Childhood Illnesses

During childhood, your little one is developing their immune system. Through their childhood, their immune system will be exposed to many common bugs and most will get sick many times. It can be stressful when little ones become unwell, so learning how to manage different illnesses and when to seek help is key for all parents.

Most children become sick with only mild illnesses. However, some children will become seriously ill. Most admissions and presentations to ED for illnesses are in children under 4.

Because babies and young children can’t communicate when they are unwell and they can become seriously sick quickly. Remember these key things that will help you stay on top of most illnesses

keep them hydrated - sick little ones need small frequent feeds. Especially little babies who can become dehydrated and low on sugars quickly
keep them comfortable - stress uses lots of energy we want our little ones to use towards getting better
check on them regularly - Keeping an eye out for those changes your little ones is getting more sick means you can act quickly when you need to

Key tips to protect your little ones against illnesses

ask sick visitors and family members to stay away
wash hands regularly - especially after changing nappies when a child has gastro
clean surfaces with disinfectant, especially where vomit or poo has touched during a gastro bug
keep your home warm and dry - a cold house means your little ones need to use lots of energy to stay warm and might not have enough to fight those bugs when they hit. Viruses also hang around longer in cold humid environments.
staying on top of nutrition - Make sure your child has a varied diet with plenty of iron, vitamins A and C, zinc, and selenium.
breastfeeding in any capacity for as long as you can - All it takes is 50mL a day to get these benefits - even with an older baby or toddler.
keeping up with immunisations

Common worries for most illnesses

Dehydration - This is when the body doesn’t have enough fluid to function properly. It can happen quickly as respiratory bugs make it hard for babies to feed well and gastro and fevers mean children lose too much fluid. Offering appropriate fluids frequently is key with an unwell child.

Low sugar levels - Children’s brains and bodies need lots of sugar to function normally. Being sick (especially with fevers) uses lots of sugar because the body uses it to fight the bug. This is a big worry in children who are vomiting, have diarrhea or not feeding well.

Working hard to breathe - unlike adults where working hard to breathe is mostly a sign of a respiratory bug, working hard to breathe (especially fast breathing) can be a sign something major is going on. Dehydration, shock and respiratory illnesses all cause children to breathe harder.

Common Illnesses

Fevers

When you’re little one is sick, their body’s defence system kicks in to fight off bugs like viruses and bacteria. One defence tool is raising body temperature, creating a fever. Fevers alone are not dangerous, they alert you to keep a lookout for the signs your child needs a doctor. There is no need to fret about taking temperatures all the time if your older baby or child is sick.

What thermometer to use

digital probe thermometers - best for babies under 6 months
tympanic thermometer - can be used over 6 months, but most accurate in over 2’s
forehead - these can be inaccurate and not recommended

General signs and symptoms

hot flushed skin
temperature over 38°c

Management at home

children over 3 months who are awake, alert and drinking well can he cared for at home
encourage oral fluids frequently
keep them cool - dress in one light layer
give paracetamol or ibuprofen if they are miserable

When to seek help

not getting better after 2 days or a fever (but well otherwise) for more than 5 days
a baby who is under 3 months and is awake, alert and feeding well

When to see a doctor urgently

children who show signs of moderate to severe dehydration
your child is drowsy and less responsive
your child is under 3 months and has a temperature over 38°c

When to call an ambulance

signs of meningitis or sepsis
decreased levels of consciousness, floppy or hard-to-wake
struggling to breathe and/or turning blue
pale, clammy or cold

Respiratory Illnesses

Most respiratory bugs are mild and can be managed at home. But there are common complications common in young babies and children such as bronchiolitis, viral wheeze, croup and pneumonia. Unimmunised babies are also at higher risk of pertussis (whooping cough), influenza and pneumococcal. Most respiratory bugs are caused by a virus, so antibiotics wont help.

