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No. 22 (April 1958)
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RECOGNITION OF
THE SICK CHILD

FROM 2 to 5 YEARS OF AGE
by Dr. A. W. S. THOMPSON

The notes that follow were written primarily for nursery play centre supervisors. They will repay careful study by parents who from time to time are confronted with sudden and apparently inexplicable upsets in their growing children. It is suggested that this page should be kept for reference.

The object of these notes is to help you to decide whether or not a child is ill, and when to send for a doctor. This is no more than Granny used to do in the old days. We need not consider cases which can be recognized as illness at a glance (e.g., where a child suddenly doubles up with a violent pain in the abdomen and lies retching and groaning). You will not know what it is, but you would naturally send for a doctor in such cases.

It is important to recognise illness early—

In case it is infectious.

In case it is serious and needs attention urgently.

Granny knew the child, and noticed some change from normal habits or disposition. It was “not itself,” It was bad tempered, quarrelsome or “grizzly,” it looked drowsy or lacking in interest, wouldn't play with its toys, refused food, perhaps visited the lavatory more often than usual—and so on.

Unless the illness begins suddenly (e.g., child feels sick or vomits, complains of “sore head” or “tummy-ache”, etc.), the child often merely loses interest in his surroundings and gradually withdraws into himself. The other children often take no notice.

It is well to remember that a pre-school child seldom complains of a sore throat, so a serious throat condition (especially diphtheria) may be overlooked. The first sign of trouble may be the refusal of food or drink because of pain on swallowing. It is a medical rule that every sick child's throat must be examined. Also, he can seldom say accurately where his pain is—especially if it is in the tummy. He generally puts a hand vaguely in the middle of it.

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HOW TO EXAMINE A CHILD SUSPECTED TO BE ILL:

(A)

Look at the child.
(B)

Ask him how he feels.
(C)

If necessary, examine scalp, ears, face and skin generally.
(D)

Take his temperature. (Pulse will not help very much.)
(E)

Look at tongue and throat—if you can.
(F)

Feel glands in neck.
(G)

Examine any part complained about.

Look him over in leisurely fashion. Notice his general appearance, the way he is made and covered, how he stands or sits, colour, etc. Does he look like an ill child? If so, what seems to be troubling him, and where?

Ask him how he feels, quietly, sympathetically, firmly. Press your questions gently. He can often tell you quite a lot.

Scalp

For head lice, examine systematic fore and aft partings across the scalp. Nits, tiny specks firmly fixed to hairs, most easily seen behind the ears, are the eggs of the head louse.

Ringworm of the scalp is indicated by circular scaly balding areas with broken-off hairs on them, usually near edge of scalp at the back.

Swollen glands develop at the back of the head in German measles, with a rash and mild general upset. (Rash begins on face, scalp, and neck, and spreads downwards over the body and limbs.)

Ears

Discharge from the ear or earache should always receive medical attention.

Face

Face may show flush, pallor, anxiety, pain.

Bloodstained discharge from the nose, and sore lip where it touches, often means a diphtheria carrier.

Impetigo consists of yellow crusting on a sore and is very contagious.

In mumps there is a tender swelling in front of the ears and behind the angles of the jaw, one or both sides. There is pain on opening mouth and temperature is usually raised, but not always.

Skin

Scabies is known as “the itch”. The itch is worst in bed at night. Rash occurs between the fingers, front of the wrists, inner side of the elbow, front fold of the armpits; perhaps also on the abdomen, buttocks, etc.

Ringworm of the body is a circular rather itchy area with a slightly raised, reddish, blistery spreading edge, forming ring shapes.

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For rashes of infectious disease—examine the whole body unclothed. In chickenpox and German measles the rash may be the first sign of the illness.

Scarlet fever rash shows on the second day. The disease begins suddenly with headache, vomiting, sore throat, fever.

Measles rash appears on the fourth day. The disease begins like a cold, with heavy eyes, sneezing, cough, running nose, rising temperature.

Temperature

Normal temperature (special mark on thermometer) is 98.4° in mouth, but may be higher for a very slight reason. Temperature 101° always means something. In these children it is best taken in the groin. With the child lying on its back, place the bulb in the crease between the thigh and the abdomen, then bend the leg up on the body. Hold there for two minutes. Short-bulb thermometer is the safest. Always shake well down below normal first. A sharp rise of temperature in some children may cause a convulsion (instead of a shivering fit, as in adults). If a child has a convulsion, put cold packs on the head and call a doctor. Do not put him in a bath.

Pulse

The normal rate is 110 per minute in the second year, 90 in the fifth.

Mouth and Throat

Persuade the child to open its mouth wide, keeping the tongue in, in good light. Place the handle of a spoon on the front half of the tongue (not far back) and press gently down. Ask the child to say “ah”. The uvula hangs in the middle at the back of the throat, the tonsils on either side.

Look for a reddening of the back of the throat, spots or coating on the tonsils. Any ill child who has these signs should be seen by a doctor; tonsillitis or diphtheria may be present. In diphtheria the child often makes little complaint about his throat, and may not appear to be seriously ill at first. In trench mouth the symptoms are foul breath, swollen, oozing gums, pain on chewing The child should be isolated.

Glands in Neck

The glands here may be swollen below the angle of the jaw in tonsillitis, at the back of the head in German measles.

Headaches and Poliomyelitis

Common early polio symptoms are headache, sore throat, vomiting, abdominal pain, pains in neck, diarrhoea. It is reassuring if the child can kiss its knees without pain, but in any doubt rest in bed is very important from the beginning.