THE SICK CHILD - Full extract 

Tessa is about 18 months old and into everything. Clanging the kitchen pots and pans is her specialty, closely followed by fiddling with the scales in my consulting room. 

One morning her mother urgently brought her into the surgery. Tessa had not eaten any breakfast and did not want to drink. She was pale, drowsy and not interested in what was going on around her. She also looked a bit floppy and limp. 

On examination, she had a mild fever but nothing else to go on. Her chest was clear and her breathing was normal. Her throat and ears were okay and her abdomen was relaxed and not tender. 

I was not sure what was wrong with Tessa, but it was obvious that she was very ill and needed immediate investigation. I wondered whether she might have had septicemia of some sort. A urinary tract infection or meningitis were other possibilities. I rang for an ambulance and also spoke to the admitting doctor at the Children's Hospital. She was in hospital within the hour. 

In casualty she had a number of blood tests, a urine test and a lumbar puncture. Tessa had bacterial meningitis and required high dose intravenous antibiotics in intensive care. After an initial stormy course she improved rapidly. It appears that she may be left with a slight hearing deficit in her left ear, but otherwise she seems to have made a full recovery.

All children get sick from time to time...the usual things like coughs, sore throats, high temperatures and pains in the tummy. But every now and again a child gets very sick indeed and needs prompt and expert medical attention. As parents it can be one of our biggest worries. How do we tell if our child is seriously ill? What clues are there that we could be dealing with an emergency? 

Trying to assess a small baby can be anything but easy. You cannot get a history and the approach is almost veterinary. However, there are some signs to look for. A baby may be pale, refusing to drink, or obviously floppy and drowsy... perhaps with glazed eyes and not interested in what's going on around it. There may be other clues too, like breathing difficulties, vomiting or not doing wet nappies. Any of these features need quick sorting out by a doctor in case there is some serious underlying problem. It is always an encouraging sign if the baby is eating and drinking normally. 

When any mother tells me that her baby is very sick I really sit up and take notice. Nobody knows a baby like its mother. Grandmothers are pretty sharp as well. If your baby seems very sick and you are just not sure what is wrong, it is better to err on the side of caution. Promptly see your own doctor...or if that is not possible, go to the casualty department at the nearest public hospital. The problem needs to be quickly sorted out and nobody will think you are a panicky parent. 

Sometimes the treating GP might not know exactly what the problem is either...just that the baby is acutely sick and requires urgent paediatric assessment. The diagnosis might have been narrowed down to two or three possibilities and several tests might be necessary. Frequently it will turn out to be something like an odd viral infection. However, it could equally turn out to be a more serious problem like a urinary infection, meningitis or pneumonia. 

Older children from say 3 to 10 years of age are a little easier to sort out. At least they can tell you what's wrong or where it hurts, even if they do need some prompting at times. Again the floppy, limp child is always a worry. This might occur in a child with gastroenteritis who has become dehydrated and continues to have vomiting and diarrhoea. Urgent casualty assessment is required for such children in case rehydration with intravenous fluids is required. 

Breathing problems like asthma and croup also need urgent sorting out. Any child having trouble breathing should be attended to quickly. Many children with breathing difficulties will settle nicely in casualty. Some do not settle and admission to hospital for treatment is necessary. 

Abdominal pain is a symptom that also causes parents a lot of concern. Any constant or very severe pain needs to be checked, especially if the pain becomes more distinct and localized, or if it is associated with vomiting. An early appendix is not easy to pick and sometimes more than one assessment by the doctor is required before the diagnosis is clear. 

Meningitis is another condition that causes a lot of worry. The usual clues are high fever, vomiting, headaches and turning away from bright light. These features are not always present. A blotchy or spotty purplish rash may be seen with meningococcal meningitis, a life-threatening bacterial infection. If meningitis is suspected, a visit to casualty is required; a lumbar puncture is the only way to confirm the diagnosis. 

It is a good idea to discuss with your doctor what arrangements are in place at your clinic should an urgent problem crop up either in normal hours or after hours. When you have a sick child you should not be concerned that you might be over-reacting or causing a false alarm. If it does happen that your child turns out to have only a minor problem...all the better! 

Health Tips:
* When a child loses interest in eating and drinking there has to be a cause. 

* If you are worried that your child might be acutely ill, either see your own doctor promptly, or go to casualty. Even if nothing is found initially, go back again to see the doctor if you feel your child's condition is getting worse.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001