In children illnesses often have different symptoms than they do in adults. Notably the condition of the child may be very changeable. One day it may feel very ill, the next day it can hardly be kept in bed. On the other hand, a seemingly slight illness may have serious results. Because of a relatively large skin surface in comparison to weight, an illness that is accompanied by a fever and diarrhoea may soon lead to dehydration.
In contrast to adults, in a sick child the whole body joins in the reaction. This makes it often very difficult to find the real cause. In adults pyelonephritis usually manifests itself by a fever, back pain and pain when urinating. In children such an infection may occur without the specific symptoms of a urinary tract infection, but with a general feeling of illness, diarrhoea, a slight fever and a headache.
An increase in bodytemperature is a common sign of an infection somewhere in the body. In children the bodytemperature may rise quickly to high values. In young children this may even be accompanied by convulsions. In the majority of cases these are so-called febrile seizures and the parents should not have to worry that their child has epilepsy. Although these seizures look frightening, after treatment of the cause and after administering febrifuges it is usually found that the child has not suffered any permanent damage. Once a child has suffered febrile seizures it has an increased chance of having them again during another period of fever. That is why it is advisable to avoid too high a rise in temperature in such children by using febrifuges. As the child grows older its brain will become less sensitive to the influence of high temperatures and febrile seizures are hardly ever present in children attending primary school.
The growth of the body
Body growth and development will proceed normally only when energy can be spared from counteracting the harmful influence of diseases. That is why, during a period of illness, the rate of growth will be considerably decreased. Chronic illnesses in particular can leave a child short in stature.
This is not so obvious in acute illnesses because there is a period of increased growth after the time of recovery. The loss suffered is nearly completely made up. Apart from that, growth itself can be a cause of disorder too.
Nearly every child complains occasionally of skeletal pains during times of increased growth. This is a nagging pain in the legs that usually starts in the evening or wakes up the child at night. Heat and massage will usually be enough to lessen the complaint and the next morning the pain is nearly always gone. Such ‘growing-pains’ should not be accompanied by a fever and inflamed skin, which is warm to the touch, over the bones or joints. If this is the case something else may be the matter – such as an infection – and a doctor should be consulted.
To a child, especially a young one, an illness may seem to be very threatening. The child is not feeling well, if there is a fever it may be delirious, the anxiety of the parents may sometimes be transferred to the child and sometimes the doctor has to make an unpleasant examination. All this makes it important that the parents pay extra attention to the child and give it a sense of security. On the other hand it is not good to be overprotective.
Rest in bed is often necessary but sometimes hard to enforce, particularly when, from one day to the next, the child feels quite recovered. But it is not advisable to give in to its wish to get out of bed until there is evidence of real recovery. When sick children are confined to bed, unlike adults they usually want company or entertainment. The younger the child, the greater are the demands on the parent’s time because the child is dependent on the parent for his or her entertainment and amusement. The parent can try to make the stay in bed more pleasant. Only when the child is back to what is more or less its normal routine, should he or she be allowed to go back to school. Generally, a sick child will neither feel like concentrating on one thing for very long nor want to do anything intellectually demanding. He or she usually wants to play with familiar toys and games rather than concentrating on anything new. In prolonged illnesses it is advisable to have an older child do schoolwork for a few hours a day. On the one hand it will not be so easily bored and on the other hand it will not have so much to catch up with when it returns to school. Usually it is not necessary to forbid friends visiting but one should keep an eye on the visit and make sure that it is not too exhausting. More than two visitors at a time is not recommended. When the disease is contagious the schoolteacher should be advised. When the child is suffering from German measles one should be careful to avoid him or her coming into contact with pregnant women or women who have not had the disease themselves or who have not been vaccinated.
