Drowsy? floppy? less alert/sociable?
Is My Baby Ill?
A summary of key points to look for when dealing with a very young child.
Susan V Toothill
St John’s Medical Practice
39 St John’s Hill
Use Your EYES
Behaviour. Are they
Colour. Are they:
dusky or mottled particularly around the mouth?
Breathing. Is it
rapid? (>40/min under 1 year)
(>35/min for 1-2 years)
To assess breathing rate:
Look at baby undressed and quiet
Watch and count number of breaths in 30 seconds.
(Tummy moves up and down)
double the count to give breaths per minute
Is there abnormal chest movement?
Sucking in between ribs
in of breast bone
Feeding. Is there
refusal to feed?
struggling to breathe while feeding?
Nappies. Is there
dry nappies for longer than 12 hours?
profuse watery diarrhoea?
bloody poo or poo like redcurrant jelly?
Use Your EARS
Crying. Is the cry
abnormal for your baby?
higher pitched or more moaning in quality?
weaker or more feeble?
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
Is your baby more floppy or more rigid?
Is there normal head control?
Does the baby feel hot?
Are the extremities cold?
Does the skin feel dry?
Press for 5 seconds on a finger nail, the back of the hand or the back of the foot.
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.
Fontanelle. This is DIFFICULT TO ASSESS
Get to know your baby’s soft spot.
Assess when baby is quiet and still.
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?
Usually higher, more prolonged temperature
Can be treated with antibiotics
What do I do?
Keep baby cool
warm towel or fan
DO NOT ALLOW TO SHIVER
Use paracetamol or ibuprofen
Keep a notebook of doses
Paracetamol if vomiting or chickenpox (or known sensitivity to ibuprofen)
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.
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
Fast, noisy or difficult breathing.
Unable to swallow.
Fever longer than 5 days (or high fever in 0-6 months)
Symptoms other than mild cough persisting over 10 days.
Unusually drowsy or floppy.
Sudden deterioration after seeming to get better.
Vomiting and Diarrhoea
Common in small children
In the UK, usually due to viral infection
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
Keep baby hydrated.
Frequent breast feeds
If bottle fed, substitute with rehydration mixture.
1-2 teaspoons every 2-3 minutes until vomiting stops.
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.
If not weaned, seek medical advice.
Watch out for signs of dehydration:
More drowsy or floppy.
lips and tongue
Slow “skin pinch test”***
Increased capillary refill time (see page 2)
persistent and frequent vomiting for more than 12 hours.
*** Skin Pinch Test:
Gently pinch up the skin on the back of the hand or the tummy wall.
It should fall back to normal immediately and not remain in a “peak”.
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!
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 1
week regurgitate regularly
50% of 0-3 months regurgitate at least once per day.
10% are regurgitating regularly at 6 weeks old.
Due to immature muscles at junction of oesophagus (gullet).
if baby is premature
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:
Increase frequency and decrease volume of feeds.
wind” well and prop up immediately after feeds (but always lie on tummy to sleep).
Poor weight gain.
Very frequent regurgitation after 8-12 weeks old.
Nasty bacterium causing:
This is VERY RARE.
Problem is that early symptoms and signs are the same as those of common mild infections.
Persistent high (39-40 degrees C) temperature with cold hands and feet.
Dusky mottling on skin.
Pale or dusky around mouth
Unusually irritable or unusually floppy/drowsy
to feed or repeatedly vomiting
Fast breathing rate
Excessive crying with high pitched or moaning cry.
Bulging fontanelle when quiet.
Slow capillary refill time (see page 2)
Unusually stiff or jerky movements
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.
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:
Unconscious or unresponsive baby.
Severe breathing difficulty.
Choking that does not improve.
First fit or fit that lasts longer that 4 minutes.
Non-blanching rash in sick baby.
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