Chickenpox (varicella) is a generalised infection caused by the virus Herpes zoster. Infection occurs when the virus passes to another person from the fluid-filled blisters that cover the body of patients, or in their breath and saliva. Patients are infectious for a day or two before the spots appear, and remain infectious for about eight days. The incubation period is 10 to 21 days.
Early symptoms are similar to those of a cold, with a vague feeling of being unwell, headache, fever and sore throat. The rash usually starts on the head or chest as red pimples, then spreads onto the legs and arms, and develops into blisters before drying up and scabbing over. New spots may develop for three to five days, and it may be two weeks or more before the last spot disappears. The diagnosis can be confirmed by varicella antibody blood tests, but none are usually necessary.
Treatment involves bed and home rest until the patient feels well, and medications to relieve the itch (eg. calamine lotion, antihistamines), fever and headache. Children must be excluded from school for at least five days from the appearance of the first blisters and until all blisters have developed a dry scab.
There is a vaccine has been available since 2000 to prevent the disease. One injection is necessary if given between 12 months and 12 years of age, but two injections six weeks apart in older children and adults.
Complications are more common in adults, and include chest infections and a type of meningitis. It is unusual for the pockmarks to scar unless a secondary bacterial infection occurs.
Complete recovery within ten days is normal. Once a person has had chickenpox, it is unlikely (but not impossible) that they will ever catch it again.
Once a patient has had chickenpox, the virus never leaves their body but migrates to the nerves along the spinal cord where it remains forever. The virus may be reactivated years later at times of stress to give the patient the painful rash of shingles.
See also VIRUS
Child abuse is also known as battered baby syndrome and Caffey syndrome (named after the American paediatrician John Caffey who in 1946 first drew attention to the phenomenon).
The physical abuse of a child is no so much a symptom, but a cry for help in many cases, from a parent who is not coping with the stress of childcare. At some stage in the first few months of their baby's life, most parents feel like throwing their bundle of joy out of the window. Fortunately, the vast majority of parents resist this desire, but there is no doubt that children can become irritating, frustrating and maddening to the most loving of parents. Inexperienced parents and a new baby who cries day and night can lead to irrational thinking and spontaneous actions, which are quite out of character and will be profoundly regretted later. Child abuse in this situation is understandable but still inexcusable. Parents must seek help from their doctor or child welfare officer before this stage is reached.
In other situations, child abuse may be more callous or sadistic. An unwanted child may be abused in order to extract unwarranted revenge. A father may hurt a child to indirectly hurt his wife or girlfriend. Some parents are simply nasty people who are violent in all their human relationships. Many child abusers were themselves abused as children.
Child abuse can be physical, psychological or sexual. Whichever form it takes, it can be difficult to detect and may continue for a long time before the child comes to the notice of a responsible person and is given protection. A person who abuses a child rarely does it when anyone else is around. If a person becomes suspicious that a child is being abused, they should talk to a doctor or children's hospital. Child abuse may be suspected if a child has repeated bruising or burn marks, and the parents delay or fail to obtain medical help, offer implausible or inconsistent explanations for the injuries, or if their reactions to the injuries seem strange. The most reliable indication of continued cruelty or neglect is often failure of the child to grow at the normal rate. Children made unhappy by repeated abuse do not thrive, and their weight drops well below the average for their age.
Neglect is as much a form of child abuse as deliberate injury. Poor hygiene and under- or over-clothing an infant may be due to lack of knowledge, but lack of food and failure to obtain attention for illnesses, skin diseases, infected eyes and injuries is unacceptable abuse.
There is sometimes a fine line between discipline by the parents, temper tantrums by the child, and criminal abuse of the child. Casual observation by an outsider may give a false impression, but if the child shows signs of injury or the problem continues consistently, then the family requires help. This help is readily available from the family general practitioner, paediatricians, community nurses and welfare workers, and special teams attached to most children's hospitals.
Some parents realise that assistance in dealing with a difficult child is required, but are afraid to seek it because of the consequences. If help is sought voluntarily, it would be exceptional for any charges to be laid against the parents. Putting a parent in jail is rarely seen as a solution for either the child or the family as a whole. Rather, every effort is made to solve the problem by counselling, medications and care. Sometimes the child can be removed from the family for a short period, if it is thought this will help to relieve stress, modify abnormal behaviour patterns in the child, and lead to normal future family life. Only those who consistently refuse to accept their responsibilities as parents and reject offers of professional assistance are likely to find the law invoked against them.
Child abuse is not new, it has occurred throughout history, and is probably occurring less now than in Victorian times when child labour was the norm. However, society today is far more aware of the problem and less inclined either to accept it or sweep it under the carpet.
Many areas have a child abuse hot line that can be called in an emergency, and any information supplied will be treated confidentially.
See also CHILDHOOD; FAILURE TO THRIVE; PAEDOPHILIA; SHAKEN BABY SYNDROME
The years from two to adolescence are mostly taken up with growing, being educated, and learning to interact with the family and society at large. By the time children are five and ready to start school, most of their behaviour problems will have settled down.
A growing child needs a well-balanced diet to provide all the kilojoules, vitamins and minerals that are essential to maintain physical and mental development. The child's diet should include meat and fish with plenty of fresh vegetables and fruit, as well as adequate calcium, usually from milk, to ensure strong and healthy bones.
Some children start to dislike sleep and to rebel against going to bed. Generally a child will be more amenable to an early bedtime if a regular routine is adhered to and there is no question that bedtime has arrived. A child who persistently appears for a chat after being put to bed, or constantly asks for a drink of water or to go to the toilet, should have its request met once and then be put to bed firmly with no further excuses for delay allowed. Of course, many children develop a fear of the dark at this time, and if this is the reason for a toddler's reluctance to stay in bed, a night-light may solve the problem.
Children should have their teeth checked every six months to ensure that the teeth are growing as they should and that they are free from decay. Checks on hearing and vision are normally carried out through the school system. A child who is suspected of having difficulties with hearing or seeing should be tested without delay, as these handicaps can affect all areas of learning and general ability to function. It is vitally important to make sure that a child has strong, healthy feet, and this depends almost entirely on their shoes. All children should have shoes that support their feet, protect them and allow them freedom to grow.
Children are affected by repeated infectious viral infections. Serious diseases such as measles, mumps, rubella and whooping cough are now rare since the introduction of immunisation programs. Scarlet fever and other bacterial infections can be readily cured by antibiotics. Coughs and colds are part and parcel of school life, and most children will get such infections every few months. An otherwise healthy child will usually have a few days of feeling off-colour and then fight off the infection and return to health.
Accidents are a hazard of the childhood years. Obviously this is because a normal healthy child leads an active outdoor life, riding bicycles, swimming, climbing trees and taking part in various other activities. Falls, fractures, knee injuries, sprained ankles and dislocated shoulders are commonplace in the five to twelve age group. Fortunately, most of these heal quickly and completely if given appropriate care. Nevertheless some accidents should not happen. Parents need to give their child a basic understanding of safety, and to steer a balance between allowing the child freedom to explore and develop its independence, and sufficient supervision and protection to ensure that serious injury does not occur. The odd sprained wrist or ankle from falling off a bike is probably inevitable in an active youngster's life, but being knocked off the bike by a car with possible serious and lifelong repercussions is a quite different matter.
See also BABY FEEDING; CHILD ABUSE; CHILDREN’S MEDICATION DOSAGE GUIDE; CHILD SMALL; FAILURE TO THRIVE; MILESTONES OF DEVELOPMENT; SPEECH DELAYED; TALKING; TRIPLE P; VACCINATION OF CHILDREN
Ensure that medication is suitable for use in children.
For children over two years of age:-
Paediatric dose = (Age in years x Adult dose)/Age in years +12 Paediatric dose = (Age in months x Adult Dose)/150
If there is concern about a child’s growth, it is initially measured for height, weight and head circumference and these measurements are compared with those of other children using statistical tables. The height of the parents will also be checked to see if there is a genetic influence.
If a significant abnormality is found, investigations will be undertaken to determine the cause. The causes are extremely varied and include chronic infections, gut infestations (eg: worms), heart disease, cystic fibrosis, food allergies and intolerance and a host of other rarer conditions. Child neglect and abuse is something that doctors have to be careful of in this situation also.