When a fever is present, clothing should be light and the room temperature not too high (about 19°C). However there should not be a draught. In order to lower the child’s body temperature one may sponge it with tepid water. It is important that one does not use very cold water for this purpose, even if the child may initially like it, because thevessels of the skin will contract and thus reduce the amount of heat that can be lost through the skin. This would actually make the internal body temperature rise. When a child has a fever or when it vomits a great deal, loss of fluids may easily lead to dehydration. In order to avoid this it is important for the child to drink a great deal (such as water, fruit juices or soup). In these circumstances yoghurt is recommended as well, because it contains a great deal of protein. When diarrhoea is present it is also important to get the child to drink a great deal. However drinks high in sugar should be avoided. The reason for this is that sugar has the same influence on the bowel as a laxative and would prolong the diarrhoea. Unsweetend tea is an excellent drink because it contains certain substances (such as tannin) that make the bowel wall less irritable. When a fever lasts for more than a few days and rises over 40°C, or when the child seems to become progressively ill (continuous diarrhoea and vomiting, drowsiness and refusal to drink) the danger of dehydration becomes more acute. In such cases advice should be sought from the family doctor. When preparing a meal for a sick child one should
Infections in children are usually caused by viruses and only in a minority of cases by bacteria. Antibiotics are effective only against bacteria and not against viruses. When a virus infection is diagnosed, medication can be directed only towards the treatment of the symptoms. In this way body temperature may be lowered with febrifuges (such as aspirin) or a blocked-up nose by saline drops. When antibiotics are actually necessary to treat an infection, it is important to finish the course completely, even when the fever disappears rapidly and the child feels fine again. The reason for this is that it takes a while for all the bacteria to be killed. If the treatment is stopped prematurely there is a chance that the infection will pick up again and this time with bacteria resistant to the antibiotic used.
It is often quite a problem to administer medicines to a child, especially if they have a bitter taste. These problems can be partly avoided by, for instance, blending or dissolving a mixture in some fruit juice or by powdering tablets and mixing them with some yoghurt. However there are medicines that must be taken whole and should not be broken up. When in doubt about the correct way of administering a medicine, it is best to consult the doctor. €U
Generally it is not advisable to use special ‘children’s medications’. In the short term, a tasty medicine (in a sweet syrup or lemon-flavoured) is an advantage. However, the disadvantage is that when unattended the child might help himself to such medicines if they are carelessly left within reach. With children it is frequently necessary to prescribe a specially adapted dose. It is also possible for certain medicines, which are quite harmless for adults, to have serious side-effects in children. For this reason it is very unwise for adults to give medicines that they use themselves to children, even if they are suffering from a similar complaint.
The sick child at home
Because of the availability of modern drugs, especially antibiotics, many illnesses which formerly needed hospital treatment can nowadays be dealt with mainly at home. If the hospital does need to be visited for examination or treatment, an examination or assessment may be carried out at a localcentre. Moreover, and this is nowadays also becoming more important, centre and home treatment costs far less than hospital admission and puts less strain on hospital resources.
In co-operation with the family doctor, a child can be given excellent treatment at home. Also, the child’s mother is the best nurse, as long as the illness is not too serious or too difficult to deal with.
The treatment of some disorders makes it necessary for the child to be rushed into hospital. Especially where young children are concerned, it is important if possible for the parent or parents to be present for most of the day. Fortunately many hospitals prepare for this and sometimes provision is made to enable one of the parents to sleep near the child at night. Sometimes parents know beforehand that in the near future their child will have to be admitted to hospital, for instance because it has to have an operation to repair an inguinal hernia or for a tonsillectomy. In these cases the parents have a chance to prepare their child for what is to come. Parents may do this by explaining what is going to happen or by ‘playing doctor’. With the help of a ‘sick’ doll they may be able to show what the doctor is going to do. Once the time of the admission arrives, it is usually found that the child can cope much better with the event. The more familiar with the idea ‘hospital’, the less becomes the child’s fear of being admitted. This fear, which largely exists as a fear of being separated from the parents, will naturally depend on many factors, such as the age of the child and its character. Furthermore the way in which the child is received will be designed to put the fears at ease. Particularly in a children’s ward of a hospital, the nursing staff is faced with a very important and difficult task. Fortunately this work may offer a great amount of satisfaction. Yet no matter how well prepared or received by the hospital, many children, especially those between the ages of one and four, become quite upset at knowing they must stay overnight. That is why, if at all possible, operations are delayed until after this age.
The dying child
Children are generally resilient people and pull through illness with little problem. In a few cases, however, the illness may turn out to be terminal. When this seems inevitable the child should be helped to come to terms with death by telling him or her about the nature of the disease and by not treating death as a taboo subject. The bravery of children who know they are shortly going to die is in most cases genuinely astounding. More than death, the child may fear painful treatment and being separated from his or her parents, from whom the child should be made to feel secure physically by their continual presence, and mentally by their honesty.