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Sepsis: spotting the signs

Sepsis is a rare but serious reaction to an infection. If you get an infection, your body's immune system responds by trying to fight it. Sepsis is when the immune system response becomes overactive and starts to cause damage to the body. It can be hard to tell if you have sepsis. Your child might have a fever or high temperature or just feel very unwell. Sepsis needs to be treated urgently because it can quickly get worse and lead to septic shock (low blood pressure and or fast heart rate)

Who is more at risk of sepsis?

Children who have: 

  • not been immunised

  • recently had surgery, trauma or minor procedures 

  • weak immune systems due to illness or drugs (like chemotherapy)

  • recently had a serious illness (including chicken pox)

  • chronic diseases (children with cerebral palsy, or cystic fibrosis)

Babies:

  • born prematurely

  • younger than 1 year

  • whose mother had an infection while pregnant.

How do I know if my child has sepsis?

If you think your child might have an infection and is more unwell than you expect or is getting worse despite treatment, it could be sepsis.  Sepsis can look like other conditions, for example flu or a chest infection.  Sepsis can be especially hard to spot in babies and young children, children and young people with a learning disability.

The diagnosis of sepsis is based on simple measurements (vital signs) such as temperature, heart rate and blood pressure.

  • Symptoms such as runny nose, cough, wheeze, sore throat, red eyes and diarrhoea are more suggestive of a viral infection than a bacterial infection. If a number of people are unwell in the same household, this also suggests a viral infection (because viral infections are easily spread).
  • Viral infections do not need treatment with antibiotics. (See antibiotic resistance video here)
  • For further information on sepsis visit the NHS website.
  • The UK Sepsis Trust also has further information, including a sepsis assessment tool.

When should you worry?

If your child has any of the following:

  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)

  • Breathing very fast, too breathless to talk, eat or drink 

  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)

  • Breathing that stops or pauses

  • Is pale, blue, mottled or feels unusually cold to touch

  • Difficult to wake up, very sleepy or confused

  • Weak, high-pitched cry or can’t be settled

  • Has a fit (seizure)

  • Develops a rash that does not disappear with pressure (the Glass Test)

You need urgent help.

Phone 999 or go to the nearest Hospital Accident and Emergency Department

If your child has any of the following:

  • Is 3 to 6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)

  • Temperature less than 36°C in those over 3 months

  • Breathing a bit faster than normal or working a bit harder to breathe

  • Dry skin, lips or tongue

  • Not had a wee or wet nappy in last 8 hours

  • Poor feeding in babies (less than half of their usual amount)

  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)

  • Swelling of a limb or joint

  • Not using or putting weight on an arm, leg, hand or foot.

  • Complaining of severe pain that is not improving with painkillers

  • Has had chickenpox in the past few days and is now getting worse with a high fever or spreading red rash

  • Is getting worse or if you are worried

You need to contact a doctor or nurse today

Please ring your GP surgery or call NHS 111

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features

If none of the above features are present

Watch them closely for any change and look out for any red or amber symptoms

If your child has any other symptoms with their fever, you may want to look at the information on sore throat, cough, earache, diarrhoea and vomiting or tummy ache.

Additional advice is also available to young families for coping with crying of well babies.

If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 or contact your local community pharmacist

This guidance has been reviewed and adapted by healthcare professionals across West Yorkshire with consent from the Hampshire development groups.

What do I do if I am worried my child has sepsis?

  • Get advice from a doctor or healthcare professional or ring 111

  • Your child will need to be examined and have a set of vital signs measured (temperature, heart rate and blood pressure)

Remember most children with fevers or who are unwell, don’t have sepsis.

Tests

There is no one test to see if your child has sepsis.  The tests to look for the infection will vary depending on their age, symptoms and medical history. They can include blood tests, urine tests, chest X-rays and occasionally lumbar puncture (needle in the back to collect spinal fluid). Your healthcare team should talk to you about any tests or procedures they would like to do, what will happen and what they are for

Remember

If you're worried that your child or baby is not getting better, still seems unwell or is not themselves, you should talk to a doctor or other healthcare professional. It is important to ask for advice if you're worried, even if you have already seen a doctor, are still having treatment, or are back home. This is because the problems caused by sepsis can come on very quickly, and you may need more (or different) treatment. You should always feel that you can ask questions at any point in your care.

Where should you seek help?

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

All community pharmacies across England are required to be Healthy Living Pharmacies. This means that they are able to offer advice on a range of healthy living matters which includes eating a healthy diet. They can provide information leaflets and give parents, carers and young people more information about other organisations that might also be able to help.

Pharmacists are experts in many aspects of healthcare, and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment, and many have private consultation areas. Your pharmacist will say if you need further medical attention.

Sound advice

  1. Visit a pharmacy if your child is ill, but does not need to see a GP.
  2. Remember that if your child's condition gets worse, you should seek further medical advice immediately.
  3. Help your child to understand. Watch this video with them about going to the pharmacy.

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns, or to the Community Paediatricians, or the child and adolescent mental health services.

 

Contact your local Health Visiting Team:

Bradford Health Visitors or call - 01274 221223

Wakefield Health Visitors or call - 0300 373 0944

Craven Health Visitors or call - 01423 544265

Leeds Health Visitors or call - 0113 843 5683

Calderdale Health Visitors or call - 030 0304 5555 (local rate number)

Kirklees Health Visitors or call - 030 0304 5555 (local rate number)

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

For more information about what Health Visitors do: What does a health visitor do?

School nurses care for children and young people, aged 5 to19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and, or emotional health needs.

 

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse. Phone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Contact your local school nursing team:

Bradford School Nurses 01274 221203

Wakefield School Nurses (0 to 19 service) 0300 373 0944 (local rate number)

Leeds School Nurses 0113 843 5683

Calderdale School Nurses 030 3330 9974 (local rate number)

Kirklees School Nurses 0300 304 5555 (local rate number)

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

All children should be registered with a GP. Anyone in England can register for free with a GP surgery. You do not need proof of address or immigration status, ID or an NHS number.

How to find your local GP.

Sound advice

You have a choice of service:

  1. Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
  2. Help your child to understand. Watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Please note, the online version of NHS 111 is only recommended for children over the age of 5. If your child is under 5 years old, please phone 111.

NHS 111 can also direct you to your nearest urgent treatment centre (minor injuries unit or walk-in centre).

Find your local urgent treatment centre.

When to visit an urgent treatment centre.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as:

  • loss of consciousness
  • breathing difficulties
  • severe bleeding that cannot be stopped
  • major trauma such as road traffic collisions

If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  1. Many visits to A&E and calls to 999 could be resolved by any other NHS services.
  2. If your child's condition is not critical, choose another service to get them the best possible treatment.
  3. Help your child to understand. Watch this video with them about going to A&E or riding in an ambulance