(March 2011) by Dr Stephen Barker

Firstly, just to say this article is really a summary of a few thoughts and ideas. To include everything would need a short book and I prefer mine to be of the entertaining variety!

What to think about when your child is unwell

(1) What is normal and common in self-limiting viral infections?

Certainly most children with a virus will feel at least a little off colour, perhaps tired, a little more irritable, and maybe have a reduced appetite. (See below for a comment on reduced breast or bottle feeding in infants). Temperatures under 38°, transient aches and pains, mild coughs, sore throat, ear ache and sometimes mild abdominal pain are common in viral infection.

(2) Things to watch out for that would need a discussion or consultation with a health professional might include:

  • persistent fever above 38°, particularly if for more than 24 hours
  • faster rate of breathing than usual
  • difficulty drinking fluids (in the case of small infants any significant reduction in feeding, either breast or bottle)
  • severe ear aches
  • sore throats with spots in throat or mouth
  • persistent bad coughs
  • unusually irritable or distressed
  • as well as those that are unexpectedly drowsy.
  • Rashes can be difficult. Although most rashes turn out not to be alarming, if you are unsure about the rash or your child is unwell, then it may be worth getting the rash checked.

    Assuming discussion or examination by your health professional shows nothing too much to worry about, how best to manage the symptoms? Paracetamol and/or Ibuprofen liquids can be used by most children. Doses are usually at 4 or 6 hour intervals according to instructions on the bottle or from your doctor, pharmacist or nurse. However, there’s no need to continue using these routinely if you feel your child is improving. As a general rule, plenty of fluids is a good idea, mostly water if in doubt. Usually juice is not suitable unless it is very dilute. If fever is still an issue then make sure the child is not overdressed, ventilate the room, consider the use of a fan. If the child is awake then perhaps playing in a bath is reasonable. The old idea of tepid sponging is now no longer recommended as it doesn’t seem to have a great benefit and can be distressing for the child.

    A note on diarrhoea; most diarrhoea in infants and children is viral. Often a rotavirus can be the culprit. These bugs are amongst the most easily spread. For this reason, if your child has a diarrhoea and vomiting bug but is managing to keep some fluids going, it is probably best to keep them at home and away from other people. At home, a higher level than usual of hand washing for other household members, particularly around meal times, is logical. The infection will usually clear spontaneously. If there is concern regarding hydration levels, prolonged duration of diarrhoea, or something unusual such as blood staining, then it is probably time to see or talk to your GP or practice nurse.

    Hopefully this provides a helpful update. Remember, if in doubt then you can always ring your practice and be connected to a nurse for advice. Another resource for similar advice is Plunket Line – Phone 0800 933 922.