Child Health

What is bronchiolitis?
It is a viral infection that affects children under two years of age and manifests itself with difficulty breathing and, sometimes, wheezing noises in the chest.

It usually starts with a cough and nasal mucus. After 3-4 days, breathing difficulties appear. The child may be irritable, eat less, and have a fever.

What should you do at home?

• Keep the child in a semi-upright position as this will help them breathe better.
• Nasal rinses with saline solution are necessary if you have mucus, preferably before eating.
• To prevent the child from fatigue, meals should be smaller and more frequent.
• Avoid smoky environments.

When should you seek emergency medical attention?

• If they are in distress – irritable, drowsy.
• If the child gets very tired when feeding, barely eating.
• If your child turns purple or pale.
• If breathing worsens: breathing becomes increasingly rapid, ribs are visible, abdomen moves significantly, chest sinks or breathing stops for several seconds.

Important issues

• Currently, there is no medicine that cures bronchiolitis.
• The symptoms of bronchiolitis may persist for up to 2–4 weeks.
• Some children, after suffering from bronchiolitis, experience successive episodes of breathing difficulties with coughing that resemble the initial symptoms.

What is a febrile seizure?
It is a response by the brain to fever that occurs in some healthy children between 6 months and 5 years of age. They almost always occur during the first day of fever. The child suddenly loses consciousness, the body may become rigid and start jerking or become completely limp. It is also common for the mouth to be purple, tightly closed, as if clenched, and the gaze to be vacant. It usually lasts for a short time, generally less than 5 minutes. In the end, the child tends to fall asleep.

What should you do at home?

• Lay the child on their side (this will allow them to breathe better) and away from objects that they could bump into.
• Do not attempt to put anything in your child’s mouth.
• If you have not given your child any medicine for fever in the last 2 hours, you can give him a paracetamol suppository.
• It is advisable for the child to be checked by a doctor to confirm the diagnosis. Go to the nearest health centre or hospital.

When should you seek emergency medical attention?

• If the seizure recurs.
• If your child is drowsy, listless or, conversely, very irritable.
• If he complains of severe headache and vomits.

Important issues

• Febrile seizures tend to have a favourable prognosis. After the seizure, the child will be in the same state of health as before.
• Any common infection (cold, tonsillitis, gastroenteritis) accompanied by fever can cause a febrile seizure.
• They are common (3–5% of children). Furthermore, after the first episode, 1 in 3 children will have another one.
• In most cases, no special tests are required.
• Children with febrile seizures do not require different treatment for fever than other children. Use the usual doses of antipyretics.

What is abdominal pain?
It is a feeling of discomfort, unease or pain that the child refers to in the abdomen.
It is very common and is usually related to many processes that are almost always benign (constipation, gas, diarrhoea, ‘nerves’).
Some illnesses not located in the abdomen can also cause abdominal pain (tonsillitis, upper respiratory tract infection, pneumonia, ear infection).

What should you do at home?

• Try to assess the intensity without constantly asking your child. Observe whether your child plays, whether the pain disappears when he/she sleeps, wakes him/her up at night, or forces him/her to rest.
• Allow your child to continue with normal activities.
• Note when he/she last had a bowel movement and what the stools were like.
• In principle, maintain a normal diet, but do not force your child to eat.
• Observe whether other symptoms are present: vomiting, fever, changes in the colour of urine or stools.
• Do not use any medication without consulting your paediatrician.
• If your child regularly complains of abdominal pain, mainly in the morning, it is important that they do not miss school.

When should you seek emergency medical attention?

• If the child is in poor general health, is listless, pale.
• If the pain becomes continuous and increasingly intense, to the extent that the child is unable to carry out their usual activities or sleep well.
• If the pain is located on the right side of the abdomen.
• If your child has continuous vomiting, greenish or bloody vomit.
• If your stools are black, like tar, or have red blood in them.
• If the abdomen is tense, hard, or swollen.
• If the child has recently undergone abdominal surgery.

Important issues

• No disease is found in 90% of children with recurrent abdominal pain.

What is gastroenteritis?

Gastroenteritis is an infection that causes diarrhoea, i.e. an increase in the number of bowel movements, which are also looser.
It also commonly causes vomiting, fever, and abdominal pain.

What should you do at home?
Prevent dehydration:

• Every time your child defecates or vomits, he/she loses fluids that must be replaced by drinking. Use low-sodium serums available at pharmacies.
• If your child vomits easily, have him/her drink the rehydration solution slowly (one spoonful every 5 minutes), gradually increasing the amount to improve tolerance.
• If he/she is not vomiting liquids, offer food in small amounts, but do not force your child to eat. Continue giving your child fluids between meals.

