Baby Fever Triage — 2 AM Decision Support

Overview

A feverish child at night is one of the highest-anxiety moments in parenting. The two failure modes are symmetrical and both dangerous:

1. Under-reacting — a 5-week-old with 38.2°C and no other signs. Under 3 months, fever is an automatic medical urgency because newborns can have serious bacterial infections with no localizing signs. Parents who don't know this "wait until morning" — and that wait is genuinely dangerous.
2. Over-dosing — a suffering 8 kg one-year-old. "Give 5 mL of the infant drops" — but infant drops are concentrated (100 mg/mL) and the same 5 mL that's correct for syrup (160 mg/5mL) is a double-to-triple overdose. Confusion between concentrations is a leading cause of pediatric acetaminophen poisoning.

This skill is a calm, structured decision-support tool for exactly that moment:

• Age-aware triage — hard-coded rules: under 3 months + ≥38°C = urgent now; 3-6 months + ≥39°C = same-day; older + responsive + drinking = usually home care with checks.
• Red-flag checklist — 14 symptoms that escalate any fever regardless of age or height of fever (non-blanching rash, grunting breathing, inability to wake, first febrile seizure, etc.).
• Weight-based dosing calculator — mg per kg by actual weight, cross-checked against the product you actually have (infant drops vs children's syrup vs adult tablets), with mL amounts per concentration and a hard error if the concentration is unknown.
• Alternating-dose scheduler — if a pediatrician approved alternating acetaminophen and ibuprofen, generate the exact safe timeline (≥4h between same-drug doses for acetaminophen, ≥6h for ibuprofen, max doses/day enforced).
• Fever log — timestamped temperature route (rectal/axillary/forehead), meds given, fluid intake, behavior — becomes the pediatrician handoff sheet.
• Handoff summary — a compact structured summary that makes the doctor visit 10x more productive.

This skill is informational support and does not replace medical judgment. When rules and your gut disagree, the doctor wins.

When to Use

• A child 0-5 years has a measured fever and parents are deciding what to do
• Calculating a correct weight-based dose of acetaminophen (paracetamol) or ibuprofen
• Planning alternating doses through the night without interval errors
• Logging a fever illness course for the pediatrician visit
• Don't use for: adult fever (different rules), fever lasting >5 days in any child (needs in-person exam regardless of how well the child looks), chronic conditions / immunocompromised children ( thresholds differ — call their specialist), or as a replacement for calling emergency services when red flags are present.

How It Works

1. Triage — python3 scripts/fever.py triage --age-months 7 --temp 39.1 --unit c returns an urgency tier (EMERGENCY-NOW / SAME-DAY / HOME-CARE) with the exact reason string and the age rule that fired.
2. Red flags — flags interactively walks the 14-item checklist; any yes escalates to the top of the flow.
3. Dose — dose --drug acetaminophen --weight-kg 8.2 --conc mg-per-ml:100 → mg dose, mL for the actual product, next-allowed time, max/day. Refuses to compute without concentration.
4. Scheduler — schedule --weight-kg 8.2 --start "2026-09-27 02:00" --hours 12 --drugs both prints a per-half-hour timeline of what's allowed when, enforcing both per-drug intervals AND the stagger.
5. Log — log temp 38.4 --route axillary / log med acetaminophen 120mg --at ... builds the illness record; log show prints the course.
6. Handoff — handoff renders the doctor-ready summary: age, course, peak temps, red flags checked, meds given with times, fluid intake, questions to ask.

All state in a single fever.json in cwd (or --db); fully local — health data should never leave the house.

Dosing Reference (memorize the shape, verify the amount)

Common concentrations: infant drops 80mg/0.8mL & 160mg/5mL syrups (US), 100 mg/mL and 120mg/5mL (EU/RU: эфералган/панадол-беби), 250mg/5mL suspension. Never compute a mL dose without reading the bottle.

Commands

# Triage by age and temperature
python3 scripts/fever.py triage --age-months 5 --temp 39.4 --unit c
# → SAME-DAY: 3-6 months with ≥39°C needs to be seen today

# Red-flag checklist (non-interactive: pass flags directly)
python3 scripts/fever.py flags --non-blanching-rash no --inconsolable yes ...
# any yes → EMERGENCY-NOW

# Weight-based dose with the actual product
python3 scripts/fever.py dose --drug ibuprofen --weight-kg 11.5 --conc mg-per-ml:20
# → 87-115 mg → 4.3-5.8 mL of the 20mg/mL suspension, next dose no sooner than 6h

# Night alternating scheduler
python3 scripts/fever.py schedule --weight-kg 8.2 --start "2026-09-27 22:00" --hours 14 --drugs both
# prints timeline: 22:00 A, 02:00 I, 06:00 A, 10:00 I ... intervals verified

# Illness log
python3 scripts/fever.py log temp 38.9 --route rectal
python3 scripts/fever.py log med acetaminophen 123mg --at "2026-09-27 23:15"
python3 scripts/fever.py log fluids 60ml
python3 scripts/fever.py handoff

Common Pitfalls

1. Dosing by age instead of weight. Two-year-olds vary from 10 to 17 kg; the age-bands on the box are a marketing convenience. Always weigh or use a recent clinic weight.
2. Mixing up concentrations. 80mg/0.8mL drops vs 160mg/5mL syrup vs 100mg/mL EU drops: the same "5 mL" spans 160 mg to 500 mg. This skill refuses a mL answer without --conc.
3. Treating the thermometer, not the child. A responsive, drinking 18-month-old at 39.5°C needs comfort and observation; a listless 39.0°C child needs a doctor. Behavior > number.
4. Sponging with cold water / alcohol rubs. Old advice, now harmful — causes shivering and raises core temp, alcohol absorbed through skin. Skip it.
5. Alternating drugs on a fuzzy memory. At 4 AM nobody remembers the 02:00 dose. The scheduler prints the timeline; the log records what was actually given.
6. Assuming fever alone is the enemy. Fever is an immune response; the danger signs are behavior, hydration, breathing, rash. A well-appearing child with fever needs comfort, not war.
7. Forgetting the under-3-months rule. No home care, no watchful waiting: any ≥38°C in this age group is same-day medical evaluation, ideally within an hour.
8. Using this skill instead of calling for help. Triage rules are conservative, but if parental instinct says emergency, the skill's "HOME-CARE" verdict loses to that instinct.

Verification Checklist

• triage returns one of EMERGENCY-NOW / SAME-DAY / HOME-CARE with a reason and age-rule citation
• Under-3-month rule fires automatically and cannot be overridden by "looks fine"
• dose refuses to output mL without a concentration; mg/kg math verified against the table
• schedule never places two of the same drug <4h (acetaminophen) or <6h (ibuprofen) apart, and enforces daily maxima
• handoff output contains course timeline, red flags checked, med times, and is readable in <60 seconds
• Disclaimers present in SKILL.md, script output, and handoff: informational, not a doctor

References

• references/triage-rules.md — full rule sources, exception cases, escalation criteria, and when NOT to use this skill