Fever
Your child has a fever if his
• Rectal temperature is over 38.0ºC
• Oral temperature is over 37.5ºC
• Axillary's (armpit) temperature is over 37ºC
The body’s average temperature when it is measured orally is 37ºC. But it normally
fluctuates during the day. Mild elevation (38ºC to 38.5ºC) can be caused by exercise,
excessive clothing, a hot bath or even on hot days. Warm food or drink can also raise
the oral temperature. If you suspect such an effect on the temperature of your child,
take his temperature again in one-half hour.
 

Causes
Fever is a symptom, not disease. Fever is the body’s normal response to infections and
plays a role in fighting them. Fever turns on the body’s immune system. The usual
fever (37.8ºC to 40ºC) that all children gets are not harmful. Most are caused by viral
illnesses. Some are caused by bacterial illnesses. Teething does not cause fever
usually..

Expected Course
Most fever of viral illnesses range between (38.3ºC to 40ºC) and last for 3 to 4 days.
In general, the height of the fever does not relate to the seriousness of the illness.
It is the behavior of your child which is more important. How sick your child acts
is what counts. Fever causes no permanent harm until it reaches 41.7ºC. Fortunately;
the brain’s thermostat keeps untreated fever below this level.
Although all children get fevers, only 4% develop a brief febrile convulsion. Since
this type of seizure is generally harmless, it is not worth worrying about. Especially if
your child has had high fever before without seizures.
 

Home Care
Acetaminophen products (panadol, paracetamol) for reducing fever.
Children older than 2 months of age can be given any one of the acetaminophen
products. Tylenol, panadol, and Tempra all have the same dosage. Remember that
fever is helping your child fight the infection. Use drugs only if the fever is over 38.5º
and preferably only if your child is also uncomfortable. Give the correct dosage for
your child’s age every 4 to 6 hours, but not more often. Two hours after they are
given, these drugs will reduce the fever 0.3ºC to 1ºC. Medicines do not bring the
temperature down to normal unless the temperature was not very elevated before the
medicine was given. Repeated dosages of the drugs will be necessary because the
fever will go up and down until the illness runs its course and the infection is taken
care off by the body. If your child is sleeping, do not awaken him for medicines.
Caution: The dropper that comes with one product should not be used with
other brands.
Dosages of Acetaminophen. As different brands come in different strength, it is
important to give the correct dose as prescribed 4-6 hourly. Recommended dose
is 10mg/kg/dose either in tab or syrup form. Do not over-load a child with
Paracetamol. Fever per se is harmless. However liver damage caused by
excessive fever medicine can kill a child.
Liquid Ibuprofen. Ibuprofen and acetaminophen are similar in their abilities to lower
fever, and their safety records are similar. One advantage that ibuprofen has over
acetaminophen is its longer-lasting effect (6 to 8 hours instead of 4 to 6 hours).
However acetaminophen is still the drug of choice for controlling fever in most
conditions. Children with special problems requiring a longer period of fever control
may do better with ibuprofen.
Voltaren Suppository (Diclofenac Sodium)
May be given to a child if the temperature does not settle 30 minutes after the oral
anti-fever medicines and the child is having a lot of discomfort from the fever
( usually >39.5ºC). The suppository is best not given to an infant less than 9 months
old. There is no necessity to sabotage the body’s warfare against the germs by
aborting the fever if the child is comfortable.
 

Other Measures
Less clothing. Bundling can be dangerous; clothing should be kept to the minimum
because most heat is lost through the skin. Do not bundle up your child, it will cause
higher fever. During the time your child feels cold or is shivering (the chills), give him
a light blanket.
 

Sponging This is usually not necessary to reduce fever especially if your child is
comfortable and you have just recorded a temperature which scares you. Never
sponges your child without giving him acetaminophen first. Sponge immediately
only in emergencies such as heat stroke delirium, a seizure or any fever over 41
C. In other cases, sponge your child only if the fever is over 40C, the temperature
stays that high when you take the temperature again 30 minutes after your child
has taken acetaminophen and your chills is uncomfortable. Until the fever
medicine has taken its effect (by resetting the body thermostat), sponging will
just cause shivering which is the body’s attempt to raise the temperate to that of
the raised thermostat temperature. Sponging works faster then immersion so sit
your child in 2 ins (5 cm) of water and keep wetting the skin surface. If your
child shivers, raise the water temperature a little or wait for the fever medicine
to take effect. Don’t expect to get the temperature below 38 C. Don’t add
rubbing alcohol to the water. It can cause come if breathed in.
Extra fluids:
Encourage your child to drink extra fluids, but do not force him to drink. Cooled
slightly chilled fluids are helpful. Body fluids are lost during fever because of
perspiration.
 