Meal plan:

• No fasting time is required. Begin by offering food, but do not force your child to eat. Children with gastroenteritis normally have little appetite.
• If the child is breastfed, continue breastfeeding but increase the number of feeds.
• Milk bottles should be prepared using the usual number of scoops, without diluting them further.
• An astringent diet is not essential; a mild diet that is appealing to the child is sufficient. The foods that are usually best tolerated are: cereals (rice, wheat), potatoes, bread, lean meat, vegetables, fish, yoghurt and fruit. Avoid foods that cause flatulence, are high in fat or sugar.

When should you seek emergency medical attention?

• If the child vomits a lot, cannot tolerate solids or liquids, or vomits even when he/she has not eaten anything.
• If the vomit is greenish, contains blood, or looks like coffee grounds.
• If the child is drowsy, listless, very thirsty, crying without tears, urinating little, or has sunken eyes.
• If the stools are very liquid, abundant and frequent to such an extent that your child is unable to drink at the same rate as fluids are lost.

Important issues

• Do not use home remedies (alkaline lemonade) or commercial soft drinks should to replenish fluids lost due to gastroenteritis.
• Ready-made rehydration solutions are particularly recommended.
• If you use powdered rehydration solutions, follow the product instructions. Ensure that the amount of water is correct.
• The risk of dehydration is greater the younger the child is.
• Do not give your child medication for diarrhoea or vomiting without first consulting your paediatrician.

What is syncope?
Syncope is a sudden, brief loss of consciousness: the child turns pale, stops responding and loses strength, possibly falling to the ground. Recovery after
such an episode usually happens quickly, in a couple of minutes. Sometimes, when the child loses consciousness, there are two or three jerks of the limbs.

Generally, before fainting, the child feels unwell with nausea, abdominal pain, blurred vision, sweating, or ringing in the ears. These symptoms
may help your child in the future to recognise what is about to happen and avoid further fainting spells.

It can be triggered by pain, fear, anxiety, standing in the same place for a long time, or standing up abruptly
after lying down.

What should you do at home?

• If you know what causes fainting spells, actively seek to prevent or change such situations. For example, do not sit up or stand up abruptly when sitting or lying down. If your child often feels dizzy when having blood taken, let the nurse know beforehand so that they can lie down during the procedure.
• When the child begins to feel unwell, he/she should sit or lie down immediately to avoid fainting and falling. It is advisable to breathe slowly and deeply.
• If the child loses consciousness, it is preferable to lay them down with their legs elevated and their head turned to one side so that they can breathe more easily.
• The child should then slowly sit up once the discomfort and feeling of physical weakness have disappeared. If the child is lying down, first have him/her sit up and then stand up only after a few minutes.
• Children who are prone to syncopes (fainting) should increase their daily fluid intake, especially if they exercise.

When should you seek emergency medical attention?

• When the child takes more than 5 minutes to regain consciousness.
• When syncope has occurred during exercise, when exerting oneself, or while sitting.
• If the episode was accompanied by limb tremors or, ultimately, urination.

Important issues

• Syncope is not a disease.
• In general, they are not caused by significant medical problems and do not require any special tests.

What is traumatic brain injury?
It is a head injury. At this time, your child will receive a normal neurological examination and therefore does not require admission.

What should you do at home?

• Observe the child for the next 24 hours to see if any problems arise. Keep it in a quiet environment under adult supervision.
• If the child is sleepy, you can let them sleep, but wake them up approximately every four hours to observe their reactions. Try to maintain normal but appropriate behaviour.
• If he/she has a headache, the usual dose of paracetamol or ibuprofen is normally permitted.
• After two hours without vomiting, your child should eat easily digestible food (bland diet).
• Twenty-four hours after the trauma, your child can resume his/her normal routine.

When should you seek emergency medical attention?

• If the child vomits again at home.
• If you experience severe or progressive headache.
• If your child is confused, drowsy, irritable, or difficult to wake up.
• If the child begins to experience abnormal movements, weakness or tingling in the limbs, has difficulty walking, speaking or seeing, or has pupils of different sizes.
• If you notice clear fluid or blood coming out of your child’s nose or ears.
• In general, any symptoms that seem unusual or cause you concern.

Important issues

• Most head injuries are minor and cause no damage. With minimal impact, injuries are very rare.
• It is normal for your child to be frightened in the first few hours, not remember the moment of the trauma, have a headache, or vomit.
• In most cases, it is not necessary to take any X-rays.

What is vomiting?
Vomiting consists of the expulsion of the contents of the digestive tract (food, gastric juice, bile) through the mouth.
They are very common in childhood illnesses: gastroenteritis, colds, ear infections, tonsillitis.

