1.1 Thermometers and the detection of fever
温度计和发热的诊断
1.1.1 Oral and rectal temperature measurements
口腔温度及直肠温度的测量
1.1.1.1 Do not routinely use the oral and rectal routes to measure the body temperature of children aged 0–5 years. [2007]
对0到5岁的儿童，测量口腔温度和直肠温度不作为测量体温的常规方式。【2007】
1.1.2 Measurement of body temperature at other sites
其他部位测量体温的方法
1.1.2.1 In infants under the age of 4 weeks, measure body temperature with an electronic thermometer in the axilla. [2007]
4周龄以下的婴儿，测量体温可在腋窝下使用电子体温计。【2007】
1.1.2.2 In children aged 4 weeks to 5 years, measure body temperature by one of the following methods:
对于4周龄到5岁儿童，测量体温可使用下列方法中的任意一种：
• electronic thermometer in the axilla
• 腋窝下使用电子体温计
• chemical dot thermometer in the axilla
• 腋窝下使用水银温度计
• infra-red tympanic thermometer. [2007]
• 红外线耳膜温度计【2007】
1.1.2.3 Healthcare professionals who routinely use disposable chemical dot thermometers should consider using an alternative type of thermometer when multiple temperature measurements are required. [2007]
习惯使用一次性体温计的医疗保健专业人员在需要进行多点测定温度时应该考虑更换温度计类型。【2007】
1.1.2.4 Forehead chemical thermometers are unreliable and should not be used by healthcare professionals. [2007]
额部化学温度计不可靠，医疗保健专业人员不应使用。【2007】
1.1.3 Subjective detection of fever by parents and carers
家长和护理人的主观判断
1.1.3.1 Reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals. [2007]
发热患儿父母描述应被医疗保健专业人员高度重视。【2007】
1.2 Clinical a**ssment of children with fever
针对发热患儿的临床评估
1.2.1 Life-threatening features of illness in children
危及生命的儿科疾病
1.2.1.1 First, healthcare professionals should identify any immediately life-threatening features, including compromise of the airway, breathing or circulation, and decreased level of consciousness. [2007]
首先，医疗保健专业人员应该识别任何危及生命的体征，包括气道通畅度、呼吸、循环以及意识水平下降程度。【2007】
1.2.2 A**ssment of risk of serious illness
危重疾病风险评估
1.2.2.1 A**ss children with feverish illness for the presence or absence of symptoms and signs that can be used to predict the risk of serious illness using the traffic light system (see table 1). [2013]
针对发热儿童现有和既往症状可以用交通灯系统（详见表格1）来预测危重疾病风险。【2013】
1.2.2.2 When a**ssing children with learning disabilities, take the individual child's learning disability into account when interpreting the traffic light table. [new 2013]
当对具有学习障碍的儿童进行评估时，须将患儿的学习障碍考虑在内。【2013新】
1.2.2.3 Recognise that children with any of the following symptoms or signs are in a high-risk group for serious illness:
发现儿童存在以下症状时，则可判断高危。
• pale/mottled/ashen/blue skin, lips or tongue
• 苍白、斑驳、灰白、青紫的皮肤、嘴唇或舌头
• no response to social cues[3]
• 无对答
• appearing ill to a healthcare professional
• 病态面容
• does not wake or if roused does not stay awake
• 不醒或唤醒后不保持觉醒状态
• weak, high-pitched or continuous cry
• 虚弱，高度紧张或持续哭泣
• Grunting
• 大叫
• respiratory rate greater than 60 breaths per minute
• 呼吸频率高于每分钟60次
• moderate or severe chest indrawing
• 中度或重度胸部凹陷
• reduced skin turgor
• 皮肤肿胀消退
• bulging fontanelle. [new 2013]
