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Introduction to Common Childhood Illnesses

Chickenpox

Incubation period:  10-23 days

Infectious period:  From 4 days before the rash appears to 5 days after

Symptoms:  Starts with feeling unwell, a rash and maybe a slight temperature.  Spots are red and become fluid-filled blisters within a day or so and eventually dry into scabs which drop off.  Spots appear first on the chest and back and then spread.  Spots will not leave scars unless badly infected.

What to do:  You don’t need to go to your GP unless you are not sure whether it’s chickenpox, or your child is very unwell and/or distressed.  Give them plenty to drink.  Paracetamol or ibuprofen will relieve discomfort and fever.  Baths, loose comfortable clothes and calamine lotion can all ease the itchiness.  Try to stop your child scratching or picking at their post, as this will increase the risk of scarring.  It’s heard for children to do this, so give them lots of praise and encouragement.  Let the school or nursery know in case other children are at risk.

It is important to note that you should keep your child away from anyone who is, or who is trying to get, pregnant.  If your child was with anyone pregnant just before they became unwell, let the woman know about the chickenpox.  In women who have not previously had chickenpox, catching it during pregnancy can cause miscarriage or the baby may be born with chickenpox.

Measles

Incubation period:  7-12 days

Infectious period:  From a few days before the rash appears until 4 days after.

Symptoms:  Begins like a bad cold and cough with sore, watery eyes.  Child becomes gradually more unwell, with a temperature.  Rash appears after third or fourth day.  Spots are red and slightly raised; they may be blotchy, but not itchy.  Begins behind the ears, and spreads to the face and neck and then the rest of the body.  Children can become very unwell, with a cough and high temperature.  The illness usually lasts about a week.  Measles is much more serious than chickenpox, German measles or mumps, and is best prevented by the MMR immunisation.  Serious complications include pneumonia and death.

What to do:  Your child will be quite unwell, so make sure they get lots of rest and plenty to drink.  Warm drinks will ease the cough, and paracetamol or ibuprofen will ease discomfort and fever.  You could also put Vaseline around their lips to protect their skin.  If there eyelids are crusty, wash it away with warm water.  If your child is having trouble breathing, is coughing a lot or seems drowsy, see your GP urgently.

Mumps

Incubation period:  14-25 days

Infectious period:  From a few days before starting to feel unwell until the swelling goes down.

Symptoms:  At first, your child may be slightly unwell with a bit of fever, and may complain of pain around the ear or feeling uncomfortable when chewing.  Swelling then starts on the side of the face, in front of the ear and under the chin.  Swelling often starts on one side, followed (though not always) by the other.  Your child’s face will be back to normal size in about a week.  It is rare for mumps to affect boys’ testes.  This happens rather more often in adult men with mumps.  If you think your child’s testes are swollen or painful, see your GP.

What to do:  Your child may not feel especially ill and may not want to be in bed.  Paracetamol or ibuprofen will ease pain in the swollen glands.  Check the package for the correct dosage.  Give plenty to drink, but not fruit juices as they make the saliva flow, which can hurt and make your child’s pain worse.  There is no need to see your GP unless your child has stomach ache and is being sick, or develops a rash of small red/purple spots or bruises.

Parvovirus B19 (also known as fifth disease or slapped cheek disease)

Incubation period:  Anywhere between 1 and 20 days

Infectious period:  For a few days until the rash appears

Symptoms:  Begins with a fever and nasal discharge.  A bright red rash, like the mark left by a slap, appears on the cheeks.  Over the next two to four days, a lacy type of rash spreads to the trunk and limbs.  Although it is most common in children, the disease can occure in adults.  In the majority of cases it has no serious consequences.  Children with blood disorders such as spherocytosis or sickle cell disease may become more anaemic and should seek medical care.  Rarely, in pregnant women who are not immune to the disease, it may affect the baby in the uterus.

What to do:  Paracetamol or ibuprofen will relieve discomfort and fever.  Avoid contact with pregnant women or women planning to get pregnant.  Pregnant women who come into contact with the infection or develop a rash should see their GP as soon as possible.

Rubella or German Measles

Incubation period:  15-20 days

Infectious period:  From 1 week before the rash first appears until at least 5 days later.

Symptoms:  Can be difficult to diagnose with certainty.  Starts like a mild cold.  The rash appears in a day or two, first on the face, then spreading.  Spots are flat.  On a light skin, they are pale pink.  Glands in the back of the neck may be swollen.  Your child will not usually feel unwell.

What to do:  Give plenty to drink, and keep your child away from anbody you know who is trying to get pregnant or is up to four months pregnant.  If your child was with anyone pregnant before you knew about the illness, you will need to let the woman know.  If an unimmunised pregnant woman catches German measles in the first four months of pregnancy, there is a risk of damage to the baby.

Whooping Cough

Incubation period:  5-21 days

Infectious period:  From the first signs of the illness until about six weeks after coughing first starts.  If an antibiotic is given, the infectious period will continue for up to 5 days after starting treatment.

Symptoms:  Begins like a cold and cough.  The cough gradually gets worse.  After about two weeks, extended bouts of coughing start.  These are exhausting and make it difficult to breathe.  Younger children (babies under six months) are much more seriously affected and can have breath-holding or blue attacks, even before the cough symptoms.  Your child may choke and vomit.  Sometimes, but not always, there will be a whooping noise as the child draws in breath after coughing.  The coughing fits may not die down for several sweeks and can continue for three motnhs.

What to do:  Whooping cough is best prevented, through immunisation (in Zimbabwe, this is routinely included in the Pentavalent vaccination scheduled for 6, 10 and 14 weeks of age).  If your child has a cough that gets worse rather than better and starts to have longer fits of coughing more and more often, see your GP.  It is important for the sake of other children to know whether or not it’s whooping cough.  Talek to your GP about how best to look after your child and avoid contact with babies, wo are most at risk from serious complications.