What should you do at home?

• Prevent dehydration by having your child drink small amounts of fluids with some sugar (juices, water), approximately one tablespoon every 5 minutes.
• If accompanied by diarrhoea, it is preferable to use rehydration solutions available at pharmacies. Do not use home remedies (alkaline lemonade) or commercial soft drinks.
• Observe how your child tolerates such remedies. If liquids are well tolerated, you can gradually increase the frequency.
• When liquid ingestion is no longer an issue, offer your child food, but never force him/her to eat, and always in small amounts.

When should you seek emergency medical attention?

• If the child is younger than 3 months and has vomited two or more feedings.
• If the child vomits a lot, cannot tolerate solids or liquids, or vomits even when he/she has not eaten anything.
• If the vomit is greenish, contains blood, or looks like coffee grounds.
• If the child has any of the following symptoms: drowsiness, lethargy, excessive thirst, sunken eyes, crying without tears, or low urine output.
• If the symptoms are accompanied by severe abdominal or head pain.

Important issues

• The risk of dehydration is greater the younger the child is.
• It is normal for children under 6 months to spit up small amounts of milk after eating – REGURGITATION -.

What is an upper respiratory tract infection?
It is a viral infection of the upper respiratory tract (nose, throat) that causes fever, sneezing, coughing, and nasal mucus.
Colds are very common during the first years of life. It is normal to have 6 to 8 colds per year, even more if the child attends daycare.

What should you do at home?

• Avoid dry air in your home. Place water containers on radiators or use humidifiers if the humidity level is very low.
• Give your child frequent nasal washes with saline solution.
• It is normal for the child to have no appetite. Do not force your child to eat. Instead, offer liquids to drink.
• Monitor your child’s temperature and administer the antipyretic medication usually recommended by your paediatrician if the fever exceeds 38-38.5°C.

When should you seek emergency medical attention?

• If the general condition worsens, the child is listless, sleepy, or very irritable.
• When breathing difficulties appear: the breathing is very rapid, the ribs are visible, the abdomen moves a lot, or the chest sinks.
• If the child is less than 3 months old and the cold is accompanied by fever.

Important issues

• No medications cure colds. Anticatarrhal syrups (mucolytics, decongestants) are considered to be of questionable effectiveness.
• Antibiotics do not cure the common cold or prevent its complications.

What are asthma attacks?
These are repeated episodes of coughing, difficulty breathing (fatigue), and chest noises ("wheezing") caused by an inflammatory reaction in the
bronchi.
They can be triggered by different causes: colds, allergies.

What should you do at home?

• Keep the child seated, at rest, without exercising until the seizure is under control.
• Begin administering the treatment recommended by your paediatrician (Ventolin®, Terbasmin®) following their instructions. It is best to use inhaled medication.
• If your child has a fever, administer antipyretics.
• Avoid smoky environments.

When should you seek emergency medical attention?

• When the child is very agitated or drowsy; or if he/she turns purple or pale.
• When breathing difficulties worsen: breathing becomes increasingly rapid, ribs are visible, abdomen moves significantly or the chest sinks.
• When very frequent inhalations are required, every two hours or less.
• Bring the child’s normal inhaler with you when you go to the emergency room.

Important issues

• Children with asthma are not always allergic. In childhood, the most common trigger for asthma attacks is colds.
• Asthma attacks sometimes begin with just a cough. Using inhalers before the child becomes fatigued will improve the outcome.
• Inhalers requiring a spacer (holding chamber) must always be administered with it, never directly into the mouth, as they are less effective.
• Children of parents who smoke suffer from more respiratory illnesses.

What is fever?
Fever consists of an elevation in normal body temperature: above 38°C when measured rectally or above 37.5°C when measured under the armpit.
The most common cause in children is a viral infection.

What should you do at home?

• Instead of just putting your hand on your child's forehead to see if he/she has a fever, use a thermometer.
• Maintain a comfortable room temperature. Do not dress your child too warmly.
• Offer your child plenty of fluids, without forcing him/her to drink.
• It is not necessary to reduce fever in all circumstances, only if the child is uncomfortable. This generally occurs at temperatures above 38–38.5°C.
• Use the doses of antipyretics recommended by your paediatrician, respecting the intervals between doses even if the fever reappears before then. Whenever possible, administer them orally, not rectally.
• Medications should not be alternated to treat the fever.
• Lukewarm baths do little to reduce fever. You can use them to help with antipyretics. Do not use alcohol or cold water compresses.

When should you seek emergency medical attention?

