What are the key clinical signs that indicate a child under 5 years with fever requires urgent referral to secondary care?

Children with 'red' features suggesting a serious or life-threatening cause of febrile illness should be referred urgently to secondary care (within 2 hours) regardless of other factors ¹.

Key clinical signs indicating urgent referral include:

• Features of sepsis or central nervous system infection, such as bacterial meningitis/meningococcal disease or encephalitis ¹.
• Signs of pneumonia or severe dehydration, such as tachypnoea (respiratory rate >60 breaths/min in infants <6 months, >50 in 6-12 months, >40 in older children), crackles, nasal flaring, chest indrawing, cyanosis, or oxygen saturation ≤95% when breathing air ¹.
• Signs of urinary tract infection in infants under 3 months with suspected UTI ¹.
• Signs of septic arthritis or osteomyelitis, such as limb or joint swelling, non-use of an extremity, or non-weight bearing ¹.
• Signs of meningococcal disease, shock, unresponsiveness, or decreased consciousness ¹.
• Any signs of airway, breathing, circulation compromise, or altered consciousness level ¹.

In summary, urgent referral is indicated if there are red features such as signs of serious bacterial infection, respiratory distress, neurological compromise, or shock ¹.