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.

Acute Bronchiolitis in Infants and Young children

Most people have not heard of this exact word in developing countries. The word "bronchiolitis" means inflammation of the BRONCHIOLES. What are bronchioles? These are the smallest size airways in our lungs. They lead out from bigger airways known as bronchi and end into our air-sacs or what we call the ALVEOLI, where the crucial gas exchange of oxygen and carbon dioxide takes place thousands of times in a day, and throughout our life. 

Because infants have small bodies and small lungs, they also have very small bronchioles. These bronchioles catch infection with viruses very easily, and when they do, they get swollen, their internal diameter gets smaller, and their ability to allow effective gas exchange to take place gets reduced dramatically. 

When this happens, the baby becomes short of breath, as he/she can no longer breathe in and out without effort to push open the bronchioles with each breath. The breathing rate goes up, the baby works hard, and soon, he/she becomes tired. This chain of events is known as acute bronchiolitis. While usually a self-limiting condition, infants with this problem can sometimes become really sick and need hospitalisation. We will come to that a little later.

Acute bronchiolitis is an illness most commonly seen during the coldest months of the year. It begins with a simple cold - a runny nose, sniffles, a mild cough and perhaps a bit of a temperature. Over the next few days, the virus descends downwards from the upper airways into the lungs. When it reaches the smallest airways or the bronchioles, it produces inflammation - swelling and secretions in the tubes. This is when the child begins to be short of breath. He/she breathes more rapidly. At this stage, the illness can either remain static, and the child will have the breathing difficulty but not look very sick; or, it can become progressively more severe, and the child may become so breathless as to be unable to feed, sleep or look well. The severity may be such as to make the child's carers reach out to the doctors, with a visit to the hospital in the more serious ones. 

As this is a viral illness, and most of the times resolves by itself, doctors attending to infants and small children with acute bronchiolitis don't usually admit the child unless his/her blood oxygen levels are falling or the child is getting progressively more and more tired. Once admitted, such infants are treated with oxygen and nutritional support. Little else is helpful or needed/ Some infants may be given additional forms of treatment with medicines that open up their airways and make them breathe more easily. However, this is an exception and not the norm. 

Once the breathing difficulty is under control, infants and small children with acute bronchiolitis are ready to go home. Some of them will need medicinal support for slightly longer. A few of the infants who recover from their first attack might develop recurrences of a similar attack repeatedly. A very small percentage of such repeat-afflicted ones may develop an asthma-like chronic problem.

To summarise: Acute bronchiolitis is a frequent problem characterised by a breathing difficulty with a self-resolving natural course. Caused by viruses, it is not an illness that usually causes much distress or loss of productivity on the part of parents. Treatment is directed at maintaining the oxygenation and hydration of the affected child and allow him/her to recover on their own.

Taming the Throat

Throat infections come in different forms in children, and toddlers are especially vulnerable to them. While bacteria cause major infections, viruses are not to be left behind in the frequency with which they occur and the misery which they cause. The commonest throat infection is the SORE THROAT, or what is called as PHARYNGITIS. Caused by bacteria or viruses, this infection is so common all over the globe that it ranks as the COMMONEST respiratory tract infection among children.

A child with pharyngitis will usually have a soreness of the throat, be unable (to some degree) to swallow food, liquids, or even his own spit, have fever, body pains, throat pain (expressing itself as a feeling of "pins and needles" when he attempts to swallow something) and, sometimes, a cough. 

Most of the times, such infections are imported through day-care or nursery schools. A pediatrician would, when asked to examine such a child, look at the back of the child's throat, his tonsils, his neck glands, take his temperature, and then take a call on what level of urgency and which kind of treatment is thought necessary. Bacterial sore throats would need to be investigated by a throat swab to look for "strep" and if positive, the child would receive oral penicillin or other alternatives (if the patient is allergic to penicillins). The duration of treatment must be up to 10 days to completely eliminate the germs from the body. If the sore throat is deemed to be viral in nature, an antibiotic is not usually required, but the child must be given good supportive care such as rest, increased intake of liquids, steam inhalation if there is blockage of the air passages, etc. 

The next form of throat infection is something that rarely occurs nowadays, but it has not yet been eradicated from the US of A. This is whooping cough, an illness that is pretty ancient. It is caused by the pertussis bacteria. This was a killer disease in pre-vaccination times, but, thankfully, with universal immunisation of children with the pertussis vaccine, it occurs rarely. However, it can still be potentially fatal, especially when it occurs in smaller infants less than 3 months of age.

The child with a whooping cough has a whoopy sound at the end of each bout of cough. The bouts can be really long, very tiring, and be very taxing on the rest of the body. The huge cough bouts can exhaust the child; they can cause haemorrhages in the conjunctivae of the eyes, tear chest muscles (the ones involved in breathing), paralyse the nerve that supplies the voice box (and cause difference in the voice) and so on. 

Patients with whooping cough are diagnosed with blood tests and with a nose swab that is cultured in the microbes laboratory to discover the pertussis bacteria. Treatment is with an appropriate antibiotic (though it does not much work) and with cough syrups that can suppress the cough. In addition, nutrition must be looked after as well as addressing the fluid needs of the child.

The last common infection I am going to discuss is infection of the tonsils, or tonsillitis. We all have several tonsillar tissues in our throats, but the one I am referring to are the pair located just behind the tongue on either side of the mid-line. When the child is an infant, they can swell up especially in bottle-fed babies; when a toddler, they can get infected by cross contamination in a day-care school or the nursery. 

A child with tonsillitis presents in much the same way as the one with pharyngitis; however, the pain and discomfort is usually greater with tonsillitis. Usually, the child with tonsillitis has enlarged neck glands in addition to the swelling of the tonsils. 

Treatment is once again with antibiotics used for at least 7-10 days. Some children keep getting repeated attacks of either pharyngitis or tonsillitis. In the latter case, they sometimes become candidates for a form of surgery where the doctor removes the tonsils (most of the time with the other pair of tonsillar glands - the adenoids - that are situated high in the roof of the mouth). There is a clear trend nowadays to NOT REMOVE THE TONSILS as they have a key role to play in defending the body against bacteria, viruses and other offending organisms.

I hope you liked this primer on throat infections. If you have to ask any questions, feel free to ask me through the comments section.