Everyone becomes ill at some time in his or her life; in children however it can be difficult to detect. They can be listless one minute, and playing the next. Most illnesses quickly pass, but sometimes guidance is necessary.

Signs of illness include:

• vomiting
• temperature
• cough
• runny nose
• runny eyes.

It may include some unusual behaviour such as:

• crying
• irritability
• refusing food and drink
• listlessness
• drowsiness

With babies, always advise parents to contact a GP if they:

• think the infant may be ill
• have one or more of the urgent signs and symptoms listed below.

Urgent signs and symptoms:

• fitting (convulsions)
• if a baby turns blue, or very pale, or seems floppy
• very high temperature (over 39 deg C), especially with a purple-red rash anywhere on the body that could be a sign of meningitis
• difficulty breathing / breathing fast / grunting breathing
• drowsy or difficult to wake-up, or doesn’t seem to know the parent
• temperature, with the skin of the hands and feet cold and clammy

If they have a rash, do the tumbler test (and be aware that even a few single spots can indicate the presence of meningitis).

Tumbler test: press the side of a clear glass firmly against the rash, if it doesn’t fade, contact a doctor immediately.

Children may want to be near a parent and can easily be tucked up on the sofa with a pillow and quilt (note: this is not recommended practice for babies). They don’t have to stay in bed.

Advise parents to:

• keep the room warm and airy without drafts
• give plenty of sugar-free fluids, but don’t worry about food for the first couple of days
• keep children amused with quiet games, stories and company
• encourage rest and sleep as needed (sick children are easily tired).

Colds

These are caused by viruses (so antibiotics don’t work) usually lasting about 5 to 7 days. A pillow under the mattress raises the head and helps them to breathe more easily. Increase the amount of fluids the child normally drinks.

Colds are spread on hands from infected secretions so encourage everyone to use disposable tissues and to wash their hands after blowing their nose.

Coughs

A cough is not usually anything to worry about if children are eating and breathing normally without wheezing. If a bad cough persists, then the child should see a GP as they may have a chest infection, which can be caused by a virus or bacteria. If it is caused by a bacteria, then a GP will give antibiotics to treat it, though it might take a couple of weeks before the cough goes away.

If a cough lasts a long time, being worse at night or brought on by exercise, it may be a sign of asthma and the child should see a GP.

Coughing is part of the body’s normal defence system and clears phlegm from the chest. Cough mixtures often don’t work, and giving warm clear fluids can be just as useful. If the child is over one year of age, a warm drink of honey and lemon can be soothing.

Croup

A hoarse, barking cough and noisy breathing may be signs of croup and the child should see a GP. Sitting the child in a steamy atmosphere may help to relieve symptoms, and this can be created in a bathroom by running the hot tap, keeping the door open and the windows closed. A child should never be left alone, and care should always be taken as very hot water can scald.

Diarrhoea

Diarrhoea is the frequent passing of unformed watery stools and when combined with vomiting is called gastroenteritis. Most young children will suffer with either/or both symptoms at some time - but fluid loss and dehydration should be monitored, especially in babies. Oral rehydration fluids include dioralyte, electrolade and rehidrat. If symptoms last for more than a couple of hours, contact a GP for advice.

For mild diarrhoea in babies suggest:

• giving extra fluids using oral rehydration fluids either between feeds or after each bout of diarrhoea
• continuation of breastfeeding, but giving extra fluids as well as breast milk
• adding extra oral rehydration fluids to normal formula feeds for bottle-fed babies.

Toddler diarrhoea

Some children between the ages of 1 to 5 years old may have frequent, smelly stools with undigested vegetables in them. Usually there is no serious cause and the child is perfectly healthy, but should be checked by a GP.

Advice includes:

• fewer fluids between meals if they drink a lot
• the introduction of more fatty food
• a reduction in  or wholemeal foods.

For older children, parents should contact a GP if:

• the diarrhoea lasts more than 2 to 3 days
• the child is vomiting at the same time
• the child has serious or continuous abdominal pain.

Generally children with diarrhoea should:

• have plenty of clear fluids
• eat if they want
• only take anti-diarrhoeal drugs if prescribed by a GP
• use separate towels from the rest of the family
• wash their hands after using the toilet and before eating.

Ear infections

These are common in babies and small children and often follow a cold. Ear infections can cause a temperature. Oil or eardrops should not be given unless advised by a GP.

Repeated ear infections may lead to ‘glue ear’ and a GP can give further information about the treatment required.

Fits or convulsions (febrile)

‘Fever fits’ are common in children under the age of three years and are most often triggered by a high temperature. If a baby or child seems feverish, or has a high temperature, then they should be cooled down immediately.

