What are the key signs and symptoms of common childhood infections that warrant further investigation or referral?

Key signs and symptoms of common childhood infections warranting further investigation or referral include:

• Meningococcal disease: fever with a non-blanching rash, especially if the child appears ill, has purpura (lesions >2 mm), prolonged capillary refill (≥3 seconds), or neck stiffness ².
• Bacterial meningitis: fever with neck stiffness, bulging fontanelle, decreased level of consciousness, or convulsive status epilepticus ².
• Herpes simplex encephalitis: fever with focal neurological signs, focal seizures, or decreased level of consciousness ².
• Pneumonia: fever with tachypnoea (age-specific thresholds: >60 breaths/min for 0–5 months, >50 for 6–12 months, >40 for >12 months), chest crackles, nasal flaring, chest indrawing, cyanosis, or oxygen saturation ≤95% on air ¹,².
• Urinary tract infection (UTI): fever in children under 5, especially with dysuria, increased frequency, new bedwetting, malodorous or cloudy urine, abdominal or loin tenderness, or capillary refill >3 seconds ¹,².
• Septic arthritis or osteomyelitis: fever with swelling of a limb or joint, refusal to use an extremity, or non-weight bearing ¹,².
• Kawasaki disease: fever lasting 5 days or more with bilateral conjunctival injection (without exudate), erythema/cracking of lips, strawberry tongue, erythema of oral/pharyngeal mucosa, oedema/erythema of hands and feet, polymorphous rash, or cervical lymphadenopathy ¹,².
• Signs of severe illness requiring urgent referral: compromised airway, breathing, circulation, or consciousness; shock; unrousable state; or signs of meningococcal disease ¹.

Children with these signs should be urgently assessed face-to-face or referred to paediatric specialists as appropriate ¹,². Safety-netting advice and follow-up should be provided if immediate referral is not required but amber features are present ¹.