It is usually possible to tell by observation when a child is ill, but some parents like to take a child’s temperature to help them to assess how serious the condition is. The temperature of the body usually remains constant at 36.9°C (98.4°F), but a child’s temperature may vary between 36.4°C and 37.5°C (97.5°F and 99.5°F) depending on whether he has been very active, has eaten a big meal or had a hot. Taking a child’s temperature is not, therefore, a completely reliable guide to illness and should be considered along with other symptoms.
To take a child’s temperature, use either a clinical thermometer (most reliable), or a heat strip.
A heat strip is a strip of material sensitive to heat, which is pressed to the forehead. A colour change indicates the level of body temperature. It is quick and easy, but not very accurate.
A clinical thermometer is a thin tube of glass with a bulb of mercury at one end and a very fine inner tube up which the mercury passes when it is warmed. The tube is marked with the temperature readings. The thermometer is usually placed (mercury end first) under the tongue and kept there for two or three minutes, with the patient breathing through his nose. Before the temperature taken the mercury must be shaken down into the bulb with a sharp flick. After it has been read the mercury must be shaken down again.
Small children and babies cannot have the thermometer placed in their mouths as they may bite it. It can be placed under the arm or in the groin and kept there for two or three minutes.When you read it after taking a temperature like this, 0.5°C (1°F) should be added to the reading. The temperature may also be taken by placing the thermometer in the child’s rectum, but great care is needed not to snap the thermometer if the child moves, so this should only be done by a doctor.
A low temperature can be just as serious as a high one. A temperature below 36.3°C (97.4°F) must be reported to the doctor, as a child can quickly suffer from hypothermia (the temperature of the whole body dropping abnormally low, so that the child gets extremely cold).
If the doctor has to be sent for, make sure the child is resting comfortably. Parents should have a list of the symptoms and a note of the child’s temperature if they have taken it. Hand-washing facilities should be ready for the doctor – the sink or bathroom is all that is needed. The child should not be given any medication; if aspirin or anything else has been given beforehand the doctor should be told. Once the doctor has been, his instructions should be followed, and the full course of any prescribed medicines should be given.
Medicines for children are usually made up as a syrup. A correct measuring spoon can be obtained from the chemist. Most children do not like taking medicine, so persuasion and even bribery must be used if necessary, although bribing a child may cause problems later. A dropper may be used for babies.
The following points must be observed when giving medicines:
- Wash your hands first.
- Read the label on the bottle to check that it is the right one, and to check the correct dosage.
- Shake the bottle if necessary.
- Hold the child’s arms firmly, and place a cloth under his chin.
- Speak to him gently, and explain what is being done if he is old enough to understand.
- Fill the spoon to the level required.
- Tip the medicine into the child’s mouth – into one of the cheeks, not pushing the spoon in so that he chokes.
- Hold his mouth closed until the medicine is swallowed.
- Reward him with extra attention, perhaps in the form of his favourite food, or a story, or a small present.
- If tablets are prescribed they can be crushed between the bowls of two spoons and then mixed with jam or honey.
When a child is ill he will need a lot more attention and loving care. He tends to become clinging and want his mummy, or the person who usually looks after him. Housework will have to be left until the child has his rest, or until someone else is prepared to sit with him.
The child who is really ill will want to stay in bed or in his, but as he begins to recover there is no need for him to be forced to stay in his room. He will much prefer to be wrapped up, lying in an armchair or on the settee where he can see his family and watch TV. He must not be allowed to overtire himself and should have a rest period morning and/or afternoon.
A child who is ill needs:
- to be in a room with a fairly constant warmth – about 22°C (72°F). If the room is too hot he will become flushed and uncomfortable.
- plenty of fluid (but food can be gone without until his appetite returns).
- to be kept clean and comfortable, with his bed freshened often.
- to be given plenty of opportunity for undisturbed rest and sleep.
- contact with his mother and the rest of the family. His bedroom door should be left open so that he is aware of their presence.
