Failure to thrive is a term use to describe babies and young children under two years of age who are lighter than 97% of children their age, and who do not put on weight or develop at the expected rate.
Obviously the most common cause is neglect and starvation, and sometimes this can be difficult for doctors to detect, and it is only when the child is hospitalised, or information is given by friends or relatives, that this problem becomes apparent.
Persistent infection, particularly of the urine, is another common cause. Infections may be low grade and not apparent, and urine infections may have no symptoms in young children, and collection of urine samples is difficult, making them hard to detect.
Infestations of the gut with various worms and parasites must be excluded by examination of a sample of faeces in a laboratory.
Genetic factors must also be considered. If both parents are very small, then the child may be also be small, but completely healthy.
A wide range of uncommon diseases can cause failure to thrive. If one of the common causes above cannot be found, it may be necessary to undertake extensive investigations to find a long term disease that is affecting the child’s growth. Examples include diabetes (rare under two years), pyloric stenosis (narrowing of the outlet of the stomach), Down syndrome (mongolism), Turner syndrome (girls born with only one X chromosome instead of two), Fanconi syndrome (failure of the kidneys), major heart valve and artery abnormalities (eg. Fallot tetralogy, patent ductus arteriosus), cystic fibrosis (failure of the glands throughout the body), coeliac disease (intolerance to gluten in flour), failure of any of the body’s major hormone producing glands (eg. thyroid gland, pituitary gland, adrenal glands and parathyroid glands) and a diet deficient in iron or other essential nutrients.
Numerous other rare congenital and acquired conditions may also cause failure to thrive.
See also CHILDHOOD; CHILD SMALL; GROWTH REDUCED
Someone who has a fever (raised temperature) is described as febrile or feverish.
See also FEVER
Small children under the age of about four sometimes have convulsions because of a rapid rise in temperature. The actual temperature is not as important as the rate at which the temperature rises. These febrile convulsions generally consist of body rigidity, twitching, arched head and back, rolling eyes, a congested face and neck, and bluish face and lips. This can be extremely alarming for parents, but generally the seizure will end quite quickly.
The carer should:- ensure that the airway is clear, and turn the child on to the side if necessary
- remove the child's clothing
- bathe or sponge the child with lukewarm water
- when the convulsion has eased, cover them lightly and obtain medical attention.
Prevention involves keeping the child cool with cool sponging and regular paracetamol.
See also CONVULSION
The normal active human has a temperature of about 37°C. The word “about” is used advisedly, because the temperature is not an absolute value. A woman’s temperature rises by up to half a degree after she ovulates in the middle of her cycle. Many people have temperatures up to a degree below the average with no adverse effects. The body temperature will also vary slightly depending on the time of day, food intake and the climate. All these factors must be taken into account when the notion of a normal temperature is considered.
A fever (pyrexia) is a sign that the body is fighting an infection, inflammation, or invasion by cancer or foreign tissue. A fever may be beneficial to the patient, because many germs (viruses particularly) are temperature sensitive, and are destroyed by the fever. A fever over 40°C though should be reduced by using paracetamol or aspirin and cool baths.
An infection by a bacteria (eg. pneumonia, tuberculosis, tonsillitis, ear infection, urinary infection), virus (eg. common cold, influenza, hepatitis, chickenpox, AIDS) or fungus (eg. serious fungal infections of lungs) is by far the most common cause of a fever. A viral infection usually causes a fever that comes and goes during the day, often with a sudden onset in the morning and evening, followed by a slow decline to normal over the next couple of hours. Bacterial infections tend to cause a constant fever, usually over 38.5°C. This is because bacteria reproduce like all animals, at random times, while viruses tend to reproduce all at once, so the body is subjected to a sudden doubling of the number of viruses, which stimulates the brain to increase the body temperature.
Infections can occur in any tissue or organ of the body, and other symptoms will depend upon where the infection is sited. An untreated bacterial infection will result in pus formation, and an abscess full of pus may form at any site of infection (eg. under the skin, in the lung, at the root of a tooth, in the bowel) and continue to cause a fever.
Remember that the absence of a fever does not mean the absence of infection, particularly in older people, as many elderly people do not develop a fever with infections.
Rarely, medications can cause a fever as a side effect.
See also TEMPERATURE MEASUREMENT
Fifth disease (erythema infectiosum) is a common childhood viral disease caused by the Parvovirus that last from two to five days, but occasionally may persist for weeks. It occurs in epidemics every few years, and virtually every child will eventually develop the infection before their teenage years.
