JOURNAL TRANSCRIPT

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THE PATIENT PRESENTS WITH

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1. Fever or rash

3

2. Heart, lung or ENT problems

9

3. Gut or liver problems

19

4. Haematuria or proteinuria

27

5. Neurological problems

31

6. Musculoskeletal problems

37

7. Pallor, bleeding, splenomegaly or lymphadenopathy

41

8. Short stature or developmental delay

49

9. Neonatal problems

55

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1

Fever or rash Objectives At the end of this chapter, you should be able to • • • •

Assess a child with fever. Understand the common types of rash in children. Identify the warning signs in a child with fever and rash. Learn a systematic approach to a child with petechial rash.

THE FEBRILE CHILD Fever is a common presenting symptom in children and can be a major challenge to paediatricians. Most of the causes are due to benign, self-limiting, viral infections but skill is needed to distinguish these from serious infection (Fig. 1.1). The latter has the potential to deteriorate rapidly so it is essential that it is identified as early as possible. Fever is defined as a central temperature of greater than 38°C. Electronic tympanic membrane thermometers correlate moderately well with rectal temperature and are adequate for most practical purposes.

History How long has the child been febrile? A duration of more than a week or two suggests diseases such as tuberculosis (TB), malaria, typhoid and autoimmune non-infectious disorders.

• Headache, photophobia and neck pain: suggest meningism. Younger children (