Lachlan is four years old. He has had a fever from the time he woke up; his mother Rachel has given him some Panadol. Now he has been to the bathroom and you notice his poo is runny.
He goes again and now she knows he’s got diarrhoea. He vomits once. In the meantime, Rachel has booked an appointment to the local GP for the afternoon. Lachlan is diagnosed with gastroenteritis.
1. High fevers
Any temperature over 38C may most likely indicate an infection. Treating fevers in children who are otherwise well is not always necessary. Fevers which are over 40C, persistent, making the child uncomfortable or causing lethargy are fevers which should be treated.
Remember, the body uses fevers as a first line defence mechanism to stop infection from multiplying. A fever that does not come down should prompt you to seek urgent medical attention.
Most commonly, paracetamol (most popular brand is Panadol) and ibuprofen (most popular brand is Nurofen) are used to bring down fevers. It is useful to know that these two medications can be used according to their instructions at the same time. Paracetamol doses are given every four to six hours with no more than four doses in a 24-hour period. Ibuprofen can be given every six to eight hours with no more that three doses in a 24-hour period. When using ibuprofen it is important to ensure it is not used on an empty stomach or to a child who is only having clear fluids (eg. water).
Lachlan had been drinking lots of fluids but his mother notices he has gradually stopped eating. He only picked at his lunch. He is still going to the bathroom, with runny stools. His mother has checked that he is still passing urine.
2. Dry nappies or not passing urine
Hydration is an important aspect of maintaining good health. When we are ill it becomes even more challenging, especially with illnesses that include vomiting or diarrhoea as part of the medical issues. Once your child is no longer passing urine or wetting nappies that is a clear indicator your child is dehydrated and needs to have water administered through an IV line or an NG tube.
An NG tube or nasogastric tube is a small tube inserted through your child’s nostrils into their stomach and allows fluids as well as nutrition to be administered when your child is not able for whatever reason to eat or drink for themselves. It is therefore important to keep an eye on how much urine your child is producing – monitor how many and how wet your child’s nappies are. If your child is potty trained keep an eye on how many times they go to the toilet to urinate.
Rachel notices that Lachlan is now vomiting more than he is drinking. In fact, he has now had three large vomits in a row and has not been able to drink anymore fluids as he says his tummy hurts. Rachel also noted that where he had been able to play with his toys in between the high fevers, he was now lying down on the couch with a normal temperature. He had become very pale, and was not really showing any interest in anything around him.
3. Persistent vomiting or diarrhoea
As stated above, it is essential to ensure your child stays hydrated. Your child may be drinking a little bit, but still having vomiting and diarrhoea. Either of these will deplete your child’s fluid levels very quickly unless your child is able to maintain a fluid intake that is equal to or greater than the amount they are losing by vomiting or having diarrhoea. You will need to be on high alert with any of these situations and keep a mental or physical record (writing down) of roughly how much your child is losing and taking in. Even if you think your child looks really well, if the amount they are passing out does not meet the amount they are taking in, seek urgent medical attention.
4. Lethargy (very tired)
Lethargy is sometimes explained as your child acting very tired but it is defined as “a relatively mild impairment of consciousness resulting in reduced alertness and awareness; this condition has many causes but is ultimately due to generalised brain dysfunction”.
This makes lethargy extremely important when it comes to illness as it is something that should not be ignored. It is important to get clarification from a medical professional as to the cause of your child feeling lethargic.
5. Change in colour
Changes in your child’s complexion or colouring can also be a sign of illness. Ranging from something as subtle as your child becoming pale or extreme like turning blue.
While more extreme changes like your child turning blue (a dangerous sign of oxygen deprivation that should have you calling 000 emergency for an ambulance) are usually the signs that prompt immediate medical action, pallor in a child should certainly not be ignored. Pallor in the setting of illness even more so.
6. Difficulty breathing
Difficulty breathing refers to any change in the nature and pattern of your child’s breathing that gives you cause for concern. It may be difficult for a parent to pick up on subtle changes in breathing that are a cause for concern but more obvious signs like fast and shallow breathing, labored breathing, wheezing and the cessation of breathing are the more obvious signs that most parents are aware of.
Any change in your child’s ability to breathe, especially for children who are known to have medical conditions such as asthma, should put you on high alert and protocols and treatment plans that have been put in place should immediately be put into action according to the severity of the condition. And when in doubt always seek medical attention. The main goal is keep your child safe and alive.
Even though Lachlan was still passing urine and talking to her, Rachel was worried and decided to seek urgent medical attention.
7. Parental concern
If you fail the sleep test, that is to say your worries for your child do not allow you to sleep, you should seek urgent medical attention. Studies have shown concerns of a parent that “my child is just not himself; he does not behave like this” is the most valid reason for seeking medical attention and is one that should not be ignored. The basis of sick children being cared for at home is one built on the parents and caregivers having enough confidence in providing that medical care. Your doctors are there to support you and in times of uncertainty you should always seek their advice.
While the list above is by no means exhaustive or conclusive, it is aimed at pointing out some important signs you may have overlooked as signs that should make you seek urgent medical attention. And while all conditions are not covered by the list above, always remember that as a parent you know your child, and if they are not well, listen to your instincts to seek medical attention.
No good doctor will ever turn a parent or patient away for having medical concerns no matter how great or small the patient or parent may feel they are.
Some doctors may seek clarification as how best to help you and if you are one of the lucky ones, your ability to act on your instincts and your knowledge can save yourself and your child.
Jeni Wellington is a full-time mother of 2 and in her “spare-time” is settling into the family-friendly career of a GP. She is author and creator of the Betty Butter Blog, an avenue through which she shares her simplified recipes, budding interests in food photography and the general chaos that comes with being a working mum trying to have it all.
