Fever
Normal 35.5 – 37 C. Try to establish “your child’s” norm.
Elevated (or <35 in 38.5 or symptomatic child who is unwell, vomiting etc. Risks – febrile/fever seizure/fit, > 40 tissue damage.
Associated symptoms:
- Rigour/shakes
- Vomiting
- The cause… snot, cough, diarrhoea etc.
Treatment:
- Remove excess clothing
- Warm bath, evaporation and warm cold peripheries
Medicinal Hierarchy:
- Paracetamol ORAL 15mg/kg/dose (120mg/5 ml) 6 hourly
- Per RECTUM 25mg/kg/dose (125/250mg) CALPOL/PANADO/PAINAMOL
- Mefenamic acid ORAL 5mg/kg/dose (50mg/5ml) per RECTUM (125mg) PONSTAN/PONSTEL/FENEMAN
- Ibuprofen ORAL 5-10mg/kg/dose (100mg/5ml) NUROFEN
- Diclofenac acid Per RECTUM 1mg/kg/dose VOLTAREN/PANAMOR/CATAFLAM
Find the cause…VIRAL… rash coming…URINE & EARS SUBTLE
DOCTOR – > 40 >48 hours…travel
Rash
From birth to puberty and beyond, our skin is a fragile organ designed to keep the outer world at bay. It can suffer from an infectious, allergic, toxic and hormonal attack. But here are a few common tips and conditions seen in children from birth to puberty.
Clues:
Big 5 most common rashes following fever:
- Roseola Infantum (Human Herpes Virus)
Fever for 2-3 days and then a spotty rash mainly on the front and back. - German Measles (Rubella)
Fever, sore joint and flat rash starting on the face and descending onto the body. - Fifth’s disease/Slapped cheek syndrome/Erythema Infectiosum (Parvo B19)
Very high temps with red ++ cheeks followed by a fine rash all over the body. - Measles
High temps, conjunctivitis, rhinitis, cough, diarrhoea and a red rash all over (++sick). - Chicken Pox (Varicella Zoster)
Liquid containing blisters all over (Hair/mouth/ears +) after a fever.
All of these are viral.
Big five rashes without a fever:
- Eczema/Allergic Dermatitis
Most often starts as a scaly rash on the face/scalp and ears in early life and later progresses to an itchy dry scaly red rash, concentrated increases (elbows, knees, neck and nappy area). - Ringworm (Tinea)
This is not a worm but a fungus often contracted from pets. It presents as well-defined red rings often with some pustules. - Molluscum Contagiosum (Pox Virus)
Round, raised and smooth “warts” with a central hard spot. It can last months and spread especially in allergic-type skin and if scratching. - Warts (Human Papilloma Virus)
Can occur anywhere and presents as rough, raised and growing lumps often on the hands and knees or on the soles of feet. - Acne
Can occur in infancy related to hormones or puberty. Can present as blackheads around the nose and face, as well as pustules.
Cough
A cough, like a fever, is a normal physiologic response to clear the airway. Pay attention to the timing (day/night); the sound of the cough and associated features like a snotty nose or fever. Be cautious of cough syrups. It is better to treat the cause of the cough, not treat the cough!
Clues:
- Snotty nose and snoring with nighttime cough = Post nasal drip
Generally is allergic or from chronic infected Rhinitis/Adenoids.
Rx Antihistamines and nasal lavage (saline) and or steroids. - Cough with exercise and at night = Asthma/ Bronchiolitis
Often there is a family history of allergies/asthma and a wheeze can be heard.
Rx Assessment and look for triggers then bronchodilator therapy with an appropriate preventer. - Barky/Dog/Seal cough = croup (inflammation of large airways – trachea)
Mostly viral triggers (parainfluenza virus) but important to exclude allergies/foreign body.
Rx Adrenaline nebulisation with oral/inhaled steroid. - Whoop. Spasms of coughing followed by a ”whoop” or vomit = Pertussis/Para Pertussis
Needs assessment and diagnosis to treat and prevent spread.
Rx Routine Vaccination prevents well. If infected Macrolide antibiotics and bronchodilator.
Vomiting
A frequent childhood problem that can vary from normal infantile reflux/positing to severe dehydrating vomiting.<
Clues:
- Positing or vomiting in the first few months of life is normal
If it is painful, projectile or green, then it needs further assessment.
Pyloric stenosis (stomach outlet obstruction), a volvulus (twisted gut) or painful damaging reflux need to be excluded. - Vomiting with fever often precedes diarrhoea in gastroenteritis often affects other family members
Rx Discuss with Health professional but Odansetron (Zofer/Zofran) dissolvable tabs are the safest and most effective antiemetics in children. Be careful of using other “older” meds which can have serious side effects in younger patients. - Bloody vomiting is always a concern.
Fresh blood suggests bleeding in the oesophagus or higher as the blood that has been in an acid stomach looks more like ground coffee! This is frequently swallowed blood (nose bleeds or cracked nipples). Seek advice at least. - GREEN vomit NOT yellow
Stomach juice is yellow and burnt yellow vomit occurs when vomiting on an empty stomach. Although horrible, green is far more concerning as it is coming from the duodenum and needs urgent assessment.
Diarrhoea
The change over from black/green meconium stools to liquid/mustardy. Milk-fed stools can be alarming and the early infant poo could be defined as diarrhoea with ++ liquid and often very frequent. The change from mustard to soft-serve ice cream to playdough takes months to years and varies depending on diet/solid food introduction. A change in consistency, frequency, smell and associated pain suggest gut pathology.
Clues:
- Preceding vomiting or fever suggests an Enteritis (infectious… usually viral)
Most are self-limiting and should be treated with fluid and electrolyte replacement. Reducing stool frequency can lead to confusion as to how to replace and is DISCOURAGED IN CHILDREN.
Rx Pain meds (codeine and antispasmodics are good for cramps) Scopex/Stilpayne +
Prevent bum burn and replace with Paed. appropriate rehydration fluids. Homemade = 1-litre water, 5 teaspoons sugar, ½ teaspoon of salt. - Bloody and mucous stools
These are suggestive of bacterial infection (salmonella/campylobacter/E. Coli) and needs a stool test and antibiotic therapy. - Large smelly brown stools of varying frequency
These are a common problem associated with Parasitic Gut infections (Giardia) but does need differentiation from “Toddlers diarrhoea” which is a non-pathologic rapid food passage with large loose stools with ++ undigested food.
Rx Zentel or Flagyl for giardia… patience for toddlers. - Frothy acidic stool
This can accompany teething, but more significantly if they occur early in infancy or after a bout of gastroenteritis and there are signs of acidic nappy rash… suggest LACTOSE (disaccharide) intolerance.
Rx Avoid dairy/lactose and use probiotics and possibly lactase enzymes