Call at the A&E Department
Immediately if
• You are worry about your child condition and your child is less than 2 months
old
• The fever is over 40.6C
• Your chills is crying inconsolably
• The child is poorly responsive
• Breathing is difficult and no better after you clear the nose
• Your child has poor feeding for the whole day and vomiting
• Your child acts and look very sick
Visit the clinic the next day
• Fever persists for > 72 hours
• Your child has had fever > 24 hours without any obvious cause or location of
infection.
• Fever returns after it has gone away for more than 24 hours
• Your child has a history of febrile seizure         Back to top

Vomiting

Definition

Vomiting is the forceful ejection of large portion of the stomach contents through the mouth.
The mechanism is a strong stomach contraction against a closed stomach outlet. By contrast
regurgitation is the spitting of one or sometimes more mouthful of stomach content, which is
usually seen in baby less than 1 year old.
 

Cause
Most vomiting is caused by viral infection of the stomach or eating something, which
disagrees with your child. Often the viral type is associated with diarrhea. However vomiting
per se as a symptom could be a warning sign of a more sinister condition. If vomiting is
persistent or in doubt, always consult a doctor.
 

Expected Course
The vomiting usually stops after 6-24 hours. Dietary changes usually speeds up recovery.
 

Home care for vomiting
Special diet for vomiting
No solid for 8 hours
Start with clear fluids for 8 hours. Offer child clear fluids (not milk) in small amount until 8 hours have
passed without vomiting. For vomiting without diarrhea, the best clear fluid at any age is water. For
infant, you can use any one of the new electrolyte solution (pedialyte or hydralyte) or rice water with
glucose can also produce excellent result. After this age, soft drinks (100 plus, H two O) are also
acceptable. Stir until no fizz remains (the bubble inflate the stomach and increase the chances of
continued vomiting).

Graduated feeding
Start with 1 teaspoon to 1 tablespoon, depending on the age every 10 minutes. Double the
amount each hour.. If your child vomits using this treatment, rest the stomach completely for 1
hour and then start over but with smaller amounts. The one-swallow at a time never fails.
Bland food after 8 hours without vomiting. After another 8 hours without vomiting, your child
can usually return to a normal diet.
 

For older children, starts with food such as Marie crackers, honey or white bread,
bland soups (eg chicken with stars), rice and mashed potatoes.
For babies, start with food such as applesauce, strained bananas and rice cereal. If your baby
only takes formula, give 1-2 ounces less per feeding as usual. Usually your child can be back
on a normal diet 24 hours after recovery from vomiting.
Diet for breast-fed babies. The key to treatment is to provide breast milk at smaller amount
than usual. If your baby has only vomited once or twice, continue breast-feeding but nurse on
only one side each time for 10 minutes. After 8 hours have passed since your baby last
vomited, return to both sides. If vomiting occurs recurrently 3 or more times, put your on water
or any rehydration solution. As soon as 4 hours elapse without vomiting, return to nursing, but
again with smaller than the usual amount for 8 hours.
Medicine: Discontinue all medicine for 8 hours. Oral medicine can irritate the stomach and
make vomiting worse. If your child has fever over 39C and is uncomfortable use a Voltaren
suppository.
 

Common mistakes when treating vomiting
A common error is to give the child as much fluid as the child wants instead of gradually
increasing the amount. This almost always leads to progressive vomiting. Keep in mind that
there is no effective drug or suppository for vomiting and that dietary modification is the
answer. Vomiting alone per se rarely cause dehydration unless drugs, which usually induce
vomiting, is continued, or too much milk or fluid is given at one go.
 

Call at the A& E Dept immediately if
Your child develops diarrhea and vomit more than 3 times greenish yellowish liquid (bilious)
No urine for > 12 hours
Crying produce no tears
Blood in vomitus not due to nose bleeding
Abdominal pain which last > 4 hours especially if it is associated with reduced walking
Your child acts sick and become confused      Back to top

Emergency Symptoms

Some emergency symptoms are either difficult to recognize or considered serious by
some parents when it is not. Most parents will not overlook or underestimate the
importance of a major burn, major bleeding, choking a convulsion, or a coma.
However, if your child has any of the following symptoms, please contact the A&E
Department immediately.
 

