The sick child

Infectious Causes

Viral infections: Common causes include upper respiratory tract infections, bronchiolitis, and gastroenteritis, often presenting with fever, cough, and malaise.
Bacterial infections: Serious conditions like pneumonia, sepsis, meningitis, and urinary tract infections (UTIs) can present with high fever, irritability, and lethargy.
Exanthematous illnesses: Conditions like measles, rubella, and chickenpox that present with characteristic rashes and systemic symptoms.
Ear infections: Otitis media presenting with ear pain, fever, and irritability, particularly in younger children.
Throat infections: Pharyngitis or tonsillitis presenting with sore throat, fever, and sometimes difficulty swallowing.
Gastroenteritis: Typically viral, presenting with vomiting, diarrhea, and dehydration.
Sepsis: A life-threatening response to infection, often presenting with fever, tachycardia, tachypnea, and altered mental state.

Non-Infectious Causes

Asthma: Can present with wheezing, cough, and difficulty breathing, often triggered by viral infections or allergens.
Allergic reactions: Ranging from urticaria to anaphylaxis, presenting with rash, swelling, and in severe cases, respiratory distress.
Congenital heart disease: Can present with cyanosis, heart murmur, failure to thrive, and respiratory distress, especially in newborns.
Gastrointestinal conditions: Intussusception, volvulus, or appendicitis presenting with acute abdominal pain, vomiting, and irritability.
Metabolic disorders: Conditions like diabetic ketoacidosis (DKA) presenting with polyuria, polydipsia, dehydration, and altered mental state.
Trauma: Accidental or non-accidental injury presenting with pain, bruising, or neurological signs depending on the site of injury.
Poisoning: Ingestion of toxic substances presenting with a wide range of symptoms depending on the toxin, including vomiting, altered consciousness, and seizures.
Febrile convulsions: Seizures occurring in young children with fever, typically self-limiting but requiring evaluation for underlying infection.

History of Presenting Complaint

Onset and duration: Acute vs. gradual onset, duration of symptoms, and any associated factors such as recent travel or sick contacts.
Fever: Document presence, pattern, and response to antipyretics.
Respiratory symptoms: Cough, wheeze, stridor, or difficulty breathing, with particular attention to onset and progression.
Gastrointestinal symptoms: Vomiting, diarrhea, abdominal pain, and feeding difficulties, noting onset and any associated signs like dehydration.
Rash: Description, distribution, and progression of any rash, along with associated symptoms like itching or pain.
Neurological symptoms: Altered consciousness, seizures, irritability, or lethargy.
Pain: Site, severity, and character of any pain, and its impact on the child’s behavior and activity.
Fluid intake and output: Monitor for signs of dehydration, including reduced urine output, dry mucous membranes, and sunken eyes.
Previous similar episodes: Any past occurrences of similar symptoms, and how they were managed.
Immunization status: Up-to-date vaccinations, particularly for diseases like measles, mumps, and rubella.

Background

Birth history: Prematurity, complications during pregnancy or delivery, and neonatal intensive care unit (NICU) stays.
Developmental history: Milestones, particularly any delays in speech, motor skills, or social interactions.
Past medical history: Chronic conditions like asthma, congenital heart disease, or epilepsy, and any previous hospital admissions or surgeries.
Medication history: Current medications, including over-the-counter drugs, supplements, and any known allergies.
Family history: Hereditary conditions, consanguinity, and any family history of similar illnesses or sudden deaths in infancy.
Social history: Living conditions, parental smoking, exposure to pets, nursery or school attendance, and recent travel.
Feeding history: Type of feeding (breast vs. formula), weaning history, and any dietary restrictions or intolerances.
Growth history: Regular growth monitoring, any concerns about weight gain or loss, and comparison with growth charts.
Recent contacts: Exposure to individuals with contagious diseases, such as chickenpox or whooping cough.

Laboratory Tests

Full blood count (FBC): To assess for infection (e.g., raised white cell count), anemia, or thrombocytopenia.
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): Markers of inflammation, useful in differentiating between bacterial and viral infections.
Blood cultures: To identify bacteremia in cases of suspected sepsis.
Urinalysis: To identify urinary tract infections, dehydration, or metabolic disorders.
Electrolytes and renal function: Important in assessing hydration status and renal function, particularly in dehydrated or septic children.
Glucose: To rule out hypoglycemia, particularly in infants or children with altered mental status.
Liver function tests: To assess for hepatic involvement in systemic infections or metabolic conditions.
Viral swabs: For respiratory syncytial virus (RSV), influenza, or other respiratory viruses.
Lumbar puncture: To evaluate for meningitis if there are signs of CNS involvement, such as neck stiffness, photophobia, or altered consciousness.
Throat swab: To identify bacterial pathogens like Group A Streptococcus in cases of suspected pharyngitis.
Stool sample: For suspected gastroenteritis, particularly to identify bacterial pathogens or parasites.

Imaging and Specialist Tests

Chest X-ray: To evaluate for pneumonia, foreign body, or cardiac abnormalities in children with respiratory symptoms.
Abdominal ultrasound: For evaluation of abdominal pain, particularly to assess for intussusception, appendicitis, or pyloric stenosis.
Echocardiogram: To assess for congenital heart disease in children presenting with cyanosis, murmur, or heart failure symptoms.
Electrocardiogram (ECG): To identify arrhythmias or other cardiac abnormalities, particularly in cases of syncope or chest pain.
Head CT or MRI: Indicated in cases of suspected intracranial pathology, such as trauma, tumor, or infection.
Oxygen saturation monitoring: Continuous monitoring in children with respiratory distress to assess the need for supplemental oxygen or escalation of care.
Allergy testing: Skin prick tests or specific IgE testing in cases of suspected allergic reactions or anaphylaxis.
Sweat test: To screen for cystic fibrosis in children with recurrent respiratory infections, failure to thrive, or chronic diarrhea.

Child health