Infections
in children
- Fever
- Early "red flags" for meningococcal disease
- Normal heart and respiratory rates at rest by age
- Chickenpox
- Herpetic infections
- Kawasaki disease
- Measles
- Mumps
- Roseola infantum
- Rubella
- Scarlet fever
- Urinary tract infection
Fever
Source: BMJ
Early "red flags" for meningococcal disease
-
Lethargy—most patients with meningococcal disease will be drowsy or unusually lethargic
-
Confusion—nearly half of older children and adults will be acutely confused
-
Headache—less than half of children overall will have headache, but this symptom is more common in older children and adults
-
Leg pain occurs in approximately one third of preschool age children and up to two thirds of older children and young adults with meningococcal disease. These pains are often so severe that the patient is reluctant to move or walk
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Cold hands or feet—peripheral perfusion may be impaired; about half of children will have cold hands and feet (even though they have a fever), and about a fifth will have abnormal skin colour, such as pallor or cyanosis
Symptoms and signs of bacterial meningitis and meningococcal septicaemia
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*With the patient lying flat on his or her back, inability to
extend the knees beyond 135° without causing pain;
with
the patient supine, one hand placed behind the patient’s head and the
other hand on the patient’s chest, while the patient’s head is raised,
flexion of the patient’s lower extremities (hips and knees) constitutes
a positive sign.
Yes=symptom or sign present; X=symptom or sign not present; NK not known if a symptom or sign is present (not reported in the evidence).
Normal heart and respiratory rates at rest by age
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12From: Advanced Life Support Group. Advanced Paediatric Life Support: The Practical Approach. 4th ed. Wiley Blackwell, 2004.
Urinary tract infection
Suspicion should always result in urine culture and microscopy (this is more important than treatment!). If significant bacteriuria and age under 5:- Rx cefalexin.
- Arrange for monthly urine samples for MC&S meantime.
- Give information including parent advice leaflet .
- Refer for DMSA scan and renal ultrasound.
Urinary tract infection (UTI) in children
Note: NICE guidelines have been published in late 2007 which potentially simplify UTI management in children. There is still much professional debate about these guidelines, however.
Measles
- Should be non-existent. Notifiable.
- Incubation 10-14 days.
- Prodromal period. Characteristic rash 3-4 days.
- Exclusion period 5 days from onset of rash.
Rubella
- Should be non-existent. Notifiable. Vaccination very effective.
- Incubation 14-21 days.
- Rash can be transient and difficult to diagnose.
- Exclusion ?
Roseola infantum
- Pronounced fever for 3 days, followed by resolution and the onset of a pinkish macular rash.
Chickenpox
- Incubation 14-17 days.
- Characteristic rash in crops over 5 days.
- Exclusion period 5 days from onset of rash.
Scarlet fever
- Notifiable. Very rare.
- Incubation 2-4 days.
- Characteristic rash of pinpoint macules + strawberry tongue.
- Check urine for protein. Throat swab/ASO titre.
- Rx Penicillin x 10 days.
- Exclusion period 10 days from onset of rash.
Herpetic infections
- Typically oral lesions, stomatitis and persistent pyrexia.
- Resolution in 7-14 days.
Mumps
- Should be non-existent. Notifiable.
- Incubation 16-21 days.
- Characteristic parotid swelling for 7-10 days.
- Exclusion period until parotid swelling resolved.