See also FAILURE TO THRIVE; GROWTH REDUCED; MILESTONES OF DEVELOPMENT
A common cold (coryza is the technical term) is a very common viral infection of the upper respiratory tract. One or more of several hundred different rhinoviruses may be responsible. A cold is a distinct entity from influenza, which is caused by a different group of viruses.
Colds spread from one person to another in droplets of moisture in the breath, in a cough or in a sneeze. Once inhaled, the virus settles in the nose or throat and starts multiplying rapidly. Crowds, confined spaces (eg. buses, aircraft) and air conditioners that recycle air are renown for spreading the virus. Most adults have a cold every year or two, usually in winter. Children, because they have not been exposed to these viruses before and so have no immunity to them, may have ten or more infections a year.
A sore throat and nose, runny and/or blocked nose, sneezing, cough, phlegm in the back of the throat, headache, intermittent fever and tiredness are the main symptoms. A secondary bacterial infection may cause pharyngitis or sinusitis.
No cure or prevention is possible. The symptoms can be eased by aspirin or paracetamol for headache and fever, and medications for the cough, sore throat, runny nose and blocked sinuses. The more the patient rests, the faster the infection will go away.
Many vitamin and herbal remedies are touted as cures or preventatives, but when subjected to detailed trials, none can be proved to be successful.
Colds usually last about a week, but some babies have a briefer course, while in others the first cold may lower their defences so that they can catch another one, and then another, causing cold symptoms to last for many weeks.
See also INFLUENZA; LARYNGITIS; NOSE DISCHARGE; PHARYNGITIS; PNEUMONIA; RESPIRATORY SYNCITIAL VIRUS; VIRUS
See INFANTILE COLIC
Some children develop an attachment for a particular toy or article. This may be a teddy bear or soft toy, or simply a piece of blanket, which gives the child a feeling of comfort and security. Some children only require their comforter before settling down to go to sleep; others carry it around all day. Provided the object can be kept reasonably clean, clearly its presence is harmless, and the child should not be deprived of it. On the other hand, some parents seem to feel that their child should have a favourite teddy or some such toy, and insist on the child taking it to bed when the child seems completely disinterested. Even young children are capable of making up their own minds about what they need in the way of comforters, and parents might sometimes ask themselves whether the behaviour they are insisting on is for the child's benefit or the parents'.
When a parent desires to reduce the child’s dependence on a comforter, repeated washing will remove all familiar smells, and reduce its desirability.
Conjunctivitis is an inflammation of the outer surface (cornea) of the eye, due to an allergy, or a viral or bacterial infection.
A bacterial conjunctivitis is the most common form, and is due to bacteria infecting the thin film of tears that covers the eye. It is very easily passed from one person to another (eg. a patient rubs their eyes with a hand, then shakes hands, and the second person then rubs their eyes). Babies suffering from a blocked tear duct may have recurrent infections. Tears are produced in the lacrimal gland beyond the outer edge of the eye, move across the eye surface and then through a tiny tube at the inner edge of the eye that leads to the nose. If the duct is too small in an infant, or is blocked by pus or phlegm, the circulation of tears is prevented and infection results.
Any one or more of a number of viruses may infect the cornea to cause conjunctivitis. This form is not quite as easily transmitted as bacterial conjunctivitis.
Bacterial conjunctivitis causes the formation of yellow or green pus in the eyes, which may stick the eyelids together. The eyes are bloodshot and sore, and almost invariably the infection involves both eyes. If allowed to persist, it may cause scarring of the eye surface and a deterioration in sight.
Viral conjunctivitis causes slight pain or an itch, redness of the eye and often a clear sticky exudate.
Rarely, resistant infections make it necessary to take a swab from the eye to determine the exact bacteria or virus responsible, but in most cases, no investigations are necessary.
Bacterial conjunctivitis is easily treated with antibiotic drops or ointment on a regular basis until the infection clears, usually in two to four days. Children must be excluded from school until all eye discharge has ceased. A blocked tear duct may be probed and cleared if conjunctivitis persists in a baby for several months, but most grow out of the problem.
Viral conjunctivitis is the more difficult form to treat as there is no cure for most viral infections, but Herpes virus infections can be cured by antiviral drops. Soothing drops and ointment may be used, but time is the main treatment, and the infection may persist for several weeks until the body's own defences overcome it.
