Flu, Gastroenteritis, Impetigo, Glue Ear and Adolescent Behaviour, Asthma

FLU

The news that a 14-year old girl died suddenly and unexpectedly from flu in England this week will have shocked and saddened many parents. (See the article.) Influenza or ‘flu is usually only a mild disease in children, and death from this virus is extremelyrare. Symptoms of flu include fever (which can be very high), aching muscles and bones, a sore throat, a runny nose and feeling extremely tired. It is best treated with bed rest, lots of fluids to drink and paracetamol or ibuprofen for the fever. Children under the age of six years may be at risk from febrile convulsions with a high fever – read our section which has advice on tepid sponging to control temperature. If your child has breathing difficulties, a cough or earache or is very unwell you should call your doctor. Never give children with flu aspirin as it can cause fatal liver inflammation. Read our section on flu for further information on symptoms and treatments and current outbreaks.

GASTROENTERITIS

A gastric viral infection is causing havoc in the United Kingdom. Read 'Gastric bug sweeps over the country'. It is often called gastric flu but is not a flu, though it is caused by a virus that can be easily passed from person to person through the air. Gastroenteritis usually starts with severe vomiting that often lasts for around 24 hours and then diarrhoea develops. There is often a severe headache, fever and muscle aching. The diarrhoea may last several days. Babies and small children are particularly vulnerable as they lose fluid faster than adults and can quickly become dehydrated. To read about the signs of dehydration in a baby read our article on diarrhoea and vomiting in babies and young children. For advice on caring for older children read gastroenteritis If a child does get severely dehydrated they may need hospitalisation for intravenous fluids but should recover fully and quickly.

Occasionally after a bout of severe gastroenteritis the diarrhoea may persist because of a temporary lactose intolerance making it hard for the child to digest milk and other dairy products; the child may complain of tummy ache and have smelly loose stools. The best thing is to avoid dairy products completely for 24 hours (make sure that you increase other fluids to compensate) and then retry the dairy products. For babies always get medical advice about changes in feeding. Oral rehydration salts are sold at the chemist and exactly replace the salts, sugars and fluids lost in diarrhoea (always read the label and mix correctly). Recommended foods to start back on after gastroenteritis include dry crackers and vegetable soup, avoiding dairy initially. Natural yoghurt contains bacteria that can help the balance of bacteria in the gut after an infection.

IMPETIGO – AND HOW TO TREAT IT

In the British Medical Journal this week there is a trial comparing antibiotic cream with an iodine disinfectant to treat impetigo. Impetigo is a bacterial skin infection usually caused by a pus-forming bacteria called staphylococcus aureus. It usually enters the skin through a small cut or scratch and is highly infectious. In the worst cases oral antibiotics may be needed, but most parents will be able to control it with topical treatment (putting cream directly onto the lesion) and keeping it dry and covered. This trial found that topical antibiotics (fusidic acid) in a cream form was a much better treatment for impetigo than an iodine containing lotion which disinfects the skin. Read the report on the treatment of impetigo in general practice, and also read our article on impetigo which tells you how to stop it spreading once your child has caught it, how to keep other family members free from infection, and how to stop your child passing it on to their friends.

GLUE EAR AND ADOLESCENT BEHAVIOUR

A recent report from New Zealand that was written about in our papers (read ‘Such a sticky problem’) suggests, rather alarmingly, that glue ear in children may lead to behavioural or emotional problems in teenagers. Read the research at the Archives of Disease in Childhood site. The research only looks at children with severe, persistent glue ear and does not give any indication whether certain treatments helped. It is, however, a big study with over a thousand children assessed and so its results are probably correct.

Glue ear is a condition where the middle ear fills up with a thick sticky mucous; this affects hearing and can affect speech development and school work as well as behaviour. Read our article glue ear. The message from this report seems to be that if your child has repeated ear infections or is diagnosed with glue ear that it should be treated promptly either with medicine or surgery (grommets and removal of the adenoids), and most importantly, checked regularly for movement of the ear drum and with a formal hearing test.

ASTHMA

A recent report suggests that asthma is increasing and may affect up to one in four children at some point (Annals of Asthma, Allergy and Immunology).

Asthma is defined as repeated episodes of wheezing. Children wheeze because the airway narrows. This can happen in response to an infection, or after being exposed to something you are allergic to, cold air or even as a response to exercise. Three things happen in the airway: the muscles around the airway constrict, the soft mucosa lining the airway swells up and there are lumps of thick sticky mucous in the airways. All of these narrow the airway and make it very hard for children to breathe.

Asthma can kill and can come on suddenly so its diagnosis and treatment should be taken seriously. Read our article on asthma, which gives a lot of detail on how asthma is diagnosed and treated. The one thing parents need is an exact plan of how to cope if asthma gets worse and when to call for medical help. A peak flow meter is essential kit for children over five years to assess the level of airway narrowing – if your child is being treated for asthma and you don’t have one talk to your asthma specialist or GP about getting one. A new site Allergy, Asthma & Immunology Online has excellent information for asthmatic people and an informative quiz to assess how bad children’s asthma is at different ages.