Sick Newborn. If your baby is less than 1 month old and sick in any way, the
problem could be serious.
Lethargy, Fatigue during an illness may be normal, but watch to see if your child
stares into space, won’t smile, won’t play, is too weak to cry, is floppy, or is hard
to awake. These are serious symptoms.
Severe Pain. If your child cries when you touch or move him or her, this can be a
symptom of meningitis. A child with meningitis also doesn’t want to be held.
Constant screaming or inability to sleep also point to severe pain.
Can’t walk. If your child has learned to walk and then loss the ability to stand or
walk, he or she probably has a serious abdominal problem such as appendicitis
or has injured a limb bad enough including a fracture.
Tender abdomen. Press on your child’s belly with your child sitting on your leg
and looking at his response. Normally you should be able to press an inch or with
your fingers in all parts of the belly without tenseness. It is significant if your
child pushes your hand away or screams. If the belly is also bloated, the
condition is even more dangerous.
 

Tender Testicle or scrotum This requires surgery within 5 hours to save the
testis.
 

Labored Breathing. You should assess your child’s breathing after you have
cleaned out the nose and when he or she is not coughing. If your child has
difficulty in breathing, tight croupy breaths, or obvious wheezing, he or she
needs to be seen immediately. Other signs of importance include a bluish lips, or
retractions in between the ribs.
Bluish lips. Bluish lips or cyanosis can indicate a reduced amount of oxygen in
the bloodstream.
Drooling. The sudden onset of drooling or spitting, especially associated with
difficulty in swallowing, can mean that your child has a serious infection of the
tonsils, throat, or epiglottis (top part of the windpipe).
Dehydration. Dehydration means that your child’s body fluids are low.
Dehydration usually follows severe vomiting or diarrhea. Suspect dehydration is
present if your child has not urinated for more than 8 hours, crying produces no
tears, the mouth is dry rather than moist, or the soft spot in the skull is sunken.
Dehydration requires immediate fluid replacement by mouth or intravenously.
Bulging Soft Spot. If the anterior fontanelle is tense and bulging, the brain is
under pressure. Since the fontanelle normally bulges with crying, assess it when
your child is quiet and in an upright position.
Stiff Neck. To test for a stiff neck, lay your child down, then lift the head until
the chin touches the middle of the chest, if he or she is resistant, place a toy or
other object of interest on the belly so he or she will have to look down to see it.
A stiff neck can be an early sign of meningitis.
Injured Neck. Discuss any injury to the neck, regardless of symptoms, with your
child’s physician because of the risk of damage to the spinal cord.
 

Purple Spots. Purple or blood red spots on the skin can be a sign of a serious
bloodstream infection, with the exception of explained bruises, of course.
Fever Over 105ºF (40.6ºC). All the preceding symptoms are stronger indicators
of serious illness rather than the level of fever itself. All of them can occur with
low fever as well as high ones.
Fever becomes strong indication of serious infection only when the temperature rises
above 105ºF (40.6ºC). However an infant with any of the above symptom without
fever could be very sick. If in doubt, always seek medical opinion.     Back to top

Bronchiolitis

DEFINITION
Diagnostic Findings
• Wheezing: a high-pitched whistling sound produced during breathing out
• Rapid breathing with a rate of over 40 breathes per minute
• Tight breathing (your child has to push the air out)
• Coughing often with very sticky mucus
• Onset of lung symptoms often preceded by fever and a runny nose
• An average age of 6 months, always less than 2 years
• Symptoms similar to asthma.
 

Cause
The wheezing is caused by a narrowing of the smallest airways in the lung
(bronchioles). This narrowing results from inflammation (swelling) caused by any of
number of virus, usually the respiratory sy virus (RSV). RSV occurs in epidemics
almost every winter in the temperate country. Whereas infants with RSV develop
bronchiolitis, children over 2 years of age and adults just develop cold symptoms.
 

This virus is found in secretions of infected individuals.
• It is spread by sneezing, coughing at a range of less than 6 feet or by hand-to nose
or hand- to- eyes contact.
• People do not develop permanent immunity to the virus.
 

