winter coughs and colds - when should I worry?
As the children return to nursery and schools in the autumn there is inevitably a large increase in the numbers who develop coughs, colds and general viral illnesses with high fevers, and occasionally rashes and other symptoms. Most of these illnesses will be minor, and your child will recover within 3 or 4 days. Unfortunately, over the course of autumn and winter most children will have recurrent infections, with an average of up to 5 or 6 in the months of September to March.
The following symptoms are referred to as "Red Flag" symptoms, as they are slightly more likely to be associated with the possibility of more serious illnesses:
- rash
- temperature or pain, unresponsive to treatment with paracetamol or ibuprofen
- grey colour, floppy or reduced consciousness
- photophobia (eye pain when looking at bright lights) or neck stiffness
- history of travel overseas
- temperature for more than 7 days
Using the Red Flags symptoms you should be able to determine how unwell the child is.
Seeing a child with a temperature can be quite upsetting, as a child with a high fever (38-39°c) can look quite unwell, be sleepy or have a rash.
Any red spots which do not disappear when pressed by a glass (called a non-blanching rash) or if your child is grey or unresponsive, should be treated as an emergency and taken immediately to A&E. Meningitis and Septicaemia are the most important conditions to exclude. Septicaemia can be meningococcal or originate from another source such as a water or urinary tract infection.
It is important to establish the cause of the fever. If you have travelled abroad this summer, it may be important to think of tropical diseases such as malaria.
Clues such as ear pain, cough and sore throat may point to a viral respiratory infection, which can be either an Upper Respiratory Tract Infection - URTI involving the ears, nose or throat, or a Lower Respiratory Tract Infection (LRTI - involving the lungs). These are the commonest minor illnesses of children and need no special treatments other then control of temperature and fever.
Any tummy or abdominal pain should prompt a thorough examination to exclude the possibility of Appendicitis and to exclude a strangulated hernia or torsion (twist) or infection of the testicles in boys.
If you take your child to see a doctor, it is important to ensure the doctor looks in your child's ears and throat to see whether the child has ear infection (called Otitis Media), or Tonsillitis, and listen to the chest to see whether there is a chest infection. A urine test, done with a simple test strip may indicate a Urinary Tract Infection (UTI). Children with a fever and no obvious focus of infection can be more difficult to treat, and sometimes antibiotics are used even if the cause of the infection is not known.
If the child looks well, fever can be controlled with paracetamol or ibuprofen, and antibiotics may be avoided if the temperature settles within 48 hours. Your doctor may wish to check the urine, and then have another look at your child in 12 hours, if practical.
Most children who are well with fever should remain at home until the temperature is back to normal even without medication. Children with a viral illness need simple fever reducing medicines for about three days; those with a bacterial infection may require appropriate antibiotics from your GP. Parents often need educating about not over-wrapping children with fever and giving appropriate doses of fever controlling medicine to prevent sharp temperature fluctuations.
Viral blanching rashes are very common in children with fever, as are conditions such as Slapped Cheek (also called fifth disease) and another called Roseola Infantum also called sixth disease - please ask your GP for help if you are unsure.