• 涨囟【2013新】
1.2.2.4 Recognise that children with any of the following symptoms or signs are in at least an intermediate-risk group for serious illness:
发现患儿具备下列症状，则可判断至少中危
• pallor of skin, lips or tongue reported by parent or carer
• 家长或护理人报告皮肤、嘴唇或舌头苍白
• not responding normally to social cues 3
• 对答不流利
• no smile
• 无笑容
• wakes only with prolonged stimulation
• 只有不断刺激才会保持清醒
• decreased activity
• 活动减少
• nasal flaring
• 鼻翼扇动
• dry mucous membranes
• 粘膜干燥
• poor feeding in infants
• 婴幼儿进食少
• reduced urine output
• 尿量减少
• rigors. [new 2013]
• 僵直【2013新】
1.2.2.5 Recognise that children who have all of the following features, and none of the high- or intermediate-risk features, are in a low-risk group for serious illness:
发现儿童体征为以下条目同时无高危或中危体征时，则可判断低危。
• normal colour of skin, lips and tongue
• 皮肤、嘴唇及舌头颜色正常
• responds normally to social cues 3
• 对答流利
• content/smiles
• 心情愉悦
• stays awake or awakens quickly
• 清醒状态或可快速唤醒
• strong normal cry or not crying
• 哭声响亮或不哭泣
• normal skin and eyes
• 眼睛与皮肤无异常
• moist mucous membranes. [new 2013]
• 黏膜湿润【2013新】
1.2.2.6 Measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine a**ssment of a child with fever. [2007]
将体温、心率、呼吸频率以及毛细血管再充盈时间作为发热儿童常规评估的一部分进行测量并记录。【2007】
1.2.2.7 Recognise that a capillary refill time of 3 seconds or longer is an intermediate-risk group marker for serious illness ('amber' sign). [2013]
毛细血管再充盈时间长于3秒或以上为中危（ “黄灯”症状）【2013】
1.2.2.8 Measure the blood pressure of children with fever if the heart rate or capillary refill time is abnormal and the facilities to measure blood pressure are available. [2007]
当发热患儿心率或毛细血管再充盈时间异常并且有设备可测量血压时测量患儿血压【2007】
1.2.2.9 In children older than 6 months do not use height of body temperature alone to identify those with serious illness. [2013]
6月龄以下儿童请勿单独使用身体温度高这一标准来鉴别危重疾病【2013】
1.2.2.10 Recognise that children younger than 3 months with a temperature of 38°C or higher are in a high-risk group for serious illness. [2013]
发现3月龄以下儿童体温为38℃或以上时则可判断高危【2013】
1.2.2.11 Recognise that children aged 3–6 months with a temperature of 39°C or higher are in at least an intermediate-risk group for serious illness. [new 2013]
发现3-6月龄儿童体温为39℃或以上时则判断至少中危。【2013新】
1.2.2.12 Do not use duration of fever to predict the likelihood of serious illness. However, children with a fever lasting more than 5 days should be a****d for Kawasaki disease (see recommendation 1.2.3.10). [new 2013]
请勿使用发热持续时间来判断危重程度。但是，发热持续至少5天以上应考虑川崎病（详见建议1.2.3.10）【2013新】
1.2.2.13 Recognise that children with tachycardia are in at least an intermediate-risk group for serious illness. Use the Advanced Paediatric Life Support (APLS)[4] criteria below to define tachycardia: [new 2013]
发现患儿存在心动过速则可判断至少中危。使用儿科高级生命支持标准（如下）来鉴别是否为心动过速【2013新】
Age年龄 Heart rate (bpm)心率
<12 months小于12月龄 >160
12–24 months12月龄到24月龄 >150
2–5 years 2到5岁 >140
1.2.2.14 A**ss children with fever for signs of dehydration. Look for:
评估发热患儿是否存在脱水，可观察是否存在以下体征：
• prolonged capillary refill time
• 毛细血管再充盈时间延长
• abnormal skin turgor
• 皮肤异常肿胀
• abnormal respiratory pattern
• 呼吸模式异常
• weak pulse
• 脉弱
• cool extremities. [2007]
• 四肢冰凉【2007】
1.2.3 Symptoms and signs of specific illne**s
某些特殊疾病的症状和体征
1.2.3.1 Look for a source of fever and check for the presence of symptoms and signs that are associated with specific diseases (see table 2). [2007]
查找发热源并确定现有症状及体征是否与某种特殊疾病相关（详见表2）。【2007】
1.2.3.2 Consider meningococcal disease in any child with fever and a non-blanching rash, particularly if any of the following features are present[5]:
当发热患儿出现不褪色皮疹，同时出现下列症状的时候，考虑流行性脑膜炎
• an ill-looking child
• 病态面容
• lesions larger than 2 mm in diameter (purpura)
• 损伤直径大于2mm（紫癜）
• a capillary refill time of 3 seconds or longer
• 毛细血管再充盈时间为3秒或以上
• neck stiffness. [2007]
• 颈项强直【2007】
1.2.3.3 Consider bacterial meningitis in a child with fever and any of the following features5:
当发热患儿存在以下任意症状时，考虑细菌性脑膜炎
• neck stiffness
• 颈项强直
• bulging fontanelle
• 涨囟
• decreased level of consciousness
• 意识水平降低
• convulsive status epilepticus. [2007, amended 2013]
• 惊厥性癫痫持续状态【2007,2013修订】
1.2.3.4 Be aware that classic signs of meningitis (neck stiffness, bulging fontanelle, high-pitched cry) are often absent in infants with bacterial meningitis5. [2007]
需要注意的是患有细菌性脑膜炎的婴儿常常不可及脑膜炎基本体征（如颈项强直、涨囟、哭声高亢）。【2007】
1.2.3.5 Consider herpes simplex encephalitis in children with fever and any of the following features:
发热患儿存在以下任意症状时考虑单纯疱疹脑炎
• focal neurological signs
• 局限性神经系统损害
• focal seizures
• 局灶性癫痫
• decreased level of consciousness. [2007]
• 意识水平下降【2007】
1.2.3.6 Consider pneumonia in children with fever and any of the following signs:
当发热患儿存在以下任意症状时考虑肺炎
• tachypnoea (respiratory rate greater than 60 breaths per minute, age 0–5 months; greater than 50 breaths per minute, age 6–12 months; greater than 40 breaths per minute, age older than 12 months)
• 呼吸急促（0-5月龄：呼吸频率大于60次/分钟；6-12月龄：呼吸频率大于50次/分钟；12月龄以上：呼吸频率大于40次/分钟）
• crackles in the chest
• 胸部听诊闻及啰音
• nasal flaring
• 鼻翼扇动
• chest indrawing
• 胸廓凹陷
• Cyanosis
• 发绀
• oxygen saturation of 95% or less when breathing air. [2007]
• 呼吸时血氧浓度为95%或以下【2007】
1.2.3.7 Consider urinary tract infection in any child younger than 3 months with fever[6]. [2007]
3月龄以下发热儿童考虑尿路感染。【2007】
1.2.3.8 Consider urinary tract infection in a child aged 3 months or older with fever and 1 or more of the following6:
3月龄及以上发热儿童存在下列症状一个或以上时，考虑尿路感染
• Vomiting
• 呕吐
• poor feeding
• 进食少
• Lethargy
• 昏睡
• Irritability
• 烦躁
• abdominal pain or tenderness
• 腹部疼痛或压痛
• urinary frequency or dysuria. [new 2013]
• 尿频或排尿困难【2013新】
1.2.3.9 Consider septic arthritis/osteomyelitis in children with fever and any of the following signs:
当发热儿童存在下列任意症状时，考虑化脓性关节炎/骨髓炎
• swelling of a limb or joint
• 关节或四肢肿胀
• not using an extremity
• 四肢无力
• non-weight bearing. [2007]
• 不可负重【2007】
