■■ The child’s age.
■■ Co-existing health conditions, such as congenital
heart disease.
■■ Duration of symptoms. Bronchiolitis, for example,
tends to worsen between the third and fifth day
after onset before improving.
■■ Amount of feeding. Infants who do not manage
75 per cent of their normal feed volume should
be considered for referral.
■■ Whether support networks are available to the
children’s parents or carers.
■■ The distance from the child’s home to the nearest
hospital and the availability of transport.
■■ Parental understanding of the child’s condition.
During examination, particular attention should be
given to:
■■ How active or inactive the child appears to be.
■■ The child’s vital signs and symptoms, including
hydration status, with reference to the child’s age.
■■ Signs of respiratory distress, such as stridor,
chest wall recessions, head bobbing, tracheal tug
and use of abdominal wall muscles for breathing.
■■ Results from examinations of the ear, nose and
throat. Examination of the throat should be
avoided in children with stridor, for example in
croup, because it can lead to airway obstruction.