Allergic (vernal) conjunctivitis is a reaction on the surface of the eye to a pollen, dust, chemical or substance to which the patient has an allergy. The eye becomes red, itchy and watery. Vasoconstrictor or antihistamine eye drops can be used to control the condition.
See also ALLERGIC CONJUNCTIVITIS
A fit, seizure or convulsion (the terms are synonymous) is a result of a disturbance in the functioning of the brain. A convulsion may be minor and involve the simple twitching of one limb, or major in which the patient loses consciousness, many muscle groups go into uncontrolled intermittent spasm, the patient falls, sweats profusely, has a rapid heart rate, clamps their jaw shut and loses control of their bladder.
The main task of anyone present at a seizure is to protect the sufferer from harm. Do not restrict their movements, since the spasms and jerking are automatic and trying to stop them may cause injury. Simply move any objects that may be a danger and, if necessary, remove false teeth (but do not prise the mouth open or force objects into it). Protect the head from banging against the floor by putting something flat and soft (such as folded jacket) under it. If necessary loosen the person's collar so they can breathe more easily. Artificial respiration will probably be impossible, and the sufferer will breathe normally again at the end of the seizure, generally after a minute or so. The sufferer may fall asleep once the seizure has ended, in which case place them in the coma position (on side with legs bent) and allow them to wake naturally. There may be a card or tag on the person saying what to do in case of a seizure - look for this and follow the instructions.
Although relatively uncommon, and very distressing when they do occur, there are scores of causes for a convulsion that vary from the obvious to the extremely obscure.
Everyone thinks of epilepsy and other serious diseases when fitting occurs, but a simple faint, severe bacterial and viral infections, high fever and a sudden shock or intense fear can trigger a convulsion. Overdoses of numerous prescribed and illegal drugs, as well as alcohol, strychnine and cyanide poisoning may also be responsible.
Children sometimes have convulsions because of a sudden rise in temperature. These febrile convulsions consist of body rigidity, twitching, arched head and back, rolling eyes, a congested face and neck, and bluish face and lips. Generally the seizure will end quite quickly, but the carer should ensure that the airway is clear, turn the child on to the side if necessary, remove clothing, bathe or sponge the child with lukewarm water, and when the convulsion has eased obtain medical attention.
Epilepsy is a condition that causes recurrent seizures (fits). Some people are born with epilepsy, while others acquire the disease later in life after a brain infection, tumour or injury. Brain degeneration in the elderly, removing alcohol from an alcoholic or heroin from an addict, or an excess or lack of certain chemicals in the body can also cause epilepsy. Fits can vary from very mild absences in which people just seem to lose concentration for a few seconds, to uncontrolled bizarre movements of an arm or leg, to the grand mal convulsion in which an epileptic can thrash around quite violently and lose control of bladder and bowel.
A head injury from any cause may cause immediate or delayed fitting because of injury to the brain, or bleeding into or around the brain. Bleeding may also be caused by the spontaneous rupture of a weakened artery or vein in the skull, and the resultant pressure on the brain can have many varied effects.
The brain is supported and completely surrounded by a three layered membrane (the meninges), which contain the cerebrospinal fluid. If these meninges are infected by a virus or bacteria (meningitis) the patient may experience headache, fever, fits, neck stiffness and in severe cases may become comatose.
Encephalitis is an infection of the brain itself, which may be confused with meningitis. The symptoms include headache, intolerance of bright lights, fever, stiff neck, lethargy, nausea, vomiting, sore throat, tremors, confusion, convulsions, stiffness and paralysis.
Severe dehydration caused by excess sweating and/or lack of fluid in a hot environment, particularly if exercising, may cause collapse and fitting. This may be combined with excessive body temperature (hyperthermia), which aggravates the problem. Marathon runners who collapse and start twitching are often suffering from these problems.
Children who have behaviour problems may have severe temper tantrums, which can appear to be similar to a convulsion. If the child is a very determined breath holder, the end stage may be collapse and fitting due to lack of oxygen reaching the brain, which usually settles quite quickly.
A lack of oxygen from near drowning, suffocation or smoke inhalation may also have adverse effects on the brain that trigger fitting.