Expected Course
Wheezing and tight breathing (difficulty breathing out) become worse for 2 or 3 days
and then begin to improve. Overall, the wheezing last approximately 7 days and the
cough about 14 days. The most common complication of bronchiolitis is an ear
infection. Occurring in some 20% of infants. Bacterial pneumonia is an uncommon
complication in only 1% or 2% of children with Bronchiolitis. They are usually
hospitalized because they need oxygen or fluid intake assistance. In the long run,
approximately 30% of the children who develop bronchiolitis go on to develop
asthma. Recurrences of wheezing (asthma) occur mainly in children who come from
families where close relatives have asthma. Asthma is very treatable with current
medication.
 

HOME TREATMENT FOR BRONCHIOLITIS
Medicines. Some children with bronchiolitis respond to asthma medicines, others less
so. However symptomatic medicines given by your doctor will reduce your child’s
discomfort somewhat. Continue the medicine until your child’s wheezing is gone for
24 hours. In addition, your child can be given acetaminophen every 4 to 6 hours if the
fever over 102ºF (39ºC).
Humidity. Dry air tends to make cough worse. Use a humidifier in your child’s
bedroom. The new ultrasonic humidifiers not only have the advantage of quietness,
but also kill molds and most bacteria that might be in the water.
Suction of a Blocked Nose. If the nose is blocked up, your child will not be able to
drink from a bottle or nurse. Most stuffy noses are blocked by dry or sticky mucus.
Suction alone cannot remove dry secretions. Warm up water nose drops are better
than any medicine you buy for loosening up mucus. Place three drops of warm water
in each nose. After about 1 minute, use a soft rubber suction bulb to suck it out. You
can repeat this procedure several times until your child’s breathing through the nose
becomes quiet and easy.
Feedings. Encourage your child to drink adequate fluids. Eating is often tiring. So
offer your child formula or breast milk in smaller amounts at more frequent intervals.
If your child vomits during a coughing spasm, feed the child again.
No Smoking. Tobacco smoke aggravate coughing. The incidence of wheezing
increases greatly in children who have an RSV infection and are exposed to passive
smoking. Don’t let anyone smoke around your child. In fact, try not to let anybody
smoke inside your home.
 

CALL AT THE A & E DEPARTMENT IF
Your child stops breathing or passes out.
The lips become bluish
Your child starts acting very sick
Feeding is difficult for 12 hours especially if associated with vomiting and
Breathing becomes labored or difficult.
The wheezing becomes severe (tight)
The chest retraction becomes severe
Breathing more than 60/mins
 

CALL AT THE OFFICE DURING REGULAR HOUR IF
Your child is unable to sleep because of the wheezing
Your child is not drinking enough fluids
A nasal discharge becomes yellow for more than 24 hours
Any fever (over100ºF [37.8ºC]) lasts more than 72 hours    Back to top

Hand Foot and Mouth Disease

Diagnostic Findings
• Small ulcers in the mouth
• A mildly painful mouth
• Small water blisters or spots located on the palms and soles and
between the fingers arid toes
• Sometimes, small blisters or red spots on the buttocks
• Fever (37.8ºc) may be as high as 40ºc
• Mainly occurs in children 6 months to 4 years of age

Cause
Hand, Foot, and Mouth Disease is always caused by a Coxsackie A virus. It has no
relationship to hoof and mouth disease of cattle.
Expected Course
The fever and discomfort are usually gone by day 3 or 4. The mouth ulcers resolve in
7 days, but the rash on the hands and feet can last 10 days. The only complication seen
with any frequency is dehydration from refusing fluids.
 

Home Care
Diet. Avoid giving your child citrus, salty, or spicy foods. Also avoid foods that need
much chewing. Chang to a soft diet for a few days and encourage plenty of clear
fluids. Cold drink, fruit juice are often well received. Have your child rinse the mouth
with warm water after meals.
Fever. Acetaminophen may be given for a few days if the fever is above 102ºF (39ºc).
Fever suppository if temperature is more than 39ºc and uncomfortable.
Contagiousness. Hand, Foot and Mouth disease is quite contagious and usually some
of your child’s play mates will develop it at about the same time. The is cubation
period after contact is 3 to 6 days. Because of the rapid spread in childcare and playschool,
it is important to isolate your child to avoid an epidemic. Please note that the
condition is seldom life threatening and no undue anxiety is warranted.
Call at the
A&E Department if
• Your child has not urinated for more than 12 hours,
• The neck becomes stiff,
• Your child becomes confused or delirious,
• Your child becomes hard to awaken completely,
• Your child starts acting very sick.
During regular hours if
• Your child is not drinking much,
• The fever lasts more than 3 days,
• The mouth pain becomes severe,
• The gums become red, swollen, or tender,
• You feel your child is getting worse,
• You have other concerns or questions.   Back to top