• When your child is less than 3 months old.
• If your child is drowsy, listless or, conversely, very irritable.
• When it is the first time your child has a seizure.
• When your child complains of severe headache and vomits.
• If the child is having difficulty breathing.
• When red spots appear on the skin that do not disappear when pressed.

Important issues

• Some people think that fever is always bad and can cause serious injury. This is not true! When we have an infection, the body produces more heat (fever) so that our defences can fight it.
• A fever does not cause brain damage until it reaches 42°C or higher.
• Antipyretics do not cure the infection, they only help the child feel better.

What is laryngitis?
It is an inflammation of the larynx, usually caused by a viral infection.
It usually presents with a barking cough, loss of voice, hoarseness, sore throat, fever and, sometimes, a noise when breathing in (stridor). It usually worsens at night.

What should you do at home?

• Avoid dry air at home by placing water containers on radiators.
• Humidity can improve symptoms: keep your child in the bathroom with the hot water taps running, or let them breathe in the fresh air outside by taking them out to the window or terrace, wrapped up warm.
• If the child has a fever, administer the antipyretic usually recommended by your paediatrician.
• It is normal for the child to have no appetite. Do not force your child to eat. Instead, offer liquids to drink.
• Monitor your child's breathing. In some cases, inflammation of the larynx makes it difficult to breathe.

When should you seek emergency medical attention?

• When there is a noise when breathing in (stridor), even though the child is calm.
• If breathing difficulties worsen: breathing becomes increasingly rapid, ribs become visible, abdomen moves significantly, chest sinks or neck stretches.
• When the child has difficulty swallowing or drools excessively.

Important issues

• Most cases of laryngitis are mild and benign.
• They do not require antibiotic treatment.
• Water and alcohol collars should not be used. They are not effective and, moreover, can irritate the skin.
• Do not administer cough syrups or suppositories without consulting your paediatrician.

Inhalation technique with holding chamber

• The child may sit down, although it is preferable that he/she stand.
• Check that the inhaler is not empty. If you do not have a dose counter, check the weight.
• Before each press, shake the cartridge for a few seconds, remove the cap, and insert it into the back of the holding chamber.

• Apply the mask over the child's face, covering the mouth and nose, until it is securely sealed.
• Press the aerosol and allow the child to take 6 to 7 breaths (10 seconds) for each press before removing the mask.
• Wait 30 seconds before taking the second inhalation, if necessary.
• Replace the cap and store the inhaler with the holding chamber in a safe place.
• Clean the chamber once a day by placing it in a container with soap and water. If it is made of plastic, do not rinse it with water. Finally, allow it to air dry.
• Bring the child’s normal inhaler with you when you go to the emergency room

• El niño puede sentarse, aunque es preferible que esté de pie.
• Verifique que el inhalador no esté vacío. Si no tiene contador de dosis, compruebe el peso.
• Antes de cada pulsación, agite el cartucho unos segundos, retire la tapa e introdúzcalo por la parte posterior de la cámara.

inhalador

• Aplique la mascarilla sobre la cara del niño abarcando boca y nariz hasta lograr un buen sellado.
• Presione el aerosol y deje que el niño realice de 6 a 7 respiraciones (10 segundos) por cada pulsación antes de retirar la mascarilla.
• Espere 30 segundos para realizar la segunda inhalación si fuera necesario.
• Vuelva a colocar la tapa y guarde el inhalador con la cámara en lugar seguro.
• Limpie la cámara una vez al día introduciéndola en un recipiente con agua y jabón. Si es de plástico, no la aclare con agua. Finalmente, deje que se seque al aire.
• Cuando acuda al servicio de urgencias recuerde llevar la cámara de inhalación que utiliza habitualmente

What is urticaria?
Urticaria consists of the appearance of very itchy welts and hives on the skin.
Hives usually last for a short time in the same place. As they appear in one area of the skin, they disappear from others. It may be accompanied by swelling of the hands, feet, elbows, face and, in rare cases, difficulty breathing or swallowing.

What should you do at home?

• Watch for difficulty swallowing or breathing.
• Avoid rubbing the child's skin.
• Do not apply powders or ointments to your skin without consulting your doctor.
• A child with hives can eat their usual food.

When should you seek emergency medical attention?

• When the child has difficulty breathing, hoarseness, or wheezing.
• When the child cannot swallow and drools a lot.
• When the child feels unwell or his/her face swells up.
• When the hives appear after a sting or after eating a food that has previously caused an allergic reaction.

Important issues

• In childhood, most cases of hives are caused by an infection. Allergic causes are less common.
• Although hives usually last 7-8 days, they can continue for several weeks.
• In most cases, no special tests are required