Is the child well or ill?Observations including capillary refill
Please consider the following in the examination of a child with a non- blanching rash. Testicular painShortness of breathJoint pain/swelling Safeguarding concerns Vomiting and/or diarrhoeaPain on urinationEpistaxis/haematuria/gum bleed Characteristics of rashįatigue or lethargyPhotophobia or neck stiffness It is important to consider the following when taking a history of a non-blanching rash in children. Purpura are non-blanching, greater than 3mm in diameter, and are sometimes palpable. Petechiae are non-blanching pinpoint spots which are less than 3mm in diameter.
2 pinpoint red dots on skin skin#
Non-blanching rashes occur from bleeding from small blood vessels in to the skin or mucosa. All children with a non-blanching rash with or without fever require same-day assessment by the paediatric team in hospital unless there is a clear, accidental mechanical cause. It therefore is important to assess all children with a non-blanching rash promptly to enable early diagnosis and treatment.
However, for a small number of children, a non-blanching rash can indicate a more significant underlying cause such as meningococcal sepsis or haematological malignancy. Other differentials include Henoch-Schonlein purpura (HSP), immune thrombocytopenic purpura (ITP) or mechanical causes including physical abuse. In many cases, a simple viral illness (often adenovirus) is the final diagnosis. Most children with a non-blanching rash who are well will not have a serious underlying cause. Non-blanching rashes are rashes which do not disappear with pressure, particularly using the ‘glass test’.
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