Medics Paediatric History taking https://geekymedics.com/paediatric-history-taking/
