Doc Talk #33 – Childhood illness (part 2)

Seal image by Ansgar WalkOwn work, CC BY-SA 3.0, Link

 

 

Following on from last week’s show, Dr Dan delves deeper into some specific childhood illnesses.

  • Bronchiolitis is a viral illness caused by RSV virus, causing snuffliness, cough and wheeze
  • It mostly affects children under 1 year of age
  • Management is supportive, with oxygen and feeding support as needed
  • There is no role for antibiotics
  • Although we sometimes try inhalers (puffers) there is not any good evidence for this and they usually don’t make much difference
  • In general it is a good idea to get babies with bronchiolitis looked at by a doctor

 

  • Viral-induced wheeze affects slightly older children (toddlers and above), who become wheezy whenever they contract a viral illness
  • Most children tolerate this quite well and do not need any specific treatment, but we sometimes use inhaled steroids if it is recurrent
  • They do not require antibiotics
  • There is a slightly increased risk of asthma, but most children with viral-induced wheeze will not go on to develop asthma
  • These children can often be safely managed at home by parents

 

The only reason I know what a seal sounds like is because I’ve heard lots of children with croup

  • Croup (or laryngotracheobronchitis as it is technically known!) is caused by parainfluenza and related virus
  • It causes a barking ‘seal-like’ cough which is very characteristic
  • It can also cause a noise when children breathe called ‘stridor’
  • The most important thing for parents who have children with croup is to try and stay calm! Children can easily pick up on adult nerves and that can make the situation worse
  • Using humidifiers, or taking the child out into cool air can often settle things down
  • Children with croup can usually be safely managed at home, but if they are seen by a doctor we will sometimes give them a single dose of oral steroid (dexamethasone) as the condition often gets worse at night and on the second day
  • Antibiotics are not helpful for croup

 

We also talked about rashes. These are often the result of viral infections and can cause blotches/spots/hives.

windpocken
This child has chickenpox. If they are otherwise well, they can usually be safely managed at home by the parents without needing to see a doctor.

 

rougeoledp
This child has measles. They are usually very sick and the rash is hard to miss.

Happily because of immunization, measles is relatively rare now (recent outbreaks at Disneyland excepted…)

I remember seeing a young girl with measles when I was working as an out-of-hours GP in England. Her mother was shocked that her daughter was so unwell. We have forgotten how devastating this illness was.

 

b19_virus
This is the ‘slapped cheek’ virus.

Photo by Kardelen Yangın – Own work, CC BY-SA 4.0

The ‘slapped cheek’ illness is caused by parvovirus. It is not dangerous to children, but if a pregnant women who has never been exposed to the virus catches it for the first time, it can affect the development of the baby

 

And one more rash we don’t want parents to miss – the purpuric rash. It is caused by bleeding into the skin and sometimes can be a sign of very serious illness including meningococcus. If this rash does not disappear when you press on it with a glass, which is the telling sign. If you have an unwell child with a rash like this, you should get them checked out as soon as possible.

purpura
By User:Hektor – the English Wikipedia: http://en.wikipedia.org/wiki/Image:Purpura.jpg, CC BY-SA 3.0, Link

As ever, I will refer you to some excellent sources of advice for parents:

Alberta Health Link ☎811

Alberta Health Services HEAL website

The MyHealth.Alberta has some good information about specific conditions as well

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