Is my child sick?

As a doctor I have both an advantage and disadvantage.

I have a medical education (thanks Flinders University) and years of experience in various emergency department and general practices (such as Darwin, Nhulunbuy, Kangaroo Island and Mackay) to know when a child is sick.
Apart from my own, I do not what your child normally does, acts and how he or she responds when stressed by illness or strangers (ie me). I have to rely on the parent to what is normal for their child.

There are some (maybe) universal fundamentals that I rely upon. It is a truism that a medical consultation begins as you watch the patient move from the waiting area to the consulting room. First impressions are important from the worried look on the parent’s face, to the way a child is held in their carer’s arms. A child who smiles and skips into your room is almost always reassuring. My heart sinks when a floppy pale child is carried in a frightened parents arms. We definitely need help for this child.

Thankfully most of the time I have the opportunity to sit and listen to the story, only sometimes do I have to start with taking vitals and sometimes reaching for the a vomit bag,

Watching how easily a child breathes is always easier with a layer of the child’s clothes off. The effort, noise, rhythm and rate are what I look at. Subconsciously, I sometimes I find myself breathing at the same rate as the sick child, my that’s fast!! A talkative child is reassuring. If …. a …. child…. has …. to …. breath …. between …. each …. word …. I worry. A pulse oximeter used to measure capillary oxygen levels can provide extra information, although it may take a bit of fuss to get it to work. Or be rejected outright by an irritable child. I had one flicked across the room once. Yep , stopped working, thankfully they are much cheaper these days.

A rough guide for normal breathing rate per minute is

  • birth to 1 year: 30 to 60
  • 1 to 3 years: 24 to 40
  • 3 to 6 years: 22 to 34
  • 6 to 12 years: 18 to 30
  • 12 to 18 years: 12 to 16

Non contact thermometers have made checking a temperature less disruptive and generally provides a reasonable estimate compared to traditional methods. I don’t use rectal, axillary or oral thermometers.

Assessing hydration comes from what I’m told about intake and outputs and what I can see. Are the eyes sunken, is the mouth dry, are there tears? How irritable or lethargic is the child. This along with pinching the skin testing turgor gives me an idea if dehydration is a problem. Dribbling, drooling and snotty noses are all taken into account.

Is there are rash, is skin colour normal and uniform. Is the rash a blanching red rash of a viral exanthem, the blisters of hand foot and mouth disease or the scary bleeding spots of sepsis.

A gentle hand on the belly can tell a lot, confirming an irritable and frightened child, reveal a source of pain, and confirm an elevated temperature.

How is the child interacting with me. Happy and chatting, screaming every time I look in their direction as though I have about to eat them for lunch, or a glazed far away look. Maybe they are sleeping comfortably, or is that unconsciousness. An acronym we use is AVPU. Short for Alert; eyes open and responding to Voice, eyes open to Pain (a finger squeezed or a rub on the chest) or not responding at all, Unconscious. For a parent, anything less than “A” may be an indication that extra help is needed.

Many illness may present in a similar way in children. For example, the list of things that cause vomiting varies from benign eating too much, posits after breast feeding, to more serious viral fever, gastroenteritis, a twisted testicle, to really serious things like poisoning, meningitis and sepsis. And it is alas true, children can get sick very quickly, but there are usually clues to found from a doctors examination.

I have stolen the following lists from https://www.kidshealth.org.nz/my-child-sick

When to call an ambulance for your child

  • has blue lips and tongue
  • has severe difficulty breathing
  • has any episodes of irregular or stopping breathing
  • has a worrying rash especially one that does not go away when you press on it
  • is unconscious or you can’t wake them up properly
  • has been in a serious accident

You should see a doctor urgently if your child:

  • is under 3 months old – young babies need a different and more cautious approach
  • looks unwell and you are concerned
  • is very pale or feels cold to touch
  • is floppy, sleepy or drowsy
  • is becoming less responsive
  • has an unusual high-pitched cry
  • has trouble breathing, has noisy breathing or is breathing fast
  • complains of a stiff neck or light hurting their eyes
  • has a severe headache
  • refuses to drink – even small sips
  • is not doing wee
  • vomits a lot – and cannot keep sips of replacement drinks down
  • vomits green fluid (bile)
  • vomits blood – this may be red or brown or look like coffee grounds if it is not fresh
  • has black tar like poo or blood in their poo
  • is in severe pain
  • is not interested in surroundings (lethargic)

You should see a doctor if your child:

  • is under 3 months old – young babies need a different and more cautious approach 
  • has a sore throat or joint pains
  • is drinking less than half of their normal breastmilk or other fluid
  • is having fewer than 4 wet nappies in 24 hours
  • is doing wee that is very dark or has blood in it
  • vomited half or more of their feed for the last 3 feeds
  • has frequent and watery poo (diarrhoea)
  • complains or cries when doing wee
  • is in pain
  • is getting sicker
  • has a fever and is not improving after 2 days
  • has had a fever for more than 5 days

You can look after your child with a fever at home if they:

  • are drinking and feeding well
  • are still interacting with you
  • do not look sick

Where, apart from your GP, can you find more information about sick kids. These are my suggestions.

https://www.rch.org.au/kidsinfo/

https://raisingchildren.net.au/

https://www.healthdirect.gov.au/kids-health

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