Drowsy? floppy? less alert/sociable?



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Is My Baby Ill?
A summary of key points to look for when dealing with a very young child.

Dr Susan V Toothill

St John’s Medical Practice

39 St John’s Hill

Sevenoaks

TN13 3NT

Use Your EYES


  1. Behaviour. Are they

  • drowsy?

  • floppy?

  • less alert/sociable?

  • irritable?

  • restless?




  1. Colour. Are they:

  • flushed?

  • pale?

  • sunken eyes?

  • dusky or mottled particularly around the mouth?




  1. Breathing. Is it

  • rapid? (>40/min under 1 year)

(>35/min for 1-2 years)

To assess breathing rate:

  1. Look at baby undressed and quiet

  2. Watch and count number of breaths in 30 seconds.

(Tummy moves up and down)

  1. double the count to give breaths per minute


Is there abnormal chest movement?




  1. Feeding. Is there

  • difficulty sucking?

  • refusal to feed?

  • struggling to breathe while feeding?

  • excessive drooling?

  • repeated vomiting?




  1. Nappies. Is there

  • dry nappies for longer than 12 hours?

  • profuse watery diarrhoea?

  • bloody poo or poo like redcurrant jelly?


Use Your EARS


  1. Crying. Is the cry

  • abnormal for your baby?

  • higher pitched or more moaning in quality?

  • weaker or more feeble?

  • incessant?




  1. Noisy breathing. Is there

  • wheeze-a rasping whistling noise when breathing out?

  • Stridor-a hoarse rasping noise when breathing in?

  • grunting at the end of each breath?



Use Your HANDS


  1. Handling.

  • Is your baby more floppy or more rigid?

  • Is there normal head control?




  1. Skin.

  • Does the baby feel hot?

  • Are the extremities cold?

  • Does the skin feel dry?


CAPILLARY REFILL TEST

  • Press for 5 seconds on a finger nail, the back of the hand or the back of the foot.

  • Release pressure

  • Does normal skin return within 2 seconds? If not, the repeat on breast bone and forehead.

  • In a warm room capillary refill time of greater than 3 seconds is abnormal, so seek medical advice.




  1. Fontanelle. This is DIFFICULT TO ASSESS

  • Get to know your baby’s soft spot.

  • Assess when baby is quiet and still.

Is it

  • sunken? (suggest dehydration)

  • bulging? (suggest brain inflammation)


The soft spot will disappear when the baby is about 1 year old.
Common Childhood Illnesses and Symptoms
Fever. What is fever?

  • A core temperature (as measured in the ear or under the tongue of over 37 degrees C.

  • A core temperature of 38 degrees C or above is considered significant

  • If measuring temperature under the armpit or on the forehead, a temperature of 37.5 is significant.


What causes fever?


  • Viral infections

          • Common

          • Short lived

          • No cure

  • Bacterial infections

          • Less common

          • Usually higher, more prolonged temperature

          • Can be treated with antibiotics


What do I do?





  • Use paracetamol or ibuprofen

          • Keep a notebook of doses

          • Paracetamol if vomiting or chickenpox (or known sensitivity to ibuprofen)



  • Fluids

          • Give lots to drink

          • If reluctant, give ibuprofen or paracetamol first


What do I watch out for?


  • Fever lasting more than 5 days.

  • Fever that gets worse after initially getting better.

  • Persistent fever over 39 degrees C.(38 degrees C in babies 0-3 months old)

  • Signs of serious illness.

  • Signs of dehydration.

Coughs and Colds
They are COMMON.

  • Average pre-school and primary school child will have 8 a year.

    • More common if parents smoke.




    • Fever, runny nose, sore throat last for 3-5 days. Cough can last for 4-6 weeks.




    • No evidence that OTC cough and cold remedies work.

      • Paracetamol and ibuprofen help symptoms.

      • Steam for short periods and saline nasal drops can help blocked noses and tickly coughs.




  • Caused by viruses so antibiotics will not cure them.




  • Children often have several one after another so that it seems as if it is one long illness.




  • Babies cannot blow their noses.

      • mucus will either run out of the nose or run down the back of the throat causing a cough.




  • Coughing DOES NOT damage the lungs.




  • Babies and small children will vomit if they cough hard enough.