Less Common Childhood Illness

Meningitis

Incubation period: Within 2-7 days of exposure

Infectious period:  This can vary depending upon the cause of the meningitis. Meningitis may be contagious from 1 to 2 weeks before the start of symptoms until months after the illness. For bacterial meningitis, the person is not contagious after 24-48 hours of effective antibiotic treatment. After exposure, another person may develop meningitis from a couple days to several weeks later, depending upon the specific infection.

Meningitis is an infection of the covering of the brain and spinal cord.  Unlike the other childhood illnesses mentioned above, this is less common, however it should be treated as a medical emergency because bacterial meningitis can lead to septicaemia (blood poisoning), which can be fatal.

Bacterial meningitis is the more serious form of the condition, caused by haemophilus influenza B (HIB), pneumococcal bacteria or meningococcal bacteria (most common). The symptoms usually begin suddenly and rapidly get worse. If you suspect a case of bacterial meningitis, you should seek immediate medical advice.

Symptoms of Bacterial Meningitis:  These are different in babies and young children, and could possibly include becoming floppy and unresponsive, or stiff with jerky movements, becoming irritable and not wanting to be held, unusual crying, vomiting and refusing feeds, pale and blotchy skin, loss of appetite, a staring expression, very sleepy and reluctant to wake up.  Some babies will develop a swelling in the soft part of their head (fontanelle).  People with Hib meningitis do not normally get a rash. A rash is typical of meningococcal infection, which is the most frequent cause of meningitis, and usually occurs together with septicaemia (blood-poisoning).

What to do:  Children under 5 years of age should be immunized against haemophilus influenza B (HIB), and pneumococcal infections, both of which can lead to meningitis or pneumonia.  According to the vaccination schedule issued by the City of Harare City Health Department, children should have the Pentavalent and the Pneumococcus vaccines, at 6, 10 and 14 weeks of age.  Although meningitis may not always be easily detected, it is normally diagnosed by a medical exam and a spinal tap. Hospitalization and intravenous antibiotic treatment are necessary for the treatment of bacterial meningitis or when symptoms of viral meningitis are severe. Close follow-up is important to diagnose and treat any disabilities that might result (e.g., hearing/speech, learning, and movement disorders).   For people in child care and at home who have been recently exposed to meningitis caused by HIB or meningococcus, they may be treated with antibiotics to prevent the illness.

Hand, Foot and Mouth Disease (HFMD)

Incubation period:  3-7 days

Infectious period:   Generally, a person with hand, foot, and mouth disease is most contagious during the first week of illness. People can sometimes be contagious for days or weeks after symptoms go away. Some people, especially adults, who get infected with the viruses that cause hand, foot, and mouth disease may not develop any symptoms. However, they may still be contagious. This is why people should always try to maintain good hygiene (e.g. handwashing) so they can minimize their chance of spreading or getting infections.

Hand, foot, and mouth disease is a relatively common viral infection that usually affects infants and children, however it can occur in adolescents and occasionally adults.  It begins in the throat, and is caused by the Coxsackie virus.  Interestingy, outbreaks seem most often in the summer months.

Hand, foot, and mouth disease is often confused with foot-and-mouth, a disease of cattle, sheep, and pigs. However, the two diseases are caused by different viruses and are not related. Humans do not get the animal disease, and animals do not get the human disease.

Symptoms:  Hand, foot, and mouth disease usually starts with a fever, poor appetite, a vague feeling of being unwell, and sore throat. One or 2 days after fever starts, painful sores usually develop in the mouth, beginning as small red spots that blister and frequently become ulcers. The sores are often in the back of the mouth. A skin rash also develops over 1 to 2 days, usually on the palms of the hands, soles of the feet, and maybe even around the mouth, on the knees, elbows, buttocks or genital area. The rash has flat or raised red spots, sometimes with blisters which are tender to the touch.  Children may get dehydrated if they are not able to swallow enough liquids because of painful mouth sores.  It is important to note that infected persons may not get all the symptoms, but only some.

Health complications of the virus are not common, but may include:

  • Viral or "aseptic" meningitis can occur but it is rare. It causes fever, headache, stiff neck, or back pain.
  • Inflammation of the brain (encephalitis) can occur, but this is even rarer.
  • Fingernail and toenail loss have been reported, occurring mostly in children within 4 weeks of their having hand, foot, and mouth disease. At this time, it is not known whether nail loss was a result of the disease. However, in the reports reviewed, the nail loss was temporary and the nail grew back without medical treatment.

What to do:  Avoid close personal contact with an infected person as the virus is spread through the air, contaminated objects and surfaces as well as contact with faeces.  There is no specific treatment for the disease, however, some things can be done to relieve symptoms as follows:

  • Over-the-counter medicines, such as Paracetamol (Panadol), can be used to treat, headaches, pain and fever. Aspirin should never be administered to children.
  • Saline (salt water) mouth rinses (1/2 teaspoon of salt: 1 glass of warm water) may be soothing if the child is able to rinse without swallowing.
  • Make sure the child gets plenty of fluids, especially when a fever is present.
  • Consult your doctor should the need arise.

As HFMD is viral, antibiotics do not work, and are therefore not recommended, unless a secondary infection develops.

Courtesy of:
NHS Birth to Five booklet
http://www.meningitis.org/disease-info/faqs
http://www.cafcc.org/10menin.html
http://www.meningitis.com/US/about/
http://www.cdc.gov/hand-foot-mouth/
Email from School Nurse at Hellenic Academy, Harare, Zimbabwe