Chickenpox

Diagnostic Findings of Chickenpox
 

--Multiple small, red bumps that progress to thin-walled water blisters; then cloudy blisters or open
sores, which are usually less than 1//4 inch across; and finally
dry, brown crusts (all within 24 hours)
--Repeated crops of these sores for' 4 to 5 days
--Rash on all body surfaces but usually starts on head and back
--Some ulcers (sores) in the mouth, eyelids, and genital area
--Fever (unless the rash is mild)
--Exposure to a child with chickenpox 14 to 16 days earlier
Chickenpox Virus

Cause
Chickenpox is caused by exposure to a highly contagious virus 14 to 16 days earlier. A chickenpox
vaccine is now available, given after the first birthday.

Expected Course
New eruptions continue to crop up daily for 4 to 5 days. The fever is usually the highest on the third or
fourth day. Children start to feel better and stop having a fever once they stop getting new "pox". The average child gets a total of 500 sores. Chickenpox rarely leaves any permanent scars unless the soresbecome badly infected with impetigo or your child repeatedly picks off the scabs. However, normal chickenpox can leave temporary marks on the skin that take 6 to 12 months to fade. One attack gives lifelong immunity. Very rarely, a child may develop a second mild attack.
 

HOME CARE
Itching and Cool Baths. The best treatment for skin discomfort and itching is a cool bath every 3 to 4
hours for the first few days. Baths don't spread the chickenpox for the first few days. If the itching
becomes severe or interferes with sleep, give your child a antihistamine
Fever. Acetaminophen may be given in the dose appropriate for your child's age for a few days if your
child develops a fever over 39° C. Aspirin should be avoided in children and adolescents with
chickenpox because of the link with Reye's syndrome.
Sore Mouth. Since chickenpox sores also occur in the mouth and throat, your child may be picky about
eating. Encourage cold fluids. Offer a soft, bland diet and avoid salty foods and citrus fruits. If the
mouth ulcers become troublesome, have your child gargle or swallow 1 table spoon of an antacid
solution four times daily after meals.
Sore Genital Area. Sores also normally occur in the genital area. If urination becomes very painful,
apply some lidocaine (Xylocaine) or 1% Nupercainal ointment (no prescription needed) to the genital
ulcers every 2 to 3 hours to relieve pain.
Prevention of Impetigo (Infected Sores). To prevent the sores from becoming infected with bacteria,
trim your child's fingernails short. Also, wash the hands with an antibacterial soap (Cetaphil or Isoderm)
frequently during the day. For young babies who are scratching badly, you may want to cover their
hands with cotton socks.
 

Contagiousness and Isolation. Children with chickenpox are contagious until all the sores have
crusted over, usually about 6 to 7 days after the rash begins. To avoid exposing other children, try not
to take your child school or childcare centre. If you must see a doctor, leave your child in the car with a
sitter while you check in to wait for your child's turn. Most adults who think they didn't have
chickenpox as a child had a mild case. Only 4% of adults are not protected. If you lived in the same
household with siblings who had chickenpox, consider yourself protected. Siblings will come down
with chickenpox in 14 to 16 days. The second case in a family always has many more chickenpox than
the first case.
 

Consultation
Immediately if your child develops
• a patch of red tender skin
• confusion and difficult to awaken
• trouble walking
• neck stiffness
• Breathlessness
• Vomiting
• bleeding into the chickenpox
• act sick with poor appetite Within 24 hours if
• the scab becomes larger
• The scabs become soft and drain pus. (NOTE: Use an antibiotic ointment on these sores until
your child is seen by a physician.)
• The fever lasts over 4 days.
A lymph node becomes larger and more tender than other
• The itching is severe and doesn't respond to treatment
• Your child develops severe pain when urinating.
• You have other concerns or questions.
Thing s happening before the typical pox appears

Febrile Fits

What Are Febrile Fits?

Fits associated with high fever are a common occurrence in children. The incidence is about 4% in children under five years of age.