Mastering Paediatric Fever Guidelines for PLAB 2 OSCE Success

Mastering Paediatric Fever Guidelines for PLAB 2 OSCE Success

Fever in a child is perhaps one of the most common and high-stakes scenarios you will encounter in the Paediatric stations of the PLAB 2 OSCE. Examiners are not just testing your clinical knowledge; they are assessing your ability to perform a rapid risk assessment, communicate effectively with anxious parents, and provide precise, life-saving safety netting advice according to UK guidelines (NICE).

Here is your definitive guide to approaching the febrile child scenario in the PLAB 2 exam, focusing on the structured approach that guarantees marks.

1. The Foundation: Rapid Risk Assessment (The Traffic Light System)

The cornerstone of UK paediatric guidelines for fever management is the stratification of risk using clinical features. You must be able to categorize the child into High Risk (Red), Intermediate Risk (Amber), or Low Risk (Green).

Key Features to Elicit in the History and Examination:

PLAB 2 Tip: Always document and communicate which risk category the child falls into. If the child presents with any 'Red' feature, they are managed as High Risk, regardless of other findings.

2. Clinical Management and Investigation Guidelines

Management is dictated entirely by the risk stratification. Your response must be immediate and decisive.

A. High-Risk (Red) Management

• Immediate Action: Admit the child to hospital. Call for immediate senior help (Paediatric Registrar/Consultant). Do not delay.

• Investigations (Typically pre-admission/immediate ED): Blood cultures, full blood count, CRP, U&Es, Blood gas, Urine dipstick/culture (if feasible and non-delayed). Consider Lumbar Puncture (especially if meningeal signs or age < 1 month). Chest X-ray if respiratory signs.

• Treatment: Start empiric broad-spectrum IV antibiotics immediately after cultures have been taken. Maintain airway, breathing, and circulation (ABC).

B. Intermediate-Risk (Amber) Management

• Action: Requires careful observation and investigation. Admission is highly likely, or a defined period of observation in the paediatric assessment unit (PAU).

• Investigations: Targeted investigation based on suspected source (e.g., urine culture if suspected UTI, viral swabs, etc.).

• Treatment: Supportive care (hydration, antipyretics). Review in 1-2 hours based on clinical course. If no source is found, consider admission for 24-hour observation.

C. Low-Risk (Green) Management

• Action: Can usually be managed at home, provided excellent safety netting is delivered.

• Investigations: Typically, none required unless there is a clear localized source (e.g., otitis media, mild viral illness).

• Treatment: Supportive care: Paracetamol (Acetaminophen) and/or Ibuprofen (ensure proper dosing based on weight), encourage fluids, manage temperature to improve comfort (not necessarily to treat the fever itself). Crucially, address parental anxiety.

3. The PLAB 2 Essential: Safety Netting Communication

For any child discharged home (usually Green Risk, sometimes Amber after observation), your safety netting advice is heavily scrutinized in the OSCE.

Always include the following components in your safety netting advice:

1. When to Return Immediately (Red Flag Symptoms): Instruct the parent to return to the Emergency Department or call an ambulance immediately if they notice any of the following:

   • The child becomes difficult to wake up or unresponsive.

   • The child develops a non-blanching rash (the 'glass test').

   • Breathing difficulties (labored breathing, grunting, or sucking in below the ribs).

   • Unusual crying (high-pitched, continuous, or painful).

   • The child has a fit/seizure.

   • The child is passing significantly less urine than normal (or no wet nappies).

2. What to Monitor: Keep a record of the child's temperature and fluid intake.

3. Expected Course: Explain that viral fevers often last 2-3 days and that symptoms may worsen before they improve.

4. Follow-Up: Advise when the child should be reviewed by a GP if they are not improving (e.g., after 48 hours).

5. Antipyretics: Reiterate dosing instructions for Paracetamol/Ibuprofen and emphasize that they are for comfort, not mandatory for every degree of fever.

Summary for Success

Mastering the febrile child scenario in PLAB 2 means adhering strictly to the structured UK approach:

1. Triage/Assess: Use the NICE traffic light system immediately.

2. Investigate/Treat: Act decisively based on the risk category.

3. Communicate: Explain your findings and management plan clearly.

4. Safety Net: Provide comprehensive, explicit instructions on when and how to seek urgent help.

By following these guidelines, you demonstrate competency, patient safety, and adherence to UK standards—the trifecta for high marks in your PLAB 2 Paediatric station.