- his medication given to him as prescribed.
- He is likely to be irritable and revert to babyish ways, so parents must be patient.
As he gets better he will need amusing much more as he will feel bored and lonely. His appetite will need to be tempted with small, attractive, nourishing meals, and he should get some fresh air – a short rest in the garden or a ride in the pushchair if the weather is suitable. A few special treats, and something to look forward to, such as a day at the zoo or the seaside when he is better, will help.
Amusing the sick child
A sick child needs activities which are slightly below his normal capabilities, and he has a shortened span of interest. TV and the radio are very good but it is more fun if someone else is there too – Mother or Father could be doing a household job whilst keeping him company. A large tray or bed table will form the base for jigsaws, building bricks and construction games, felt shapes, lacing and threading games; and children will spend a long time crayoning, painting or drawing, especially if the picture is hung on the wall afterwards, or sent to grandparents. The young child will enjoy making odds-and-ends toys with the help of an adult. Bits of wool, string, beads, empty cartons, foil, cotton-reels, squeezy bottles, etc., can be made into different fun objects.
The child will enjoy simple games of picture dominoes, noughts and crosses, ludo, picture lotto, word and number games – according to his ability.
Books are invaluable when a child is ill. Children always love being told stories. V shown picture books or having rhymes and songs sung to them. Older children will spend some time looking at books and comics by themselves.
As the child becomes more active he will enjoy helping in the house. He can help with the baking or dusting. If he is with one parent all day he will enjoy the company of the other parent or brothers and sisters when they are at home. Grandparents and other relations or friends can be encouraged to visit and keep him company for a while.
Going into hospital
Sometimes a small child needs to have a stay in hospital. Almost half of all children under five will need to go to hospital for one of the following reasons:
- accidents at home such as poisoning.
- infections of the chest or stomach.
- surgery to deal with broken bones or special conditions.
- treatment of congenital conditions.
If possible the child should be prepared for the situation. It can be very traumatic and a serious emotional shock, and no child should just be delivered to the hospital and left. The child should go to a hospital which has special wards for children with specially trained staff. There should be unlimited visiting hours and if possible accommodation for the parents of children, especially those under the age of two. The Department of Health has made these recommendations and parents should if necessary form pressure groups to see that their local hospitals carry out these recommendations.
The National Association for the Welfare of Children in Hospitals (NAWCH) is concerned with the comfort and care of children in hospital and helps to fight for the rights of parents.
A child should be prepared for going into hospital by:
- discussing the matter with him fully, if he is old enough.
- showing him books and telling him stories about being in hospital.
- explaining about the staff and the jobs that they do.
- if possible, visiting the place beforehand.
- playing games of doctors and nurses, letting him have a toy stethoscope an,: bandage up his teddy.
- letting him help pack his suitcase, and buying him new pyjamas or a new toothbrush. Let him take his favourite toy, his teddy, and his comforter if he has one.
- leaving his favourite soft toy on his bed, ready for when he comes home.
When he goes into hospital his parents should take him, undress him, show him where the toilets are, and stay with him as long as possible. One of them should visit as often as possible – several times a day – and friends and relations should be encouraged to visit. Take a small present each time, but not food or drink. Keep reassuring him that he is loved and missed at home, and how much everyone is looking forward to his homecoming. Try to be there when he comes round from an operation.
Parents should keep a check that the child is being well looked after and should be prepared to make enquiries if they think he is not.
When he comes home, he will probably cling to his mother or father and may act in a babyish way. He will need patience and understanding as it will have been a traumatic experience.
Parents can expect a few problems. He may be aggressive or withdrawn, he may start to wet the bed, or he may develop a stammer. These are all results of psychological upset, and will disappear when he readjusts.
Medication and follow-up checks and any special care instructions must be attended to.
A child who needs a long-term stay in hospital, or frequent stays, may develop long-term psychological problems and will need special care and attention.