General signs and symptoms

runny or stuffy nose
cough
fever

Common complications

Airway and breathing issues - Their airways are small, so only a small amount of inflammation and mucus can make it hard to breathe.
Bronchiolitis - This is a common complication of cold viruses. Inflammation in the small airways creates lots of mucus, making it hard to breathe
Croup - A viral infection of the upper airways - causing inflammation and narrowing. Known for its “barking” like cough. It’s most common in toddlers
Pneumonia - An infection in the lung tissue. Also known as a chest infection. It often happens after another respiratory bug
Viral Wheeze - 1 in 3 children will have viral wheeze at some point in childhood. Signs are a noise when breathing out, caused by airway inflammation and excess mucus

Management at home

keep airways clear
use saline drops to thin mucus - always buy from the pharmacy, never make your own at home for children.
use a nasal aspirator to remove mucus
keep them hydrated
babies under 12 months - offer breastmilk and formula regularly and frequently
children over 12 months - offer small amounts of fluid frequently. Older toddlers and children can go a longer time without eating, as long as they are drinking enough fluid and staying hydrated - suggested fluids paedialyte, 1:1 water and apple juice, milk

Keep them comfortable

support little ones to sleep when they need
if your little one seems miserable a dose of paracetamol can help them feel more comfortable
lots of cuddles

What isn't recommended

over-the-counter cold and flu medicines are not recommended for children under 6 years, including cough medicine (this doesn’t include paracetamol or ibuprofen)
using humidifiers or diffusers with essential oils. this can irritate the lungs, make the room too damp and is a poisoning risk

When to seek help

Most young children who need to see a doctor with a respiratory bug need to be seen within a few hours. If you can’t make an appointment with your family doctor, head to your nearest Emergency Department or A&E.

Head to a doctor urgently

All babies under 3 months who are unwell need to be seen by a doctor within a few hours - even if they have no other concerning symptom
is breathing fast, has noisy breathing and is having to use extra effort to breathe
looks pale and unwell
is taking less than half of their normal feeds
hasn’t had a wet nappy for more than 6 hours

When to call for an ambulance

blue lips and tongue
struggling to breathe, noisy breathing or long pauses in breathing
pale, cold and clammy skin
floppy, hard to wake or unresponsive

Gastro

Gastroenteritis is common in kids, often it’s called a tummy bug, the stomach flu or gastro. It’s usually caused by a virus that spreads quickly and many children will get gastro more than once.

General signs and symptoms

diarrhoea (runny poos)
vomiting
tummy pain
not wanting to eat
fever

Management at home

Encouraging children to drink is extremely important especially if you see any signs of dehydration. Offer small amounts of fluid regularly.

protect skin from diarrhoea - change nappies as soon as they become dirty, and make sure their bottom is fully clean and dry before applying a thick layer of barrier cream.
keep a close eye - children get sick quickly from gastro

Babies under 6 months

offer breastmilk or formula very frequently, do not offer water.
for any signs of dehydration give 5ml of formula/expressed milk or offer breast every 5 minutes

Children over 6 months

offer milk to babies under 12 months
best fluids for children over 12 months - apple juice mixed with equal parts water, rehydration fluids or ice blocks
any signs of dehydration - aim for 5ml of fluid every minute or 1/4 cup every 15 minutes
offer plain food (babies over 12 months) - simple starches are best

When to seek help

All babies under 6 months need to be seen by a doctor urgently if they have any signs of gasto.

See your family doctor if your child’s diarrhoea continues for more than 10 days.

When to see a doctor urgently

yellow or green vomit
refuses to drink anything
fewer wet nappies or has not had a wet nappy for over 6 hours
there is blood or mucus in their stool

When showing signs of moderate/severe dehydration

no wet nappy or pee for over 6 hours
sleepy or difficult to wake
sunken eyes, no tears when crying
cold hands and feet and mottled bluish skin

When to call an ambulance

sudden and severe abdominal pain or a swollen stomach
if a child is pale, floppy has changes to consciousness levels or is unresponsive

Febrile Seizures

Febrile seizures

When your little one is sick, their body’s defence Febrile Seizures are when a child has a seizure when they have a fever. Around 1 in 20 children in New Zealand will have febrile seizures. It’s important to know a high fever doesn’t cause a febrile seizure, instead, it’s triggered by the same inflammatory reaction that also causes the fever. Once a child is unwell there is no way to prevent them from happening.

Febrile seizures are most common in children 6 months - 6 years, peaking at 12-18 months. Most febrile seizueres only last 1-2 minutes.