1.2.3.10 Consider Kawasaki disease in children with fever that has lasted longer than 5 days and who have 4 of the following 5 features:
当发热儿童发热时间长达5天或以上同时存在以下5个症状中的四个时，考虑川崎病
• bilateral conjunctival injection
• 球结合膜出血
• change in mucous membranes in the upper respiratory tract (for example, injected pharynx, dry cracked lips or strawberry tongue)
• 上呼吸道黏膜改变（例如咽喉充血、唇充血皲裂或草莓舌）
• change in the extremities (for example, oedema, erythema or desquamation)
• 手足症状（例如：水肿、红斑及脱屑）
• polymorphous rash
• 多形性皮斑
• cervical lymphadenopathy
[I] - Information: Soft return used in paragraph
Be aware that, in rare cases, incomplete/atypical Kawasaki disease may be diagnosed with fewer features. [2007]
• 颈部淋巴结肿大
需要注意的是，在某些罕见病例里，不足4个症状也可诊断川崎病。【2007】
1.2.4 Imported infections
输入性感染
1.2.4.1 When a**ssing a child with feverish illness, enquire about recent travel abroad and consider the possibility of imported infections according to the region visited. [2007]
当评估发热儿童时，询问近期旅游记录同时考虑外来地区输入性感染可能。
Table 1 Traffic light system for identifying risk of serious illness
[new 2013]
表格1 危重疾病风险评估交通灯系统【2013新】
Children with fever and any of the symptoms or signs in the red column should be recognised as being at high risk. Similarly, children with fever and any of the symptoms or signs in the amber column and none in the red column should be recognised as being at intermediate risk. Children with symptoms and signs in the green column and none in the amber or red columns are at low risk. The management of children with fever should be directed by the level of risk.
发热儿童存在“红灯”一栏里的任何症状时均可判断为高危。同样的，发热儿童存在“黄灯”一栏里的任何症状同时不存在“红灯”里的任何一项症状时可判断为中危。无“红灯”和“黄灯”一栏的符合“绿灯”一栏的儿童可判断为低危。对发热儿童的治疗应与危险程度匹配
This traffic light table should be used in conjunction with the recommendations in this guideline on investigations and initial management in children with fever.
在对发热患儿进行诊断及初步治疗时，交通灯系统应与本指南中的建议共同使用。
A colour version of this table is available.
Green – low risk
绿灯—低危 Amber – intermediate risk
黄灯—中危 Red – high risk
红灯—高危
Colour
(of skin, lips or tongue)
皮肤、嘴唇、舌头颜色 • Normal colour
• 正常
• Pallor reported by parent/carer
• 家长或护理人报告苍白 • Pale/mottled/ashen/blue
• 苍白、斑点状、发灰、青紫
Activity
行为 • Responds normally to social cues
• 对答流利
• Content/smiles
• 心情愉悦
• Stays awake or awakens quickly
• 清醒状态或可快速唤醒
• Strong normal cry/not crying
• 哭声响亮或不哭泣 • Not responding normally to social cues
• 对答不流利
• No smile
• 无笑容
• Wakes only with prolonged stimulation
• 长时刺激才可唤醒
• Decreased activity
• 活动度下降
• No response to social cues
• 无对答
• Appears ill to a healthcare professional
• 病态面容
• Does not wake or if roused does not stay awake
• 无法唤醒或无法保持清醒状态
• Weak, high-pitched or continuous cry
• 虚弱、哭声高亢或持续哭泣
Respiratory
呼吸 • Nasal flaring
• 鼻翼扇松
• Tachypnoea: respiratory rate
• 呼吸急促：呼吸频率
->50 breaths/minute, age 6–12 months;
-6-12月龄：大于50次/分钟
->40 breaths/minute, age >12 months
-大于12月龄：大于40次/分钟
• Oxygen saturation ≤95% in air
• 血氧饱和度95%或以下
