4 Common Symptoms  of An Unwell Child – What to watch out for!

All parents get worried when their child is unwell. That is a universal law. However, it is not necessarily the time to panic. Panic is when you are unprepared As parents you would be much better prepared to help your child  if you know what to watch out for in the common symptoms of an unwell child.

After completing 4 months of paediatric posting, I wish to advise all parents on what to observe involving these 4 common symptoms. When you bring your child to the hospital, these observations can help the doctor make an accurate diagnose and start treatment quickly. Quite commonly, many parents come unprepared and unable to provide the essential observations about these 4 symptoms. Essential observations that help the medical team make accurate diagnosis and start treatment quickly.

The 4 common symptoms of an unwell child

1. Fever

Fever is the first of common symptoms of an unwell child. Body temperature above the normal 37^oC, is considered a fever.  A fever below 38^oC is a low grade fever. Children are prone to get fever as it is a natural immune response to a foreign invader like virus, bacteria. A few characteristics of fever are of concern and should be monitored. When a child is admitted, doctors will usually ask parents these three questions about the fever:

• Onset
  • Medical personnel needs to differentiate between a normal & a prolonged fever and will ask you when the fever started. Prolonged fever exceeding 3 days, should be investigated and tested for antibiotic sensitivity.

• Fever Relieving factor
  • Normal fever is usually resolved by tepid sponging or treated with Paracetamol syrup. When a fever is not resolved by these methods, the cause of the fever is most likely due to bacteria or virus. In the case of bacteria infection, which is confirmed by a blood or urine test, antibiotics will be prescribed. However in viral infections, treatment is more challenging. However it usually resolves on its own and antiviral drugs are used only if necessary.

• Temperature
  • A low-grade fever is usually be treated with tepid sponging and medication could be avoided. However, monitoring for high grade fever is important to prevent febrile fits. Use a thermometer to monitor fever temperature.

2. Diarrhoea and Vomiting

The next, diarrhoea and vomiting is one of common symptoms of an unwell child. It is most likely Acute Gastroenteritis (AGE) or food poisoning when a sick child has diarrhoea and vomiting.  Although it may seem harmless, frequent purging can lead to dehydration, a potentially life threatening condition. Parents should monitor the onset, the vomit content and frequency:

• Onset
  • Medical personnel are more able to pinpoint the cause if they know when symptoms started. Children with these symptoms usually have taken outside food, and often, at a place where the hygiene is questionable. Siblings would also show similar symptoms, if they consume the same food.

• Content
  • In most cases of AGE, the content of vomit would usually be food content or milk content. These findings indicate  acute gastroenteritis. You must observe if there is blood or bilious (green) seen in the vomit, indication of a more serious condition.

• Frequency
  • You should count the number of times your child vomits or has diarrhoea. Surprisingly many parents could not provide such information. AGE will usually resolve on its own, but if necessary, the doctor will start IV drip to treat dehydration, a fatal condition if treated late. Also if the child suffered from persistent purging, correction of potassium needs to be added to the IV Drip.

3. Fits

Third most common of the common symptoms of an unwell child is fits. A febrile fit is a seizure associated with a high body temperature but without any serious underlying health issue. Fits have to be one of scariest experience for a parent. Any parent would be traumatised to see their child convulsing, with stiff limbs, eyeballs rolling up  and drooling with saliva. Observe the duration and the characteristics

• Duration
  • The duration of a fit episode defines the severity of the condition. In terms of duration, a simple febrile seizure is defined by a short duration lasting less than 15 minutes. A complex febrile seizure is defined as seizure lasting longer than 15 minutes or multiple episodes occurring  within 24 hours., whereas a febrile seizure longer than 30 minutes is a febrile status epilepticus. This occurs in about 5% of febrile seizure cases.

• Characteristics
  • The nature of a fit episode differentiates the kinds of seizures. You need to inform the doctor of the characteristics you observe such as
    • Up rolling of the eyeball
    • Drooling of saliva
    • Tonicity or tension of the upper and lower limbs
    • Focal features– are absent in simple febrile seizure, while it may be present in complex febrile seizure and febrile status epilepticus. The symptoms can be split into motor and non-motor symptoms:
      

      Motor symptoms

      Non-motor symptoms

      Part of your body, for example one arm, going stiff or going limp or ‘floppy’ Rhythmic jerking in part of your body Brief, irregular jerks in part of your body Head and eyes turning to one side Lip smacking, repeated swallowing or chewing A jerking movement that starts in one part of your body – usually your hand or face – and then spreads bit by bit to other parts of your body Having repeated movements such as rocking, pedalling or pelvic thrusting Undressing Running or walking

      Experiencing fear, anxiety, anger or pleasure Changes to vision, hearing, smell or taste Having sensations of being hot or cold Seeing or hearing things that aren’t there (hallucinations) Sensation that your body is distorted A notion that part of your body is missing or doesn’t belong to you Feeling of being sick Changes to breathing, heart-rate or skin tone A sense like what’s happening has happened before (deja vu) Difficulty processing language

      Source: Focal features by Epilepsy Action

      • Postictal drowsiness– is the altered state of consciousness after a seizure. It usually last between 5 and 30 minutes, however longer if the seizures are severe. Usually associated with drowsiness, confusion, nausea, headache, hypertension, or migraine.
      • Frequency As mentioned above, frequency of the seizures will allow the doctors to diagnose between these three types of seizure.

4. Fast or noisy breathing

Lastly the 4th most common symptom: Fast breathing (tachypnoea) or noisy breathing (wheezing) in children are usually due to an asthmatic attack. If your child is asthmatic and has an asthma pump, please use it. However, when they are not, PLEASE BRING YOUR CHILD TO THE NEAREST HOSPITAL OR MEDICAL CENTER. Most likely, your child would need a nebuliser.

On the way to the hospital count the respiratory rate of your child, which is the number of breaths per minute (see the breathing effort from the chest rise).

For more information, please refer to Is night coughing a sign of Asthma? Hidden Asthma Facts Parents should know!

It is important to monitor and observe these 4 common symptoms of an unwell child. You would be better prepared to assist the medical team make a faster and accurate diagnosis when you seek medical help. Children are our responsibility. It is our role, as parents, to be well prepared on take the necessary actions in a medical emergency.

If you would like to make an appointment with a paediatrician:

Find a paediatrician in Malaysia, on GetDoc

Find an paediatrician in Singapore, on GetDoc

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