Illnesses system by system
Most babies contract recurrent minor illness within the first 2-3 years of life when their immune systems are immature and all the bugs they encounter are “new” to their systems. Babies in crèche/daycare and babies with older siblings are exposed to more bugs and tend to get sick more frequently.
Do not be surprised if the child has 5-10 minor infections (eg common colds) per year in the first 2-3 years of life. In addition, every cold may last 1-3 weeks so it can feel as if your baby is “always sick.”
Remember that children have a higher breathing rate than adults (30-50 breaths per minute can be quite normal for young children, compared with 16-20 in adults); they also have a higher resting heart rate (90-150 beats per minute), which is increased even more when they have a fever.
Coughs and colds/Respiratory illnesses
Snuffly noses and wet coughs are usually caused by the common cold virus, which lasts 1-3 weeks, and for which there is no specific treatment. Keep the child comfortable with saline nose drops, paracetamol if needed, frequent small feeds and lots of hugs. Children are often “grumpy” or “difficult” when they feel unwell, and often that is the first sign of a viral illness
Ask your doctor about doses of fever/pain medication that need to be given. An example of commonly used fever medications are:
- Paracetamol (eg calpol syrup, panado syrup- NOT infant drops): 0.6mL per kg body weight 6 hourly, eg For a 5 kg child: Panado syrup 3 mL 6 hourly; for a 10kg child 6 mL 6 hourly
- Ibuprofen (e.g. Nurofen syrup) : 0.3mL per kg body weight 6 hourly. e.g for a 10 kg child: Nurofen syrup 3 mL 6 hourly
We do not recommend over the counter cough or flu medicines or sedatives for young children except if advised by your doctor.
Not every snuffle needs a doctor’s opinion; however please see your doctor if the child is:
- feeding poorly
- has a high fever (> 38 degrees in the first 6 months and > 38.5 degrees after that)
- is unusually lethargic or irritable
- is breathing fast (more than one breath per second/60 breaths per minute; especially
if you have already controlled the fever)
- has a wheeze when breathing out (often bronchitis or asthma) or a “whoop” when
breathing in (usually croup)
- is not “getting better” after 5 days or (they may have developed a secondary bacterial
infection such as a middle ear infection or tonsillitis).
Tummy bugs/Gastroenteritis
The most common cause of an upset tummy is a viral gastroenteritis; these viruses are very catchy and often pass through the family.
Typically, they present as vomiting for a day or two, followed by diarrhoea for 3-7 days. Of course there can be many variations of this pattern.
Keeping the child hydrated is the most important management step, it works best by feeding them fluid little and often. If they are drinking and active despite runny stools, they are coping well. Relax about solids while the child has gastro- fluids are much more important. Commercially available rehydration solutions are best, if your child refuses those try some diluted apple juice or even milk if all else fails.
If the diarrhoea lasts more than a week, you may need to try a lactose free diet (eg lactose free formula, reduce dairy in the diet) for the child a week or two while the tummy settles.
Consult your doctor if:
- The vomiting is persistent and the child can’t keep any fluids down
- The diarrhoea is very frequent (> 10 stools a day) or has blood in it
- The child looks drowsy or is very lethargic as they may be dehydrated
- The child has a high fever or a rash.
Rashes
Rashes are very difficult to self- diagnose so a prompt visit to your doctor is justified if you are not certain of the cause. Some rashes are part of a harmless virus (usually pink spots that fade if you apply pressure to them and are non-itchy); some are the very common, such as seborrhoeic dermatitis (cradle cap) rash in the first few months of life (scaly rash on face and upper body, typically non itchy).
Consult your doctor if:
- The rash is accompanied by a high fever or the child is very unwell
- The rash consists of red spots which do not fade when you press a glass on them (this may be the dreaded meningitis rash)
- The rash is itchy (this may be eczema which should be treated promptly)
- The rash is getting worse with time
Other illnesses
A child with a high fever and no obvious source of infection (like a runny nose), may well have a flu-like illness (often other members of the family are also unwell), but always seek medical attention if the child is:
- Very irritable (meningitis and urine infections will need to be excluded)
- Has respiratory distress or unexplained rashes
The illness “Roseola” typically presents with a high fever and irritability for 2-3 days, followed by a rash once the fever settles. Very often the child will have incorrectly be placed on an antibiotic while they have a fever (the throat may also be red), and when the rash appears it gets misinterpreted as a reaction to the antibiotic!
Dr Claudia Gray, Paediatrician and Allergologist, Vincent Pallotti Hospital and Red Cross Children’s Hospital, Cape Town