• Crackles in the chest
• 肺部听诊可及啰音 • Grunting
• 咕哝声
• Tachypnoea: respiratory rate >60 breaths/minute
• 呼吸急促：呼吸频率大于60次/分钟
• Moderate or severe chest indrawing
• 中等或严重胸部凹陷
Circulation and hydration
循环和水合作用 • Normal skin and eyes
• 皮肤和眼睛正常
• Moist mucous membranes
• 黏膜湿润
• Tachycardia:
• 心动过速
->160 beats/minute, age <12 months
-12月龄以下：大于160次/分钟
->150 beats/minute, age 12–24 months
-12-24月龄：大于150次/分钟
->140 beats/minute, age 2–5 years
-2到5岁：大于140次/分钟
• Capillary refill time ≥3 seconds
• 毛细血管再充盈时间为3秒以上
Dry mucous membranes
• 粘膜干燥
• Poor feeding in infants
• 婴幼儿进食量少
• Reduced urine output
• 尿量减少
• Reduced skin turgor
• 皮肤肿胀消失
Other
其他 • None of the amber or red symptoms or signs
• 无“黄灯”或“红灯”中的症状或体征
• Age 3–6 months, temperature ≥39°C
• 3-6月龄，体温为39℃或以上
• Fever for ≥5 days
• 发热持续5天或以上
• Rigors
• 僵直
• Swelling of a limb or joint
• 四肢或关节肿胀
• Non-weight bearing limb/not using an extremity
• 无法负重/四肢无力
• Age <3 months, temperature ≥38°C
• 3月龄以下，体温为38℃或以上
• Non-blanching rash
• 不褪色皮疹
• Bulging fontanelle
• 涨囟
• Neck stiffness
• 颈项强直
• Status epilepticus
• 癫痫持续状态
• Focal neurological signs
• 局限性神经系统损害
• Focal seizures
• 局灶性癫痫
Table 2 Summary table for symptoms and signs suggestive of specific diseases
[2013]
表格2 特殊疾病提示性症状总结表【2013】
Diagnosis to be considered
考虑诊断 Symptoms and signs in conjunction with fever
与发热同时出现的症状和体征
Meningococcal disease
流行性脑膜炎 Non-blanching rash, particularly with 1 or more of the following:
不褪色皮疹，同时伴随下列一个或以上症状：
• an ill-looking child
• 病态面容
• lesions larger than 2 mm in diameter (purpura)
• 损伤直径大于2mm（紫癜）
• capillary refill time of ≥3 seconds
• 毛细血管再充盈时间为3秒或以上
• neck stiffness
• 颈项强直
Bacterial meningitis
细菌性脑膜炎 Neck stiffness
颈项强直
Bulging fontanelle
涨囟
Decreased level of consciousness
意识水平下降
Convulsive status epilepticus
惊厥性癫痫持续状态
Herpes simplex encephalitis
单纯疱疹病毒脑炎 Focal neurological signs
局限性神经系统损害
Focal seizures
局灶性癫痫
Decreased level of consciousness
意识水平下降
Pneumonia
肺炎 Tachypnoea (respiratory rate >60 breaths/minute, age 0–5 months; >50 breaths/minute, age 6–12 months; >40 breaths/minute, age >12 months)
呼吸急促（0-5月龄：呼吸频率大于60次/分钟；6-12月龄：呼吸频率大于50次/分钟；12月龄以上：呼吸频率大于40次/分钟）
Crackles in the chest
肺部听诊闻及啰音
Nasal flaring
鼻翼扇动
Chest indrawing
胸廓凹陷
Cyanosis
发绀
Oxygen saturation ≤95%
血氧饱和度为95%或以下
Urinary tract infection
尿路感染 Vomiting
呕吐
Poor feeding
进食量少
Lethargy
昏睡
Irritability
烦躁
Abdominal pain or tenderness
腹部触痛或压痛
Urinary frequency or dysuria
尿频或排尿困难
Septic arthritis
化脓性关节炎/骨髓炎 Swelling of a limb or joint
关节或四肢肿胀
Not using an extremity
四肢无力
Non-weight bearing
不可负重
Kawasaki disease
川崎病 Fever for more than 5 days and at least 4 of the following:
发热5天或以上同时至少存在以下4条症状：
• bilateral conjunctival injection
• 球结合膜出血
• change in mucous membranes
• 上呼吸道黏膜改变（例如咽喉充血、唇充血皲裂或草莓舌）
• change in the extremities
• 手足症状（例如：水肿、红斑及脱屑）
• polymorphous rash
• 多形性皮斑
• cervical lymphadenopathy
• 颈部淋巴结肿大
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