Uncommon causes of convulsions in babies include a tumour or cancer affecting the brain or surrounding structures within the skull, significant liver or kidney disease, hydrocephalus, and a lack of thyroxine (hypothyroidism). Rapid shallow breathing may alter the balance of carbon dioxide and oxygen in the lungs, and thus the blood. The blood becomes more alkali, and irritates small muscles, particularly in the hands, which go into spasm and may appear to be a convulsion. This is known as tetany (totally different to tetanus infection) and patients have fingers and sometimes wrist, forearms and feet, which are pointed in a firm spasm.
Numerous rare syndromes, inherited conditions and congenital abnormalities may also be responsible.
See also FEBRILE CONVULSION
The sudden infant death syndrome (SIDS) or cot death is the sudden unexpected death of an apparently normal healthy child in whom a subsequent detailed post-mortem examination reveals no cause for the death. A baby is put to bed and some hours later is found dead. There is no evidence of disturbed sleep and no cry is heard.
It affects two out of every 1000 children between the ages of one month and one year.
The cause is unknown, but there are many theories. It is not infectious or contagious, nor are the deaths due to suffocation, choking or allergies. It occurs in both bottle and breastfed babies and there is no relationship between immunisation and cot death. There is no evidence that vitamins, dietary supplements or any medication can prevent the syndrome. If one baby in a family dies from cot death, there is some evidence that subsequent babies are at a higher risk. Another theory implicates high body temperatures due to over wrapping or dressing a baby, so that the baby cannot sweat effectively.
Babies who sleep face down are more susceptible to cot death, and it is strongly recommended that babies should never be placed on their stomach to sleep.
It is imperative that the parents receive adequate and immediate counselling by trained professionals as they develop an acute sense of guilt, thinking that they are in some way responsible, and fear that someone will blame them for the death of their child due to neglect or mistreatment, but this is not so. Other children in the family will also be affected because they are often unable to understand or accept the tragedy.
Some parents have found their child on the verge of death, lying blue in the cot and not breathing, and rousing them has started breathing again. After such an event, affected babies can be monitored by a sensing device that sounds an alarm if breathing stops for more than a few seconds. Only a very select group of infants require this type of care.
Interestingly, the incidence of cot deaths halved in the decade between 1990 and 2000, but the reason is not known.
Babies cry for only a limited number of reasons:
- pain (eg. colic, teething, sore throat, injury)
- hunger
- discomfort (eg. a wet nappy, cold)
- tiredness
- if their carers are stressed or upset.
The first four are fairly obvious causes, but many parents forget about the last one, and if the parents are arguing, overtired themselves, upset or stressed, the baby will rapidly sense this and become upset itself.
The obvious ways in which to deal with a crying baby are to deal with the cause of the crying, but becoming upset about a crying child will only make the situation worse.
A cytomegalovirus (CMV) infection is an extremely common viral infection affecting between 10% and 25% of the entire population at any one time. Infection rate may be in excess of 80% in homosexual men. It may be a serious illness in patients who have reduced immunity due to treatment with cytotoxic drugs for cancer, have suffered other serious illnesses, are anaemic, suffering from AIDS or other immune affecting diseases, or who are extremely run-down from stress or overwork.
The virus passes from one person to another in saliva or as droplets in the breath, but may also spread through blood transfusions or sexual contact. In all but a tiny percentage of infected people, there are absolutely no symptoms, and they appear and feel totally well. Adults with reduced immunity develop a fever, headaches, overwhelming tiredness, muscle and joint pains, enlarged lymph nodes and a tender liver. In patients with severely reduced immunity, pneumonia and hepatitis may develop.
If a pregnant woman with reduced immunity acquires a significant CMV infection, her baby may be affected in the womb and be born with liver damage (jaundice), enlarged liver and spleen, poor ability to clot blood, bruises, intellectual disability, and one in six are deaf.
The infection can be detected by specific blood tests, and the virus may be found in sputum, saliva, urine and other body fluids.
There is no specific treatment. Aspirin and/or paracetamol are used to control fever and pain, and prolonged rest is required for recovery. It is not necessary to exclude children from school.
An uneventful recovery is expected in normal patients. In immune compromised patients, pneumonia and hepatitis may be fatal.
See also VIRUS