Children present to general practitioners with a wide range of problems, but most of the time they are not particularly unwell. Children with a more serious illness often compensate very well initially, so there is a risk that their illness will be overlooked or underestimated. In this 10 minute clinic we look at what we should be doing when we are assessing a possibly very sick infant, and highlight important red flags that should alert us to hospital admission being required.
Take-home points:
- A carefully performed clinical assessment, including observation history and physical examination, can detect serious illness with up to 90% sensitivity.
- Physical signs may be deceptive or absent in the ill child
- Infants may deteriorate clinically very rapidly
- If a sick baby or infant has not responded to simple treatment, they should always be assessed
- Always perform a full physical examination in every case however busy you may be. Petechial rashes or other localising signs can easily be missed otherwise
- Always listen to the mother – they know their child far better than you do
- The younger the child, the lower the threshold for seeking a paediatric opinion
- With the exception of dehydration, an infant who is alert and feeding well is unlikely to have a serious acute illness
- Significant symptoms include persistent or bile-stained vomiting, inappropriate drowsiness or irritability, an unusual cry, poor feeding, rapid breathing and few wet nappies
- Significant signs include poor muscle tone, dehydration, poor response to stimuli, rib recession, grunting, a bulging fontanelle and a temperature above 38.5 degrees C
- A diagnosis may be unclear even after a full physical examination
- Always take note of any gut feeling you may have about an unwell child
- If you remain worried but do not feel admission is warranted at that time, advise the parents to update you on the child’s condition in a set time period, or arrange re-examination a few hours later
- Admit the child to hospital for observation if you have concerns about them
References and resources:
Home | Spotting the Sick Child
Looking after a sick child – NHS
Unwell child – Alder Hey Children’s Hospital Trust
Managing the unwell child – PMC