Six vital parameters needs to be kept in mind while in office practice for early recognition of a sick child.
Mental status: Is the child Lethargic/ drowsy?
Heart Rate: is the child having an abnormally higher heart rate (in the absence of fever or agitation) or abnormally lower heart rate.
Respiratory rate:Is the child breathing fast (≥60 for < 2mths, ≥50 for 2-12 months, ≥40 for 1-5 yr old) or is having an abnormally slow respiratory rate. Is the breathing laboured and child is having retractions, nasal flare or abnormal breath sounds (stridor/ grunt etc).
Urine output:Has the child passed adequate urine (> 0.5 ml/kg/hr) in the last 24 hrs and more importantly in the last 6-8 hrs.
Pulse: How is child's central and peripheral pulse? Not able to feel dorsalis pedis / posterior tibial arterial pulse means that the child's peripheral perfusion is inadequate and child is deteriorating.
Capillary refill time: Cold peripheries and Capillary refill time > 3 secs shall indicate that the child's perfusion is compromised. Best place to check capillary refill time is sternum. A difference in the temperature of the core and the peripheries can also be an early marker of the disease severity.