Red Flags - when to be concerned
Red Flags typically refer to features that may suggest serious life threatening disease such as malignancy (e.g., leukaemia), infection (e.g., septic arthritis or osteomyelitis) or non-accidental injury.
Red flags may also refer to features that may suggest inflammatory joint or muscle disease.
It is important to remember that the child who is immunosuppressed from disease or treatment may not demonstrate typical features of sepsis. It is important to have a low threshold to be concerned and seek specialist advice.
Further information is available:
- NICE guidance: Child abuse and neglect
- NICE guidance on suspecting cancer in children
- NICE guidance on fever in young children
- Recognition of the Sick Child
- NICE guidance on Sepsis
It is noteworthy that red flag features may also suggest inflammatory or multisystem disease:
- Malaise or / systemic upset (fever, reduced appetite, weight loss, sweating, lethargy, pallor, lymphadenopathy, organomegaly).
- Night pains - not responding to simple (paracetamol/ibuprofen) analgesia.
- Myoglobinuria – “coca-cola coloured" urine (sign of muscle destruction).
- Pain in bones - often described as deep and throbbing in nature, rather than joints.
- Bone tenderness.
- Behavioural change (irritable, poor sleep).
- Swollen joint(s) (often subtle or difficult to appreciate).