Check out the PedsDocTalk YouTube Video: 5 Things to Monitor When Your Child is Sick for more information and guidance on what to monitor when your child is sick, including signs of dehydration, shortness of breath, fever trends, behavioral changes, and rashes.
Do you have a kiddo that is sick at home – whether it’s their first illness or 20th, it’s never fun when they’re sick. As a parent, it can also be difficult to decide if you can let your child ride out the illness at home or if a visit to their clinician is necessary.
These are big-picture things when your child is sick at home with general viral symptoms. This list doesn’t encompass every situation or illness. These are things to monitor as they may signify further workup or intervention may be needed, such as medications, fluids, labs, or imaging.
Dehydration happens when you lose more fluid than you’re taking in. This can happen from losing too much fluid from vomiting, diarrhea, or fever. Fevers cause your metabolism to rise and breathing rate to increase, resulting in you breathing out extra moisture and also sweating it out. Things like stomach bugs can cause repetitive diarrhea or vomiting, putting kids at high risk for dehydration. You can also become dehydrated from decreased fluid intake. Many kids don’t drink as much when they are sick due to fatigue or sore throat. Therefore, it’s important to encourage fluid intake when a child is sick.
A moderately dehydrated child will urinate less frequently. For infants, this is less than 4 wet diapers a day. They may also have a parched, dry mouth and make fewer tears when crying. For infants and toddlers with an open soft spot, you may feel it sunken in.
A severely dehydrated child will look much sicker, have extremely low urine output combined with low fluid intake, be very fussy and excessively sleepy, and their eyes can look sunken in.
If you are concerned, that your child is dehydrated, it’s important to bring them to the doctor or call their doctor to discuss their status further and develop a plan.
The second important thing to monitor is a child’s breathing. As I mentioned, kids with a fever will breathe faster than they normally would. We would expect the rate of breathing to slow and return to normal when the fever comes down. When monitoring breathing, it’s important to not only monitor the rate of breathing but also the work of breathing.
There are several signs of difficulty breathing. For example, intercostal retractions where the muscles are pulling into the ribs quickly, or suprasternal retractions where the chest wall is tugging above the sternum or collar bone. Other signs include grunting, trouble talking, skin around their lips or face is turning blue, or wheezing.
If your child has any signs of difficulty breathing or is working hard to breathe, seek medical attention promptly for further evaluation.
All infants under 3 months of age need to be evaluated for any fever above 100.4F due to their age and developing immune system. For older infants and children, fever can often be managed at home.
Overall, when we’re looking at a sick child, we are looking at fever persistence or irritability with a fever that is unable to be managed.
If your child has a persistent fever for more than 5 days, it’s important for their doctor to assess them and make sure there are no serious identifiable causes. Many viruses can cause fever persistence. Sometimes it lasts for 7-10 days, but an assessment would ensure there’s no need for any antibiotics or other workup.
It’s important to clarify, always look at your whole child – so if your child has a fever for 5 days or less and is not breathing well, super uncomfortable, or dehydrated DO NOT wait to bring them in. We’re looking at the big picture here when sick – how are they acting, are they getting worse as the days go by? Are their fevers spiking higher? Are they looking more miserable? Are the pain/fever-reducing medications just not cutting it anymore to keep them consolable? Do you just FEEL like a doctor should see them? Don’t hesitate to bring them in.
Many viral illnesses can cause a rash.
Typically a viral-related rash is light pink and blanchable, meaning when you push down on the skin the pink disappears with pressure and then returns when you let go. These rashes, also called viral exanthems, do not typically cause discomfort or bother a child.
If a rash is bothersome to the child (digging into their skin), or starts to rapidly spread in the setting of a fever, it’s a good idea to see your pediatrician. It still may be viral in nature or not concerning, but it’s important to assess your child to confirm what type of rash it is. Also, if a rash ever appears atypical to you or worries you, it’s never wrong to have it evaluated.
Rashes are common in kids and have many causes that can be hard to figure out at home. If a visit to your clinician will bring you peace of mind, that’s reason enough to go!
This one is huge and most important to me. This just means that your kid just looks off to you. Kids will not be at baseline when sick (eating, behavior, maybe sleep, and activity), but you should see moments of interaction at their developmental level. They should be breathing comfortably, they should be hydrated, and they should be able to be comforted and not completely inconsolable.
Monitor how your child is feeling overall. If they have a fever and they’re happy and playful – this is great. If that fever persists for more than 5 days, a doctor visit is helpful to make sure it’s viral. However, if they have a fever and appear miserable, dehydrated, or have difficulty breathing, it’s important to get them evaluated.
If they don’t have a fever, but they seem to be in pain – for example, their ears are hurting despite ibuprofen or acetaminophen for pain relief, their belly is hurting and is unrelenting, they’re just not playful or active and seem off despite a normal routine, or they are just irritable, and your gut is telling you something is off – seek medical care. We can offer reassurance, things to monitor, and help develop a plan.