When to seek Medical Help


        1. Breathing problems.

          1. Fast, noisy or difficult breathing.




        1. Unable to swallow.

          1. Excessive drooling




        1. Fever longer than 5 days (or high fever in 0-6 months)




        1. Symptoms other than mild cough persisting over 10 days.




        1. Unusually drowsy or floppy.




        1. Sudden deterioration after seeming to get better.



Vomiting and Diarrhoea


  • Common in small children

  • In the UK, usually due to viral infection


Usually:

  • Starts with repeated vomiting

  • May be associated with mild fever

  • Diarrhoea starts after a few hours

  • Vomiting stops within a few hours

  • Diarrhoea resolves after 2-5 days


Management:

  • Keep baby hydrated.

  • Frequent breast feeds

  • If bottle fed, substitute with rehydration mixture.

      1. 1-2 teaspoons every 2-3 minutes until vomiting stops.

      2. Then as much fluid as baby will take.

  • Paracetamol if fever.

  • Light diet once vomiting stops until diarrhoea settles.

  • If diarrhoea for more than 3 days, for 24 hours trial without dairy products in case of temporary lactose intolerance.

      1. If not weaned, seek medical advice.


Watch out for signs of dehydration:

  • More drowsy or floppy.

  • Sunken eyes

  • Dry lips and tongue

  • Slow “skin pinch test”***

  • Increased capillary refill time (see page 2)

  • Sunken fontanelle

  • And persistent and frequent vomiting for more than 12 hours.


*** Skin Pinch Test:

              1. Gently pinch up the skin on the back of the hand or the tummy wall.

              2. It should fall back to normal immediately and not remain in a “peak”.


Colic
COMMON

    • 3 out of 10 babies cry for 3 hours/day for 3 days/week for at least 3 weeks.

    • Usually worse in the evening

NB. Baby is WELL between bouts of excessive crying.!


  • Gets better by 3-4 months old.

  • Nobody knows why

  • No specific treatment.




  • SHARE THE BURDEN!


Gastro-oesophageal Reflux


  • Used to be under-treated, but now it is over-treated




  • Non forceful regurgitation of milk and stomach contents into oesophagus.

    • 85% of infants in 1st week regurgitate regularly

    • 50% of 0-3 months regurgitate at least once per day.

    • 10% are regurgitating regularly at 6 weeks old.







  • NOT vomiting that travels at force over several feet

    • This is projectile vomit and, if recurrent, needs medical attention as babies can develop a blockage of the stomach at age 6-8 weeks called PYLORIC STENOSIS.


Management of Reflux:

    • Avoid overfeeding.

      • Increase frequency and decrease volume of feeds.

    • wind” well and prop up immediately after feeds (but always lie on tummy to sleep).


Watch for:

  • Poor weight gain.

  • Constant irritability

  • Very frequent regurgitation after 8-12 weeks old.


Meningococcal Disease
Nasty bacterium causing:

  • Meningitis

  • Meningococcal septicaemia


This is VERY RARE.
Problem is that early symptoms and signs are the same as those of common mild infections.
Checklist


  1. Persistent high (39-40 degrees C) temperature with cold hands and feet.




  1. Dusky mottling on skin.

    • Pale or dusky around mouth




  1. Unusually irritable or unusually floppy/drowsy




  1. Refusal to feed or repeatedly vomiting




  1. Fast breathing rate




  1. Excessive crying with high pitched or moaning cry.




  1. Bulging fontanelle when quiet.




  1. Slow capillary refill time (see page 2)




  1. Unusually stiff or jerky movements




  1. Rash

    • Not always present

    • Non-fading with tumbler test

    • Red/purple spots and patches like small bruises.


Remember that a non-blanching rash in a WELL child is NOT meningococcal disease.

Further Information
Websites: www.patient.co.uk
www.nhsdirect.nhs.uk
www.stjohnsmedicalpractice.co.uk

To contact a GP: 01732 727200


  • If outside surgery hours, you will be automatically put through to the “out of hours” service.

  • Please give as much information as possible.

  • Try and keep calm and be as accurate as possible with information.

  • You may be asked to speak to a doctor before an appointment is offered.


Call 999 if:


  1. Unconscious or unresponsive baby.




  1. Severe breathing difficulty.




  1. Choking that does not improve.




  1. First fit or fit that lasts longer that 4 minutes.




  1. Non-blanching rash in sick baby.



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