Why does it feel like children, especially those at daycare, are always sick?

Children have immature immune systems – they are constantly being exposed to new bugs that they haven’t experienced before.  All this exposure leads to frequent illnesses.  However, this doesn’t mean that there is something wrong with them.  It simply means that their little bodies are working hard to strengthen their immune defenses. But knowing when to worry (and when to wait and see) can save a lot of stress.

Respiratory (breathing & lung) infections in kids

• Children average of 6-12 respiratory tract infections per year, especially for children in daycare
•  Around 75% are caused by viruses
• Only a small proportion (5%) will progress to more serious infections like bronchitis or pneumonia
• These infections can be classified as Upper (ears, nose or throat) or Lower (bronchi, lungs)

Upper Respiratory Tract Infections (the “common cold”)

• Involves the ears, nose and throat
• Almost always viral.
• Can have a dry cough
• Fevers are not common
• Infections will usually last between 7-14 days.
• Cough can last up to 3 weeks
• No treatment needed beyond simple pain relief (analgesia) for comfort

Lower Respiratory Tract Infections

• The two most common areas involved are the bronchus (bronchitis) or alveoli (pneumonia)
• Still usually caused by a virus however can sometimes be bacterial
• Can be a dry or moist cough
• Fevers can be common
• Infections will usually last between 7-14 days.
• Cough can last up to 3 weeks
• Usually no treatment needed beyond simple analgesia for comfort

RSV (Respiratory Syncytial Virus)

RSV is a virus that can cause a respiratory infection at any age however can cause significant issues for:

• Infants <12 months old usually presents as Bronchiolitis

Peak severity is around day 2-3 and usually resolves in 7-10 days.

Typical signs/symptoms:

• Runny nose
• Cough (usually dry)
• Fevers
• Increased work of breathing
• Difficulty feeding
• Episodes of apnoea (stop breathing)

When to go to the hospital:

• Increased work of breathing
• Unable to drink/feed (signs of dehydration)
• Episodes of apnoea
• The infant is younger than 10 weeks old

Management at home:

• Paracetamol as needed for comfort
• Nasal saline +/- suction
• Encourage smaller, more frequent feeds

RAD (Reactive Airway Disease)

This is commonly described as “Pre-school wheeze” “pre-school asthma”. It is common:

• Children between 1-5 years old
• Usually associated with infections
• This does not mean the child will have asthma forever
• Only half of children who wheeze during preschool years will have asthma at school age.

Typical signs/symptoms:

• Recurrent episodes of wheeze (2 or more)
• Cough
• Activity limitation
• Increased work of breathing
• At home treatment: Ventolin (nebuliser/ inhaler)

When to go to the hospital:

• Increased work of breathing

Croup

Inflammation of the upper respiratory tract caused by multiple different viruses (most commonly Parainfluenza).

• Typically occurs between 6 months and 6 years; Usually worse during the night and peaks on nights 2-3

Typical signs/symptoms:

• Runny nose
• Barking Cough
• Hoarse voice or cry
• Stridor when upset/active
• Increased work of breathing
• Stridor (difficulty breathing, higher pitched wheezing sound) at rest

When to go to the hospital:

• Increased work of breathing
• Stridor at rest

Management with a GP:

• Oral steroids

Note: Not all barking coughs and stridor are Croup. We need to consider other causes:

• Inhaled foreign body (Rapid onset of symptoms and during the day)
• Anaphylaxis (Rapid onset of symptoms, exposure to allergens and other allergic signs)
• Serious bacterial infections (Fevers, drooling and unwell)

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How to spot respiratory distress in children

It’s a good to know the warning signs so you can act fast if your child’s condition worsens.

If you’d like, we can show you video examples of respiratory distress during a consultation.  If your child is unwell, we have urgent appointments available and our nurse can help triage phone calls.

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Common Childhood Rashes and Skin Issues

Hand Foot and Mouth Disease (HFM)

• Caused by Coxsackie virus
• Spread via direct contact with blister fluid or droplets from the mouth
• Self-limiting – will resolve by itself
• Symptoms:
  • Blisters on hands, feet, inside or around the mouth
  • Fever, sore throat, loss of appetite, and lethargy
• Many children remain well despite the rash
• Blisters appear 1–2 days following the fever
• Oral intake may be significantly impacted, especially in infants and younger children
• Commonly seen in children under 5 years of age
• Treatment: Maintain hydration, simple pain relief – Panadol and Nurofen, Icy poles (No aspirin)

TIME OUT! Until all blisters have crusted over and no new lesions

 

Viral Exanthem (widespread rash)

• A widespread, non-specific rash
• Typically appears with general viral symptoms such as fever, malaise, headache, runny nose
• Usually a termed a “virus”
• Can be a bit itchy, can be red when the child is hot
• Specific exanthems include HFM, chicken pox, measles, parvovirus
• Treatment: cool/tepid showers, supportive treatment for other viral symptoms

Impetigo (school sores)

• Superficial, highly contagious bacterial skin infection. Usually caused by bacteria Staphylococcus aureus or staph pyogenes.
• Pustules, golden or honey-coloured crusts
• Usually young children
• More common (risk factors) with children who suffer from dermatitis, eczema, insect bites, other skin traumas
• Treatment is medication: typically topical antibiotics (mupirocin)
  • On lesion and into nostrils
  • Can develop into cellulitis requiring oral antibiotics
• Tips:
  • Change clothing and bedding daily and wash in hot water
  • Avoid close contact with others
  • Do not share towels or clothes

TIME OUT!

• Until lesions have crusted over or at least 24 hours of treatment

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Otitis Media (Middle ear infection)

• Middle ear inflammation and fluid build up behind the ear drum
• Usually an acute self-limiting viral illness but can be viral or bacterial
• Usually resolves spontaneously within 2-7 days
• Antibiotic therapy does not improve pain, and only shortens duration of illness by about 12 hours
• Adequate pain relief is normally all that is required

Consider antibiotics if:

• Ear discharge,
• Child is under 6 months,
• Child is under 2 years with both ears involved,
• Or systemic illness ie fever, lethargy, pale, irritable

Does my child need grommets?

• Persistent otitis media with effusion for more than 3 months
• Signs of hearing loss on audiometry (hearing test)

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When to Contact your GP (The Practice at Clem Jones Centre, Carina)

You don’t have to wait until it’s an emergency. Reach out when you notice:

• Worsening breathing symptoms

• Dehydration / poor feeding

• Fever that doesn’t settle

• Rapid onset of ear pain or discharge

• Skin infections not improving with home care

• Any new or concerning symptom

We can assess, provide treatment, and advise whether further care is needed.

Health Talk Series

This blog is from our monthly in person events being run at Carina Leagues Club.  Each month we focus on a different health topic.

For more information or to join us in person click here: