Sunday 24 September 2017

Short-term illness and long-term scars

Ask the GP...

There is no need to seek medical treatment for a mild norovirus
There is no need to seek medical treatment for a mild norovirus

Nina Byrnes

Advice from our GP on whether or not vomiting in a child is a cause for concern, and why a teenager shouldn't squeeze spots.

Question: My four-year-old daughter is generally very healthy and rarely gets sick. She has a very healthy appetite and eats a broad variety of foods. She has recently been belching a lot and one morning last week she vomited in the morning when she woke. When I went in to her room later to clean her sheets, I noticed that the sheets were a bright, almost luminous green. She wasn't feeling unwell and just went about her business as usual. The same thing happened the next morning but since then she has been totally fine. Should I bring her to be checked out? Do you have any idea what this could be?

It's very worrying as a parent when your child is sick, especially if you can't pinpoint what's wrong. Most young children will vomit occasionally. If this occurs in isolation and the child is otherwise well, it is unlikely anything is seriously wrong.

Signs of more serious illness include recurrent bouts of vomiting, associated fever, reduced consumption of fluids and food, and concurrent profuse diarrhoea, especially if there is blood in it. If a child is very flat and difficult to rouse, this can be a sign of meningitis, so it is always important to be vigilant. Simple causes of sporadic vomiting include eating too much or simply severe constipation. Reflux may be another cause of vomiting but this is likely to be recurrent and would be very rare in a four-year-old child.

Another common cause this time of year is the winter vomiting bug. This is caused by a group of viruses called noroviruses. These are extremely contagious so often occur in clusters. They are more common during winter months but can occur any time of year. Norovirus are the most common cause of vomiting bugs in Ireland the UK and the USA. It is thought to affect up to 20,000 people a week here during peak season.

Norovirus causes inflammation of the stomach, intestines or both. This results in abdominal pain, nausea, vomiting and diarrhoea, which often come on quite suddenly. You may also have a fever, headache and body aches and pains. Most people recover within one to three days. So a 24-hour episode is not unusual. Those with severe illness, especially children or the elderly, are at risk of dehydration. Signs of dehydration include dark or reduced urine, dry mouth and lips, dizziness when standing, headache, and unusual tiredness.

There is no need to seek medical treatment for a mild norovirus. The most important thing to do is to ensure to stay well hydrated. Provide plenty of fluids in order to replace those lost through diarrhoea and vomiting. Give paracetamol for fever. If eating, try bland, easily digested foods. If symptoms are going on more than three days or those affected are unable to consume fluids you will need to seek medical help.

Norovirus is extremely contagious and spreads easily among those in close contact. Those who are infected should stay out of work, school or crèche until at least 48 hours after the last vomiting or diarrhoea episode.

As the virus can remain present in stool for up to two weeks after infection, it is also important to remain extremely vigilant about hand hygiene and to avoid swimming pools for this time.

Norovirus is passed either through direct contact with someone who has the virus or by touching a surface, which has become infected. The virus can live on surfaces for several days so once again strict hygiene is one of the best ways to avoid it spreading. Surfaces should be cleaned regularly. Fruit and veg and shellfish (norovirus can live here) should be well cleaned prior to consumption. Those who are sick should not prepare food for others while they are sick or for three days after.

Lastly, clothes that have been used by someone who is ill should be washed thoroughly on a hot wash.

Q. I’ve been telling my teenage son not to squeeze his spots, but he doesn’t believe me that it will damage his skin in the long term. Who’s right?

Dr Nina replies: Acne occurs in over 90pc of people at some stage. For many it is associated with the occasional break out or cluster of spots and pimples. For others it results in years of painful cysts, pimples and redness that can cause permanent scarring. Acne is most common between the age of 14 and 17 in girls, and 16 and 19 in boys. It disappears in most adults into their 20s, but persists beyond the age of 25 in 5pc of women and 1pc of men. Acne occurs most commonly on the face but can occur on the neck chest and back also.

In those with acne the sebaceous glands can become blocked by plugs of keratin and sebum, and this initially leads to a small spot, which is white if it is below the skin surface. If it comes to the surface the pigment turns black, creating blackheads. As the sebaceous glands become increasingly congested, there is local inflammation in the deeper layer of skin, which causes a red bump to appear on the skin called a papule. Local bacteria, which normally live on the skin, can invade this. The inflammation and infection leads to the development of pus. This causes the papule to rise to the surface causing the common spot or pimple.

Bacteria in the pores can make the situation worse but acne is not a condition of poor hygiene. It is important to clean the skin daily but over-cleaning can irritate the skin and make the situation worse. Acne may be a chronic problem but regular treatment that involves clearing the hair follicles, reducing inflammation, and treating infection, can help. It may be very tempting to squeeze spots but in the long run this may do more harm than good. You may end up pushing bacteria deeper into the skin causing further inflammation. Squeezing spots also increases the risk of scarring which may be permanent.

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