The Canadian Acute Respiratory and Flu Scale (CARIFS) measures the severity of symptoms associated with acute respiratory infections in children. It can be used to monitor the illness and the response to any interventions. The authors are from the Universities of Toronto, Calgary and Dalhousie in Canada and Hoffman-La Roche in New Jersey.


Patient selection: children from 0 to 12 years of age


The scale is most applicable to community acquired viral respiratory infections.



(1) poor appetite

(2) not sleeping well

(3) irritable, cranky, fussy

(4) feels unwell

(5) low energy, tired

(6) not playing well

(7) crying more than usual

(8) needing extra care

(9) clinginess

(10) headache

(11) sore throat

(12) muscle aches or pains

(13) fever

(14) cough

(15) nasal congestion and runny nose

(16) vomiting

(17) not interested in what's going on

(18) unable to get out of bed



• Some items were not applicable to infants: headache, sore throat, muscle aches/pains.


In addition, the parents or caregivers made a mark on a 10 cm visual analogue scale (VAS) anchored at the end by "best possible health" and "worst possible health."



no problem


minor problem


moderate problem


major problem


not applicable or don't know

not counted


score =

= SUM(points for all answered measures)


If there were any responses of not applicable or not known:


total score =

= (score) / (number of answered questions) * 18



• minimum total score: 0

• maximum total score: 54

• The higher the score the more problematic the illness.



• The score was responsive to change in illness status.

• Cronbach alpha for enrollment assessment was 0.89.

• The intra-rater reliability for mothers on the second day was 0.808.

• The score correlated well with physician and nurse assessments of illness severity.


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