Fever
Normal 35.5 – 37 C (try establish “your childs” norm)
Elevated (or <35 in 38.5 or symptomatic child (unwell, vomiting etc)
Risks – febrile/fever seizure/fit, > 40 tissue damage
Associated symptoms:
- Rigor/shakes
- Vomiting
- Cause ..snot, cough, diarrhoea ++
Treatment:
Remove excess clothing
Warm bath, evaporation and warm cold peripheries
Medicinal Hierarchy:
- Paracetamol ORAL 15mg/kg/dose (120mg/5 ml) 6 hourly
Per RECTUM 25mg/kg/dose (125/250mg)
CALPOL/PANADO/PAINAMOL
- Mefenamic acid ORAL 5mg/kg/dose (50mg/5ml)
Per RECTUM (125mg)
PONSTAN/PONSTEL/FENEMAN
- Ibuprofen ORAL 5-10mg/kg/dose (100mg/5ml) NUROFEN
- Diclofenac acid Per RECTUM 1mg/kg/dose
VOLTAREN/PANAMOR/CATAFLAM
Find the cause….VIRAL….rash coming…..URINE & EARS SUBTLE
DOCTOR - > 40 >48 hours…travel

Rash
From birth to puberty and beyond our skin is a fragile organ designed to keep the outer world at bay.It can suffer from infectious, allergic, toxic and hormonal attack. But here are a few common tips and conditions seen in children from birth to puberty.

Clues
Big 5 commonest rashes following fever:
- Roseola Infantum (Human Herpes Virus) fever for 2-3 days and then spotty rash maily on front and back.
-German Measles (Rubella) fever, sore joint and flat rash starting on face and descending onto body
-Fifth’s disease/Slapped cheek syndrome/Erythema Infectiosum (Parvo B19) very high temps with red ++ cheeks followed by fine rash allover the body
-Measles high temps, conjunctivitis, rhinitis, cough, diarrheoa and red rash allover (++sick)
-Chicken Pox (Varicella Zoster) liquid containing blisters allover (Hair/mout/ears +) after a fever

All viral…..
Big five rashes without a fever:

- Eczema/Allergic dermatitis most often starts as a scaley rash on face/scalp and ears in early life and later progresses to an itchy dry scaley red rash, concentrated in creases (elbows, knees, neck and nappy area)
- Ringworm (Tinea) is not a worm but a fungus often contracted from pets, well defined red rings often with some pustules.
- Molluscum Contagiosum (pox virus) round raised smooth “warts” with a central hard spot, can last months and spread especially in allergic type skin and if scratching.
- Warts (Human papilloma virus) can occur anyway, rough raised growing lumps often on hands and knees or on soles of feet
- Acne can occur in infancy related to hormones or puberty, black heads around nose and face and pustules ….

Cough
A cough, like a fever is a normal physiologic response to clear the airway, the timing (day/night); sound of the cough and associated features like a snotty nose or fever.
Be cautious of cough syrups it is better to treat the cause of the cough, not treat the cough!

Clues:
- Snotty nose and snoring with night time cough = Post nasal drip
Generally is allergic or from chronic infected Rhinitis/Adenoids
Rx Antihistamines and nasal lavage (saline) and or steroids

- Cough with exercise and at night = Asthma/ Bronchiloitis

Often there is a family history of allergies/asthma and a wheeze can be heard

Rx Assessment and look for triggers then bronchodilator therapy with appropriate preventer

- Barky/Dog/Seal cough = croup (inflammation of large airways – trachea)
Mostly viral triggers (parainfluenza virus) but important to exclude allergies/foreign body…
Rx Adrenaline nebulisation with oral/inhaled steroid
- Whoop…Spasms of coughing followed by a ”whoop” or vomit = Pertussis/Para pertussis
Needs assessment and diagnosis to treat and prevent spread
Rx Routine Vaccination prevents well. If infected Macrolide antibiotics and bronchodilator
 
Vomiting

A frequent childhood problem which can vary from normal infantile reflux/positing to severe dehydrating vomiting.
Clues
- Positting or vomiting in the first few months of life is normal BUT if painful, projectile or green the needs further assessment….
Pyloric stenosis (stomach outlet obstruction), a volvulus (twisted gut) or painful damaging reflux need to be excluded.
- Vomiting with fever often precedes diarrhoea in a gastro enteritis often effects other family members
Rx Discuss with Health professional but Odansetron (Zofer/Zofran) dissolvable tabs are the safest and most effective anti emetics in children. Be careful of using other “older” meds which can have serious side effects in younger patients.
- Bloody vomiting is always a concern. Fresh blood suggests bleeding in oesophagus or higher as blood that has been in an acid stomach looks more like ground coffee ! This is frequently swallowed blood (nose bleeds or cracked nipples)

Seek advice at least.

- GREEN vomit NOT yellow…..stomach juice is yellow and burny yellow vomit occurs when vomiting on an empty stomach, though horrible green is far more concerning as it is coming from the duodenum and needs urgnt assessment.
 
Diarrheoa

The change over from black/green meconium stools to liquid/mustardy milk fed stools can be alarming and the early infant poo could be defined as diarrheoa, with ++ liquid and often very frequent. The change from mustard to soft serve ice cream to play dough takes months to years and varies depending on diet/solid food introduction.
A change in consistency, frequency, smell and associated pain suggest gut pathology.

Clues
- Preceding vomiting or fever suggests an Enteritis (infectious…usually viral), most are self limiting and should be treated with fluid and electrolyte replacement. Reducing stool frequency can lead to confusion as to how to replace and is DISCOURAGED IN CHILDREN.

Rx Pain meds (codeine and antispasmodics are good for cramps) Scopex/Stilpayne +
Prevent bum burn and replace with Paed. appropriate rehydration fluids. (home made = 1 litre water 5 teaspoons sugar/ ½ teaspoon of salt)

- Bloody and mucous stools are suggestive of bacterial infection (salmonella/campylobacter/E. Coli) and needs a stool test and antibiotic therapy.

- Large smelly brown stools of varying frequency are a common problem associated with Parasitic Gut infections (Giardia) but does need differentiation from “Toddlers diarrheoa” which is a non pathologic rapid food passage with large loose stools with ++ undigested food.

Rx Zentel or flagyl for giardia…patience for toddlers

- Frothy acidic stool can accompany teething, but more significantly if they occur early in infancy or after a bout of gastro enteritis and there are signs of acidic nappy rash….suggest LACTOSE (disaccharide) intolerance

Rx Avoid dairy/lactose and use probiotics and possibly lactase enzymes Back Home