Recognition of serious illness in infancy

Question 1

The signs of a very sick child include:

Answer 1

It is vital to diagnose serious life-threatening disease in children, esp. in early infancy.

• inactive, lying quietly, uninterested
• reduced mental state
• increased respiratory rate
• increased work of breathing
• noisy breathing:

–chest wall retraction

–wheezes, grunting, stridor

• tachycardia
• sunken eyes
• mottled, cold, pale skin
• drowsines

Question 2

Important childhood emergencies include

Answer 2

respiratory distress

poisoning

infections including severe gastroenteritis

seizures

SIDS/ALTS

Question 3

Serious illnesses to consider include:

Answer 3

• meningococcal infection

–septicaemia

–meningitis

• H. influenza type B (Hib) infection (now uncommon since Hib immunisation)

–acute epiglottitis

–meningitis

• other forms of meningitis
• acute myocarditis
• asthma/bronchitis/bronchiolitis
• pneumonia
• intussusception/bowel obstruction/appendicitis
• severe gastroenteritis
• urinary tract infection

Note:Meningococcaemia can present with a maculopapular rash before becoming purpuric.

Question 4

Red flag pointers—recognising the very sick child

Answer 4

• observations well outside normal range for age
• neonate >38°
• pulse >140
• BP <90/60
• respiration >40
• increased work of breathing
• noisy breathing—wheezing, grunting, stridor
• chest wall/sternal retraction
• pallor
• cold extremities
• capillary refill >2 secs
• rash—fine maculopapular → purpuric
• sunken eyes
• inactive, lying quietly, uninterested
• drowsiness
• reduced mental state
• seizure

Question 5

A golden rule:

Answer 5

Babies who are:

• febrile
• drowsy and
• pale

are at very high risk and require hospital admission.

Question 6

One general pattern for appraisal of the sick child is:

Answer 6

A—airway

B—breathing

C—circulation

D—disability (neurological assessment)

E—exposure

F—fluids in and out

G—glucose (not to be overlooked)

Question 7

Another approach to risk and indicator of toxicity is:

Answer 7

A—poor arousal, alertness and activity

B—breathing difficulty

C—poor circulation (persistent pallor, cold legs)

D—decreased fluid intake and/or urine output

• ‘fluids in’ = feeding
• ‘fluids out’ = <4 wet nappies in 24 hrs

Children with any of these signs must be seen early, investigated and treated as a priority.