(Note: tepid sponging is no longer advised, but cooling can be achieved by either removing clothing and/or using a cool fan in the room - but not directed at the child).

When a child has a fit they may suddenly turn blue, become rigid and staring with their limbs sometimes twitching or jerking and their eyes rolling.

First aid for fitting includes:

• laying the child on their side to make sure they don’t vomit or choke
• removing objects from the mouth and not putting anything into the mouth
• removing clothing and coverings making sure the child is cool but not chilly.

Most fits stop within three minutes, and when over, the child needs to be reassured and made comfortable.

Sore throats

These are usually caused by viral illnesses similar to colds or flu. Sore throats usually clear up by themselves after a few days. Sometimes sore throats are caused by tonsillitis making it hard and painful to swallow, with a temperature and swollen glands.

You should send a child to hospital after an accident if they:

• are unconscious
• are vomiting or drowsy
• are bleeding from the ears
• have stopped breathing
• have internal injuries
• complain of severe pain anywhere
• are having fits
• have tissue / bone injuries.

Accidents are the most common cause of death among children aged between 1 and 5 years.

Children should not be given any food or drink after an accident in case they need a general anaesthetic.

Advice can be sought from NHS Direct in England, NHS Direct Wales or NHS 24 in Scotland in the first instance. Many general practices are able to manage minor injuries such as cuts or items trapped in the nose or ear. Inform parents if the local practice can deal with such injuries and where it is best to go in such circumstances.

Broken bones

Children should not be moved without expert help if either the neck or spine is involved. If they can’t easily be moved, then an ambulance should be called. If they can be moved, then the injury should be supported using blankets or clothing, and the child taken to a hospital.

Burns & scalds

Immediately put the burn or scald under cold running water for at least ten minutes to reduce the heat in the skin.

• Cover the burn with a clean non-fluffy cloth (pillow case or linen tea towel) or cling film to reduce the risk of infection.
• Don’t try to remove clothes if they are stuck to the skin.
• Seek medical help for anything other than a very small burn.
• Don’t put anything on the burn or scald.
• Don’t burst blisters, it delays healing and can cause infection.

Items in the nose or ear

Do not attempt to remove items yourself; send the child immediately to the nearest A&E department if the local surgery doesn’t usually manage this type of accident.

Cuts

If there is a lot of bleeding, press firmly on the wound using a clean cloth, or your fingers if one isn’t available until the bleeding stops. It can sometimes take ten minutes or longer depending upon the wound.

• Don’t use a tourniquet or tie anything tightly that stops the circulation.
• Raise the injured limb to help stop the bleeding, but not if the limb is broken.
• Cover the wound with a clean dressing if available; don’t remove it if blood soaks through, put another pad on top.
• Call an ambulance or send the child to A&E.
• Consider a tetanus injection if the child has not been immunised.

Poison

If you think a child has swallowed something harmful, then send them straight to a GP or to a hospital (whichever is the quickest). Instruct the parents to:

• take the container with them if possible
• watch closely to see if the child becomes drowsy or unconscious (ensure parents know how to do ABC of resuscitation)
• avoid giving salt and water, or anything else that might make the child sick.

Animals can pass diseases to humans (zoonoses). Children come into contact with animals as pets in the home, early learning care settings, healthcare settings and on educational trips to farms and zoos. Specific diseases include E. coli 0157, salmonella, campylobacter, toxoplasmosis and toxocariasis.

General precautions for farm visits include:

• thorough hand washing after touching farm animals
• not eating or drinking whilst on the farm but waiting until you have left the farm, thoroughly washing the hands and then eating away from the animals
• not putting the face against an animal or the hands into the mouth after touching an animal (not before the child has washed his or her hands)
• not touching animal droppings (and washing hands immediately if the child does)
• clean shoes on leaving the farm and wash hands thoroughly afterwards.

Sensible hygiene precautions for managing pets around children include:

• young children not playing with animals unsupervised
• children washing their hands after handling animals, their bedding or cleaning their cages
• not letting children handle litter boxes
• not sharing food with animals
• not allowing pets to lick children, especially on the face
• keeping pets away from children’s play areas, especially sandpits
• taking particular care with exotic pets and reptiles.

Nurses and other healthcare professionals are placed in an ideal position to identify vulnerable children. It is therefore important that they are aware of their professional responsibilities on this issue, where to access information and how to take action.

Information can be found from:

• local designated lead for child protection issues
• local area child protection committee
• the CPHVA and RCN websites
• national charities including the NSPCC, Kidscape and Barnardos
• the NSPCC child protection helpline 0808 800 5000
• Childline 0800 1111.
  

Figueroa, J., Hall, S., Jharra, J. (1998), Primary Health Care Guide to Common UK Parasite Diseases, (ISBN 0953314405)