Children encounter all different manner of bugs as they grow up, and, at this time of year, it can sometimes feel like your child is unwell for months on end. As a paediatric registrar, I know it can be hard to know when to seek advice when your child is unwell. That’s why I’ve written this article: to offer some advice for those of you caring for a poorly kid this winter.
When children catch something, be it a virus or a bacteria, they are likely to develop a high temperature and a range of other symptoms. Bacterial infections may need treatment with antibiotics to improve, whereas viruses do not respond to antibiotics at all and generally get better on their own. The concern amongst parents and doctors alike is that a fever may represent a serious bacterial illness (called sepsis) that can make the child very poorly without quick treatment. This can be difficult to judge, but I’ll talk about some warning signs and some reassuring features later on.
If you are worried about your child it’s always best to get them seen in person, but hopefully this article will help you avoid having to seek advice for every illness during the winter months.
Caring for your unwell child
Diet & Fluids
Most infections get better on their own, and the best way to help this happen is to allow your child as much rest and fluids as possible.
Often, a child may have gone off solid food. As long as they are drinking properly, this is no major cause for immediate concern. These days, most drinks are sugar-free, so if your child isn’t eating much make sure to find something with a bit of sugar in.
Large amounts of fluid in the stomach can exacerbate the sickness. If your child is vomiting, try giving small amounts of fluid regularly (even every 5 minutes). In this situation, oral rehydration powder (available from the pharmacy) may stay down more easily than juice or water. Milk can often make the vomiting worse, so try to avoid it for 24 hours during a sickness bug.
A temperature is a sign that a person is suffering from some kind of infection. Unfortunately, the height of the temperature does not help us determine whether it’s a serious infection or a simple virus. Young babies (less than three months old) with fever need to be seen quickly by a doctor, but older children often do not.
Many parents are concerned that allowing a child’s temperature to get too high will cause a febrile convulsion (also known as a febrile seizure or a fever fit). This illness is a topic in itself, but the key point to remember is that having a temperature does not cause this condition—instead, it is the body’s attempts to generate the temperature that are at play and these cannot be alleviated with medication. In fact, allowing your child to have a temperature, rather than treating it, has been proven to reduce the length of illnesses as it allows the body to fight infections naturally.
Unfortunately, children often appear very unwell when they are hot, and it’s difficult for parents or doctors to know if they are really ill or simply distressed by the situation. Therefore, we often give medicines to lower the temperature (ibuprofen or paracetamol) and help see if they improve once the fever is settled. Children who return back to being playful and happy when they have a normal temperature are less likely to have a serious illness than those who remain quiet and lethargic.
At home, you can use either paracetamol or ibuprofen (or both) unless your child has chicken pox, where ibuprofen is currently not recommended. If your child is well and playful but has a temperature, you do not have to treat it, but if they are miserable and unwell then treating it will help them feel better and make it easier to tell if they are OK.
When to bring your child to the doctor
Essentially, if you are worried about your child at any time then bring them to see your GP. If they are really unwell, come to A&E to be seen urgently. We would much rather see a relatively well child that can go home than a sick child who is dangerously ill. Any child who is confused, floppy, lethargic, unrousable, or has a non-blanching rash (one that doesn’t disappear when pressed under a glass) requires urgent review by a health professional.
A high temperature by itself is not a reason to seek medical help in children over three months of age. Children very commonly develop temperatures for any number of reasons and they do not necessarily indicate a serious illness. If the fever has only been going on for less than 24 hours, it is rare for us to be able to identify the cause—it may be the early stages of a cold, tonsillitis, pneumonia or any other infection that has yet to show clear signs. If your child seems to ‘perk up’ when the fever settles (after paracetamol, for example) this is generally reassuring and suggests that they are fighting off the infection on their own.
If you think that your child is only getting worse and they seem to be less active and playful, even after ibuprofen and paracetamol, then they should be seen at the walk-in centre, GP or, if very unwell, A&E. If they remain fairly well but have ongoing, consistent temperatures for more than 3-5 days, you may wish to have a review from the GP.
What happens when you go to see a paediatrician?
If your GP is worried about your child, particularly when they have a temperature and there is a concern they might have sepsis, they will refer your child into hospital for a review by a paediatrician. This can be a daunting (and sadly lengthy) process, and my concern is that by rushing things, many parents don’t feel they have a full explanation about what’s happening. This last section should hopefully give you an idea of what we do for children when they come in with an illness and why.
When you first arrive, a nurse will take some details from you and then perform observations on your child. This will generally include the temperature, the heart rate, breathing rate and oxygen levels in the blood. These all give us a really helpful idea of how your child is doing, particularly if they are all within normal limits. Unwell children will often have a high heart rate, but we expect this to settle when their temperature is normal (this can be a big clue as to whether something worrying is going on). These observations will be repeated at least once to check that everything is stable before you go home.
A doctor will then come and ‘take a history’ from you, which involves asking lots of details about the illness and any background problems your child might have. Some of the questions may seem a little invasive (for example, we often ask about what kind of house you live in), but please bear with us as there’s method to the madness!
We’ll then examine your child, during which time we listen to the chest and the heart, feel the tummy, and look in the ears, nose, and throat. This is to find a cause for your child being unwell (certain sounds on the chest might suggest a chest infection or a viral problem, for example). We will also often ask to get a urine sample to look for signs of infection there.
Depending on what we find, we may offer treatment in the form of antibiotics or specific medicines (such as an inhaler for wheeze). As is very often the case in viral infections, including most coughs, it may also be that no treatment is possible. If we are happy that we know the cause of the illness and the observations appear normal (or as expected for an illness), then you may be discharged home. This is by far the most common outcome: most children are diagnosed with a viral infection and go home without treatment.
If the observations are worryingly abnormal or the history or examination is of concern, we might consider doing blood tests to look for infection. Blood tests in children are only performed if they might provide some useful information. Although they will tell us if your child has an infection, they tend not to tell us what it is (i.e. virus or bacterial). We will put special cream on your child’s hand to numb it because the needle does hurt a little, but we still try to avoid putting children through this if we can. Sometimes we wait for these results before discharging you home, while other times we start antibiotics through a drip straight away whilst we wait for them.
Don’t hesitate to ask your nurse or doctor if you have any concerns or questions about the treatment. If they’re anything like me, they’ll be more than pleased to explain anything at all.
I hope this article has been of some help and that your loved ones stay well this winter. Remember, don’t sit at home worrying—if in doubt, get them checked out!
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