The infection is characterised by red flushed cheeks (slapped cheeks appearance), paleness around the mouth and a red patchy rash on the arms and legs. Many children will have very mild symptoms that may be overlooked, or confused with German measles. Rarely joints may become sore and inflamed. Complete recovery is normal and no treatment is necessary.
Six diseases that caused a rash were known by numbers. They were first disease (measles), second disease (scarlet fever), third disease (German measles - rubella), fourth disease (Duke’s disease - Coxsackie virus infection) and sixth disease (exanthema subitum - roseola infantum).
Only the fifth disease nomenclature is commonly used today.
See also GERMAN MEASLES; VIRUS
The floppy baby syndrome is a partial widespread muscular paralysis in an infant. Babies fed honey contaminated with dust containing Clostridium botulinum are affected by the toxin produced by these bacteria. The infant is unable to use some of its muscles and becomes very floppy.
A test on faeces for the infecting bacteria is used to make the diagnosis.
No specific treatment available, but the condition usually settles spontaneously with time and is rarely fatal.
See also BABY FLOPPY
Mushrooms, the green slime that forms on stagnant pools, and tinea are all related. They are fungi. Fungi are members of the plant kingdom, and are one of the types of microscopic life that can infect human beings in many diverse ways. The technical terms for a fungal infection are a mycotic infection or mycosis.
The most common site of infection is the skin, where they cause an infection that is commonly known as tinea. The fungus that causes tinea can be found everywhere in the environment in the form of hardy spores. These are microscopic in size and may survive for decades before being picked up and starting an infection. Between the toes the fungus causes a type of tinea commonly known as athlete's foot. This is because athletes sweat and wear close fitting shoes that lead to the ideal warm, damp environment favoured by fungi. Similar infections in the groin cause a red, itchy, rapidly spreading rash. In both situations, creams or lotions are used to kill off the fungus before it spreads too widely. The rash is often slow to clear, because the treatments destroy the fungus, and do not necessarily heal the rash. The body heals the rash itself once the infection is controlled.
Unfortunately, fungal skin infections (dermatomycoses) tend to recur because the fungus in its cyst form is resistant to many types of treatment. The active forms of the fungus are killed, but the spores may remain in the skin pores to reactivate once the treatment is ceased. To prevent this condition, keep the affected areas cool by wearing the correct clothing and foot wear, and dry carefully when wet.
Fungi are also responsible for many gut infections, particularly in the mouth and around the anus. It is a rare infant that escapes without an attack of oral thrush. The white plaques that form on the tongue and insides of the cheeks are familiar to most mothers, and this is due to one of a number of fungi. Paints or gels used in the mouth usually bring it rapidly under control.
Around the anus, the fungus can cause an extremely itchy rash, but in women it may spread forward from the anus to the vagina to cause the white discharge and intense itch of vaginal thrush or candidiasis. Movement from the anus to vagina is aided by nylon underwear, tight clothing (particularly jeans), wet bathers and most importantly, sex.
Fungi live normally in the gut, and are in balance with the bacteria that are meant to be there to help with the digestion of our food. Antibiotics may kill off the good bacteria, allowing the fungal numbers to increase dramatically, or they may migrate to unwanted areas. In these circumstances, they can cause trouble.
The most serious diseases develop when fungal infections occur deep inside the body in organs such as the lungs, brain and sinuses. These diseases are very difficult to treat and it may take many months with potent antifungal drugs to bring them under control. Fortunately, this type of condition is relatively rare.
The most obvious form of fungal infection is ringworm. This is not really a worm, but a fungal infection growing outward from a central spore, in exactly the same way that mushroom rings form in the garden in damp weather.
Every species of fungus (and bacteria, but not viruses) has two names - a family name (eg. Candida) which uses a capital initial letter and comes first, and a specific species name (eg: albicans) which uses a lower case initial letter and comes second. The fungus which causes thrush is thus called “Candida albicans” but may be abbreviated to “C. albicans”.
Common fungi, and the diseases they cause or the tissues they attack, include: -
TYPE OR PLACE OF INFECTION
Mouth, vagina, penis (thrush)
Skin (pityriasis versicolor)
Scalp (cradle cap), nails.
Lungs (usually in AIDS patients)
Feet (athlete’s foot), nails.
See also OTITIS EXTERNA; THRUSH; TINEA;