Monday 23 April 2018

Ask the GP: What to do when your child is unwell

It is really important to actually check the temperature.
It is really important to actually check the temperature.

Nina Byrnes

Advice from our GP on looking after children when they are sick.

Question: My daughter has picked up a runny nose and cough. Should I take her to the doctor or look after her at home?

Dr Nina replies: Many parents are concerned to see a child coughing or sneezing and would like to go to the GP to ensure everything is okay. For those under 6 a GP fee is no longer a concern, but parents may still like to weigh up the necessity of a GP visit versus caring for the child at home.

There are several facts to consider when faced with a sick child. How quickly did their symptoms occur? Have they had a fever over 38.0 degrees centigrade and did this settle when given paracetamol and / or ibuprofen?

It is true that a temperature is high over 37.5 but milder fevers don't usually herald serious disease. It is really important to actually check the temperature. How hot the child feels is not a good guide.

Are they active and in good form or are they lying down and listless? A listless child is a sick child. Parents always apologise when a child explores the surgery. I am always reassured. Sick children don't do this.

Is there any vomiting or diarrhoea and how often has this occurred? One or two vomits or loose stool is okay, eight or nine could herald dehydration. Are they eating and, more importantly, are they drinking? Children can go without food for a few days but fluid intake is vital for survival.

Symptoms like a cough and runny nose worry parents more than doctors. If these occur in the absence of any other signs of illness there is little need for concern. I often ask parents if you couldn't hear the cough would you be worried about your child? If the answer is no, it is very unlikely there is an underlying infection requiring antibiotic treatment.

Many mild viral infections cause a rash but this is usually across most of the body, is pale or salmon coloured and disappears easily when you roll a glass over it.

If your child has a rash that doesn't disappear, or looks like tiny bruises in the skin, it is important to seek medical review.

Hands and feet should be warm like the rest of the body. If a child is hot but hands and feet are cold or lips look blue infection may be more severe.

As a parent, your instinct is very important. I was taught early on in my paediatric training to listen to the parents and value their concerns. Most doctors are happy to reassure a parent that their child is okay.

Question: My 13-month-old baby just started in a crèche. She seems to be picking up one infection after another. Vomiting and diarrhoea really worry me. What signs should I watch out for if this occurs?

Dr Nina replies: Vomiting bugs are very common this time of year. Dehydration is the most common serious complication of gastroenteritis and young children are especially vulnerable.

Thankfully most vomiting bugs are short lived, passing over 24 to 48 hours. If a child has some vomiting and diarrhoea but is still managing to eat and drink and is producing wet nappies, apart from the soiled ones, they are probably okay at home.

In this instance give bland plain food and lots of fluids. If they vomit after taking a large drink give frequent small sips or even teaspoons of fluid every few minutes. If fever occurs give some paracetamol first. Ibuprofen can be given but as this can irritate the stomach I would suggest it as a second choice.

Suppositories may work better in a vomiting child.

Fever that doesn't settle, or spikes again quickly, may herald a more serious infection.

Other things to watch out for are blood in the diarrhoea, dry or only damp nappies, irritability or fussiness, and refusing food and drink.

Signs of dehydration include sleepiness, sunken eyes, a dip in the fontanelle (soft spot on head) or pink staining in the nappies. These warrant medical review as intravenous hydration may be required.

If you are caring for your child at home give whatever fluids they will take. Ice cream, jelly and yoghurt are another way to replace fluids in a fussy child. A certain amount of sugar is important as a vomiting child's glucose levels may also drop. An old-fashioned remedy is flat lemonade.

Finally if you are worried, or if your child is getting worse rather than better, it is important to seek medical review.

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