What to do if your child has a febrile seizure

keep them safe - lie them on their side, remove any tight clothing around their neck
take note of the time or start a timer
call an ambulance if your child starts going blue or the seizure lasts more than 5 minutes
most children will be sleepy or confused after a febrile seizure but able to be woken, this can last for up to 1 hour

When not to do

don’t put anything in their mouth
don’t put them in a cool bath or shower

When to seek help

see your family doctor if your child recovers quickly after their seizure and is awake and alert.

See a doctor urgently

they are difficult to wake
you are worried

When to call an ambulance

the seizure lasts longer than 5 minutes
your child is having trouble breathing
your child looks very unwell
your child is not waking up and responding after the seizure.

Most parents will want to call an ambulance when a seizure starts, this is completely ok to do.

Meningitis and Sepsis

Although these are not common illnesses, they are the most serious illnesses that happen more commonly. Meningitis is when the protective layer around the brain and spinal cord gets inflamed. Sepsis is an abnormal full-body inflammatory response to an infection. Both are medical emergencies but their signs are not always obvious (especially in young babies). One illness, meningococcal causes both meningitis and sepsis.

There is no at-home management for meningitis or sepsis. Always call for an ambulance if you think your child has meningitis or sepsis

Signs of meningitis

very high or low temperature
unwell and inconsolable
not wanting to be handled (babies)
complaining of headache, stiff neck, not wanting to look at lights (children)
not wanting to walk
refusing to feed
vomiting
floppy, hard to wake, unresponsive

Signs of sepsis

very high or low temperature
non-blanching rash (rash that does not go away with when pressed)
fast breathing or shortness of breath
refusing to feed
floppy, hard to wake, unresponsive
pale, cold and clammy skin

Rashes and Eczema

Rashes are extremely common in childhood. There are several causes of factors from viruses, bacteria, fungus, parasites and environmental triggers. Some rashes do not cause the child any distress, others can cause major discomfort or be a sign of significant and severe illness. Make an appointment with your family doctor if your child has a new rash but is awake, alert and well. If they have a new rash but are unwell, aim to see your family doctor that day. If you are worried head to your nearest ED or A&E.

Eczema

Eczema is an inflammation (rash) of the skin, which is often red, dry and itchy. What causes eczema is not known but there appears to be increased reactivity of the immune system, and children affected by eczema often have other allergic conditions. Some ‘triggers’ which make symptoms worse in some children include dietary factors (such as cow’s milk, peanuts, fish, eggs), stress, and contact with chemicals such as certain perfumes, lanolin and some detergents. Woollen clothing can irritate eczema, while continuing with breastfeeding can delay the onset of eczema.

Some ideas that may help:

try to work out what triggers make your child’s eczema worse
if wool makes it worse, try putting cotton singlets or cotton tops under woollen jerseys
if perfumed soaps make it worse use a non-perfumed soap or a bath oil instead. You can discuss bath oils with your health professional
avoid overheating which can often make the eczema worse
if your child scratches the eczema, try to keep their finger nails short. Putting gloves on your child may help at night or at sleep times. If the eczema is on your child’s arms or legs, dress them in long pants or tops with long sleeves
discuss creams to improve the eczema with your doctor. Moisturisers are the usual form of treatment. They can be applied several times a day and the greasy ones trap water in the skin. Sometimes steroid creams are used for red inflamed areas. Weepy crusted areas may be due to infection and may need oral antibiotics

Rashes

Most rashes children have are mild or don’t need immediate attention and only need to be seen by your family doctor within a few days (like eczema). However, these two rashes are concerning and need immediate medical attention.

Cellulitis

if a cut gets infected, it causes cellulitis. This rash needs antibiotics and left untreated can cause a severe infection and even sepsis
signs to look out for - irritated skin that is painful, hot, red and sometimes shiny
what to do - see a doctor within a few hours. Head to your nearest ED or A&E if your child shows other general signs of feeling unwell such as fever or nausea

Non-blanching rash

most rashes are caused by a viral illness and are not harmful. However, a non-blanching rash can be a sign your child is seriously unwell
signs of a non-blanching rash - doesn’t go away when you push on it, it looks like little pin-pricks or a small bruise. This rash is bleeding underneath the skin
if your child is unwell and has a non-blanching rash, assume it is a serious sign
what to do - always call and ambulance if your child is unwell with a non-blanching rash