Managing the Sick Child

Some symptoms that are frequently encountered in a sick child include fever, vomiting, and diarrhoea.

Fever in children

The human body has a thermostat which helps us to regulate our body temperature. Normal body temperature is between 36.5°C and 37.5°C. With infection or other illnesses, various chemicals are released in the body. This re-adjusts the thermostat, resulting in fever.

A few points to note about fever:

• Fever is the body’s way to fight infection. However, it is not just caused by infections alone.
• The higher the fever, does not indicate the severity of the illness that is causing the fever.
• Overwrapping and a generally hot environment can cause the body temperature of a young child to be slightly above normal.
• High fever per se does not cause brain damage. A small percentage of children between 6 months to 6 years may have seizures with high fever. However, febrile seizures (fever fits) usually do not lead to brain damage.

What measures at home can be done first for fever?

• Encourage your child to take plenty of fluids.
• Dress your child in light clothing to allow heat exchange.
• Keep the room environment cool and well-ventilated.

What medications can I use to manage fever in my child?

• Paracetamol – First-line medication
  • Give 6 hourly if temperature is below 38.5˚C, and 4 hourly if temperature is 38.5˚C and above.
  • Do not use for infants less than 3 months old.
  • Follow the dosing instructions carefully.
• Ibuprofen – Used when fever is persistently above 38.5˚C, 1 to 2 hours after paracetamol.
  • Give 6 hourly in children above 1 year old.
  • Can be given 8 hourly in infants 6 months to 1 year old.
  • Do not use in infants less than 6 months old.
  • Follow the dosing instructions closely.

Consult a doctor if:

• Is feeding poorly, vomiting or lethargic
• Is very young, especially aged 6 months old and below
• Has difficulty breathing
• Is drowsy
• Has severe headache or change in behaviour
• Has abdominal pain or discomfort
• Has rash
• Has reduced urine output (less than 5 wet diapers a day in a younger child)
• Has a persistent fever
  • Fever in mild viral infections usually lasts 2 to 4 days.

Vomiting in children

Most vomiting is caused by a viral infection of the lining of the stomach/intestines or by food poisoning. Often, a child who is vomiting may also develop diarrhoea.

Occasionally, the vomiting may be caused by a more serious illness, such as intestinal obstruction (blockage of the bowels), which will require surgical attention. Other more serious causes of vomiting include brain infection, bleeding or growths in the brain. This is usually associated with symptoms such as severe headache, irritability or change in behaviour.

Consult a doctor if:

• Your child is aged 6 months and below
• Your child shows any signs of dehydration (such as reduced urine output, dry lips or tongue, no tears when crying)
• Your child does not want to drink, or is drinking less than half of his usual amount
• The vomitus is bloody or greenish in colour
• The vomiting is persistent
• Your child starts acting very sick (e.g. lethargic, doesn’t seem interested in playing or interacting)
• There is drowsiness or a change in behaviour
• There is swelling in the abdomen
• Your child complains of abdominal pain or headache
• Your child appears pale

Expected course of vomiting in mild viral infections of the stomach/intestines

• The vomiting usually stops in 6 to 24 hours.
• Anti-vomiting or anti-nausea medications are not safe for home use in children. The mainstay of treatment is ensuring good hydration (i.e. your child is still able to drink enough fluids to hydrate himself) and close observation. You can continue to give your child milk, or try offering fluids like glucose, barley or rice water, or dilute apple juice. Avoid giving just plain water alone. If in doubt about your child’s vomiting, please see a doctor.

Diarrhoea in Children

Diarrhoea is the frequent passage of loose watery stools due to an infection of the intestines. The infection may or may not be accompanied by vomiting. This infection is known as gastroenteritis.

Gastroenteritis is commonly caused by viruses such as rotavirus. Rarely, it can be caused by bacterial infections such as salmonella, E coli or campylobacter.

A major problem with gastroenteritis is dehydration. This occurs when your child loses too much fluid from the diarrhoea and vomiting.

Consult a doctor if your child:

• Shows signs of dehydration such as reduced urine output, dry lips or tongue, no tears when crying, loss of weight
• Does not want to drink, or is drinking very little fluids (less than half their usual amount)
• Is lethargic or drowsy
• Is vomiting
• Has blood or mucus in the stools
• Has frequent and/or large amounts of diarrhoea
• Complains of persistent abdominal pain or discomfort (or constantly crying or curling up the legs in a pre-verbal child)
• Has swelling of the abdomen
• Has prolonged diarrhoea

Diarrhoea in mild viral gastroenteritis usually lasts 2 to 4 days.

Are there any medications for diarrhoea?

• The main treatment in gastroenteritis is to ensure your child is drinking well to replace the fluids lost and remains well-hydrated.
• Generally, medications used to stop diarrhoea in adults are not used in children due to side effects.
• Occasionally, your doctor may prescribe some medications for stomach pain or vomiting.
• If your child is still in diapers, you can apply suitable barrier creams to protect the nappy area.

Is there any way to prevent my child from getting gastroenteritis?

• It is difficult to prevent your child from coming into contact with the germs that cause gastroenteritis. These germs are present in the community all the time.
• However, good hygiene habits will minimise the risk of spreading infections.
• For newborns and infants, bottle hygiene is very important. Milk bottles need to be sterilised before each feed, either by boiling or with the use of sterilisers/sterilising tablets.
• For older children, frequent handwashing, especially before meals and after using the toilet, should be taught.

Reference: KK Women’s and Children’s Hospital