Special Consideration for Signs and Symptoms in Children
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CONSIDERATIONS FOR SIGNS AND SYMPTOMS IN
Fever is defined as an elevated body temperature above the normal range of 97.7° F–99.5° F (36.5° C–37.5° C). Fever is a common sign of illness in children and is often accompanied by other signs and symptoms of illness, such as a headache, muscle aches, chills, loss of appetite, low energy, difficulty sleeping and vomiting. An infant who has a fever may seem fussy, or he or she may be quiet and not as active as usual.
Fevers that last a long time or are very high can result in febrile seizures. A febrile seizure is a convulsion brought on by a fever in an infant or small child. Febrile seizures are the most common types of seizures
in children. Most febrile seizures last less than 5 minutes and are not life threatening. Call 9-1-1 or the designated emergency number for a febrile seizure if:
This is the first time that a child has had a febrile seizure.
The seizure lasts longer than 5 minutes or is repeated.
The seizure is followed by a quick increase in body temperature.
When a child or infant has a fever, make him or her as comfortable as possible and encourage the child to rest. Check to ensure that the child or infant is not overdressed or covered with too many blankets. Usually a single layer of clothing and a light blanket is all that is necessary. As long as the child or infant is alert and able to swallow, offer clear liquids such as water, juice or chicken broth, or
continue to nurse or bottle-feed to prevent dehydration.
If the child has a high fever, it is important to gently cool the child. Never rush cooling down a child. If the fever has caused a febrile seizure, rapid cooling could bring on other complications. Instead, remove any excessive clothing or blankets and sponge the child with lukewarm water.
Myth-Information. Rubbing alcohol helps cool the body and bring down a fever. Rubbing alcohol (isopropyl alcohol) is dangerous to use to bring down a fever. It is quickly absorbed through the skin and is easily inhaled, placing the infant or child at risk for alcohol poisoning. Moreover, alcohol only cools the skin; it does not lower the internal body temperature.
THE PROS KNOW.
Never give aspirin to an infant or child who has a fever or other
signs or symptoms of a flu-like or other viral illness. In this situation, taking aspirin can result in Reye’s syndrome, an extremely serious and life-threatening condition that causes swelling in the brain and liver.
Contact a healthcare provider if:
The infant is younger than 3 months and has a fever of 100.4° F or greater.
The child is younger than 2 years and has a fever of 103° F or greater.
The child or infant has a febrile seizure.
Vomiting and Diarrhea
Vomiting, diarrhea or both are frequently signs and symptoms of infection in children. In young children, vomiting, diarrhea or both can lead to dehydration (too little fluid in the body) and shock. Infants and young children are at especially high risk for dehydration because they tend to lose more fluid, and at a faster rate, than adults do.
When a child or infant has an illness that causes vomiting, replace solid foods with clear fluids (e.g., water, popsicles, gelatin or oral rehydration solutions designed specifically for children and infants) for 24 hours. Wait 2 to 3 hours after a vomiting episode to offer the infant or child fluids. Offer 1 to 2 ounces every half hour, four times. Then alternate 2 ounces of rehydration solution with 2 ounces of water every 2 hours. After 12 to 24 hours with no vomiting, gradually reintroduce the infant’s or child’s normal diet.
To care for diarrhea:
Maintain the infant’s or child’s normal well-balanced diet, including a mix of fruits, vegetables, meat, yogurt and complex carbohydrates. Try to limit sugar and artificial sweeteners.
If the infant will not tolerate his or her normal feedings, or if the child is drinking less fluid than usual, add a commercially available oral rehydration solution designed specifically for children and infants.
Do not give over-the-counter antidiarrheal medications to children younger than 2 years. In older children, use these medications under the guidance of a healthcare provider.
When a child has vomiting, diarrhea or both, consult a healthcare provider if:
The diarrhea or vomiting persists for more than a few days.
The child or infant is not able to keep fluids down.
The child or infant has not had a wet diaper in 3 or more hours (or, if toilet-trained, has not urinated for more than 6 hours).
The child has a high fever.
The diarrhea is bloody or black.
The child is unusually sleepy or irritable.
The child cries without tears or has a dry mouth.
There is a sunken appearance to the child’s abdomen, eyes or cheeks (or, in a very young infant, the soft spot at the top of the infant’s head).
The child’s skin remains “tented” if pinched and released.
For children, respiratory distress is the second-most common emergency condition. Children are more susceptible than adults to respiratory distress because their airways are smaller, narrower and less rigid. In addition to the signs and symptoms of respiratory distress seen in adults (see Chapter 5), children may have the following signs and symptoms:
Nasal flaring (widening of the nostrils when breathing in)
Use of the chest and neck muscles to breathe (muscles pull in around the collarbone and ribs)
Two common infections associated with respiratory distress in children are croup and epiglottitis.
Croup (laryngotracheobronchitis) is an infection of the upper airway that causes difficulty breathing and a harsh, repetitive, bark-like cough. When the child breathes in, he or she may make a high-pitched whistling noise. Croup is most common in children younger than 5 years. Croup usually is not serious and can be managed at home; however, in some cases, a child with croup can progress quickly from respiratory distress to respiratory arrest.
Epiglottitis is swelling of the epiglottis (the piece of cartilage that covers the trachea), usually caused by a bacterial infection. Epiglottitis is life threatening because the swelling can block the windpipe and lead to severe breathing problems. Since the implementation of routine vaccination against H. influenza type B with the Hib vaccine, the number of cases of epiglottitis has dropped significantly in the United State