What to do when you see a rash on your child

Rashes are any spots or blotches that appear on the skin. They can be of different kinds. Each kind of rash has a medical name, but we will try and talk about this without using jargon.

This post is about rashes that occur in an ill child. We are going to ignore rashes that have been present for a long time, and most probably represent a skin condition needing the attention of a skin specialist (dermatologist). We are also going to stay away from spots that occur due to any condition in the newborn period.

Having said that, this discussion is mostly about spots or rashes that appear acutely, and are a hallmark of an acute medical condition that needs urgent attention. We will be speaking about rashes that indicate infection, and rashes that are actually bleeds in the skin and may indicate EITHER an infection, an immune condition, a bleeding disorder or even a malignancy.

Let me begin by talking about spots that occur in a child presenting with fever, reduced feeding, or/and vomiting of acute onset. There are TWO main kinds of rashes - from the point of view of their being harbingers of something serious. A BLANCHING rash is rash that disappears when you press it with a transparent item such as a plastic or glass plate. A NON-BLANCHING rash is one that DOES NOT similarly disappear. Between the two, a blanching rash is more likely to be a benign one, and may suggest a viral infection. A non-blanching rash is the one to be taken seriously. It may be a harbinger of infection with a particularly fast-attacking germ that is called the MENINGOCOCCUS. It can cause sepsis or meningitis very very quickly and can kill the affected child within hours when it is severe. This infection is more common in the west, although, with time, its incidence is likely to decline since vaccination is now available against most of the kinds of this deadly organism.

The test described above to differentiate between the two kinds of rashes is called the GLASS TEST. Every parent should be aware of this test and know how it is to be done.

Source:meningitisnow.org - The Glass Test

Important disclaimer: A rash is harder to see and understand in someone with dark skin. Always contact your doctor if you are unable to understand the rash.

Coming to bleeding rashes in the skin. These can be pin-point like or large blotches that are raised above the level of the skin. Both  these rashes can be the rash of meningococcus described above. However, they can also indicate a bleeding condition such as a defect in the function of the coagulation system of the body, a platelet disorder or a blood cancer. Whenever you see someone who has one of these skin rashes, please contact the doctor or your health representative urgently, and within an hour if feasible, especially if the child has been unwell.

I hope this helps you to understand rashes on the skin of an acutely unwell child better. Thank you for reading this post. Do leave your comments.

Remember  to click on the links above for more information on the subjects therein.

Fever is a symptom and not a disease, but ...

As I have mentioned in my earlier post, fever is not a disease by itself. Treating it with paracetamol merely causes the fever to subside, without actually affecting the underlying cause of the fever. It is important to know the following additional facts about fever:

1. High fever can produce fits in infants and toddlers; although these fits look very dangerous to parents and care-takers, they are merely a reflection of the immaturity of a small child's brain and nervous system pathways; no long-term medicine is needed except in the rarest of circumstances.
2. In children (and adults) of all ages, fever increases the thirst and fluid requirements of the patient; thus, febrile children or adults must be given extra liquids - usually 10% more than the usual for every degree Centigrade the fever is above 38 degrees.
3. A patient who is running a fever should never be force-fed food; nor should food be withheld from one who desires it. In short, let the patient decide what, how much and in what form he needs. Starving a child with fever is a criminal act, since it further weakens his/her body and prevents it from fighting the underlying cause of the fever (usually an infection with bacteria).
4. Very high fever (more than 105 degrees Fahrenheit) is termed malignant hyperpyrexia ... and in the extreme case, it can be potentially fatal, i.e. kill the patient due to complete derangement of all systems in the body.

While most causes of fever in children are easy to manage and not life-threatening, fever accompanied by any of the following additional symptoms should be considered as "not just fever" and such children should be referred to a Paediatrician immediately:           

• High grade fever
• Uncontrolled or repeated or very large-sized vomiting or loose stools
• Irritable, excessively jumpy or crying child
• Older child who remains in bed all the time and refuses to drink liquids or appears inactive, dull or lethargic
• Has had fever-associated fits in the past, or during the present illness
• There are significant symptoms pointing to a serious infection such as arching of the back (meningitis), dark coloured, blackish urine (malaria), stomach bloating (typhoid) or moist, hacking cough with sputum and chest pain (pneumonia)

Learn to understand fever and try not to panic.  Check out the link to my earlier detailed post on fever to learn how to manage fever at home. When in doubt, go to your child's doctor immediately.