It's often difficult for parents to understand what's serious and what's not when it comes to childhood ailments, writes SYLVIA THOMPSON
MOST COMMON childhood illnesses occur between the ages of six months and six years, which means that parents of young children have little time in which to try to understand what’s serious and what’s not when it comes to such problems as fevers, coughs, colds, earaches, vomiting and diarrhoea.
There is a lot more anxiety surrounding common illnesses too. This is compounded by such factors as the lack of extended family support, parents working long hours and childcare facilities which understandably won’t take children when they are sick means.
Having to pay the doctor every time you take your child (doctors who offer a free or reduced-price follow-up visit within 24 hours are a rarity) certainly adds to the stress for families who don’t have medical cards.
So, are there ways you can learn to read the symptoms of common childhood illnesses and decide whether to treat your child at home or take him or her straight to the doctor?
One GP I spoke to says that the first test of whether a child is sick or well is to find out whether they are playing and fighting with their brothers and sisters. “Generally, if they are moving around, interested in their food and playing with their toys, sleeping at night, they’re okay,” she says.
Once a child has a temperature over 38 degrees, they need to be more carefully monitored to see what other symptoms they may have. A fever can be a symptom of anything from a urinary tract infection to an earache to tonsillitis to meningitis.
“The temperature is higher for most bacterial infections. The reason why we give antipyretics is to keep the child comfortable, drinking and in good form,” explains Dr Ciara Martin, consultant in paediatric emergency medicine at the National Children’s Hospital, Tallaght, and member of the faculty of paediatrics at Royal College of Physicians.
“A child with a temperature over 38 degrees who appears unwell and is not improving when given antipyretic medicine needs to be seen by their GP.”
When it comes to vomiting and diarrhoea, Martin says that the most important thing is to give the child fluids. “When a child comes into the emergency department, we will immediately give the parent a jug of flat 7 Up and ask them to give the child a teaspoon every five minutes.
“Most children will improve within two days, but the diarrhoea might come back a little over the following 10 days.”
The paediatric emergency departments are at their busiest outside regular GP surgery hours. Half of all children seen are under five and one third are under one. The biggest advantage of taking a sick child to an emergency department is that, unlike in a GP’s surgery, they can be observed for 24 hours to see whether their symptoms deteriorate.
“Sometimes, we’ll admit a child with a parent simply to observe the child overnight – especially if they live far away – so that they can either go home better in the morning or we see what’s wrong,” says Martin.
She says that many parents’ biggest fear is that their child might have meningitis and that they might miss the symptoms.
“The rates of bacterial causes of meningitis have dropped hugely in the last five years with the introduction of the vaccine for meningitis C and the pneumococcal vaccine last year – both of which prevent serious bacterial diseases that can cause meningitis,” she says.
Parents should take their child to their GP or emergency department if they are worried, however. “One thing we teach junior doctors never to say is ‘Why are you here?’ but instead to ask ‘What are you worried about?’ If you’ve packed up your child and brought him or her to the emergency department, you are anxious about something and need to be seen by a doctor,” she says.
While the €100 fee for attending an emergency department without a GP letter might be prohibitive, there is no charge for a follow-up visit if the child’s condition doesn’t improve or gets worse within the following 10 days.
WARNING SIGNS: COMMON CHILDHOOD ILLNESSES AND HOW TO DEAL WITH THEM
Coughs, cold, flu: All children catch colds, coughs and flu from time to time. Flu symptoms are similar to a cold (runny nose, sore throat, cough) but more severe and can include fever, headaches, vomiting, diarrhoea, loss of appetite and tiredness. They are viral infections and won't respond to antibiotics. The difficulty is that flu symptoms are also similar to other conditions such as sinusitis and urinary tract infections which are bacterial and require treatment with antibiotics.
Sinusitis: If a cold lasts longer than a week and is followed by a persistent runny nose, congestion and pain in the cheeks or forehead, your child may have sinusitis. Some children will also develop a fever. A GP will prescribe antibiotics to clear the infection.
Urinary tract infections: As well as general flu symptoms, the child will experience pain or burning when having a wee and may have pain near their kidneys. Plenty of fluids will help flush out the system but the child may also need an antibiotic to clear a bladder or kidney infection.
Bronchiolitis: This chest infection is most common in the under-twos. It is caused by a virus in the lungs, which makes breathing difficult. It reaches its peak between the third and fifth day but the cough can last for up to a month. Fluids little and often are essential. Paracetamol is recommended if the baby is cranky or irritable. You should go to the doctor or emergency department if breathing becomes difficult, if the child becomes tired and listless or if there is blueness around the lips.
Tonsillitis: Symptoms of tonsillitis are a sore throat and bad breath. Children will generally go off their food as well, because it is difficult to swallow. If you look very carefully, you can usually see the white spots at the back of the throat which indicate that the tonsils are infected by bacteria. Antibiotics are the standard treatment. Croup: Croup is a viral infection of the larynx. The night-time cough sounds like a seal barking and can be scary for parents. It generally only lasts a couple of nights. A child with croup may also have a temperature. Most don't need any treatment. If they have distressed breathing, a doctor will prescribe anti-inflammatory medicine.
Earaches: Earaches can be very painful but if treated quickly should clear up without causing problems. A child with an earache will generally wake up screaming at night with their hand on their ear. Medicine to relieve the pain is usually all that is required. You should contact your GP if your child is in a lot of pain and has a temperature over 38 degrees, has pink/red swelling behind the ear and/or a stiff neck.
Rashes: Rashes are a symptom of many conditions such as chicken pox, measles, German measles (rubella) and meningitis. The rash (flat, dark red or purple blood spots) in meningitis is usually a late symptom. Earlier symptoms are fever, drowsiness or sudden dramatic and uncharacteristic irritability or restlessness, headache and reluctance to bend the neck forward, screwing up the eyes or turning the head away from bright light. Meningitis is a very serious condition that needs immediate medical attention.
Vomiting and diarrhoea: Babies and young children will suffer from vomiting or diarrhoea from time to time. Once vomiting stops, give your child a flat clear soft drink (flat 7 Up is best, don't give sugar-free drinks) or rehydration sachets from a pharmacy. The infection is viral in most cases but if the symptoms last for more than six hours and the child shows signs of dehydration (few wet nappies, sleepiness, dry mouth) or if vomit is green and/or stools contain blood, you should seek a medical opinion.
Fever: A normal temperature is 37 degrees. A temperature of 38 degrees is mild and just needs to be monitored. A temperature of 39 degrees is high and a temperature of 40 degrees is very high. Generally speaking, doctors will recommend medicine containing paracetamol or ibuprofen to reduce pain and discomfort for children with temperatures higher than 38.
Febrile convulsions: A sharp rise in temperature can lead to a febrile convulsion. It's a very scary experience for parents to witness symptoms such as the eyes rolling backwards, the limbs shaking and a loss of consciousness. However in 95 per cent of cases, the convulsion will last for less than five minutes. Medication is required if symptoms last longer than five minutes.
Adapted from Guide to Childhood Accidents, Emergencies and Illnessesat the National Children's Hospital, Tallaght
