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A remote nurse asked me this week during a clinic training session, how I recognised if a child was sick or not.

Here are my thoughts and some resources

When my own children get sick, a few things commonly happen:

  1. Stop eating and drinking. I dont care about the eating but lack of fluid intake worries me always
  2. Get irritable and altered behaviour. cant sleep or sleep too much. As a health care provider you must ask very carefully about this and BELIEVE the child’s carer.
  3. Breathe differently. Sick kids breathe harder. Really sick kids breathe shallower. Dead kids stop breathing. Shock affects breathing and is most earliest sign to look for in my opinion.
  4. The VOMITING child always worries me. This is a red flag for pathway to deterioration in the sick child.
  5. FEVER is a distractor from your assessment. You must look for 1-4 above first before considering FEVER. ABsence of 1-4 above with a fever, I dont get worried about usually (EXCEPT IN NEONATES)

Examination tips :

  1. Observe first. Most of my gestalt for sick kids comes from observation alone. Look at breathing and activity/behaviour
  2. I first listen to heart. Occasionally I get the diagnosis of Acute carditis from acute rheumatic fever ( a disturbingly common presentation in my region) from cardiac auscultation immediately. Also it helps before the child starts screaming
  3. Then listen to lungs. Same reason: before the kid starts screaming. Leave all possibly painful parts of the exam till last!
  4. Good look over for a rash
  5. Ears next. Its not easy and you just have to do your best. Get carer to help hold child as still as possible. Video-otoscopy with a USB device to your laptop is great and aids carer confidence and often the child if old enough.
  6. Nostrils next. Look for that pus coming out of a sinus ostia. Polyps can be seen in allergic conditions
  7. Oral exam last including dentition, tonsils, mucosa for enanthem signs.
  8. Urinalysis completes your workup .

Check out these useful free web resources

recognition of sick child powerpoint

Recognition of the sick child in ED guideline NSW

The video above is an advertorial but shows some useful footage of sick children to demonstrate the signs of critical illness. I am not sponsored by the company at all who makes that training course package!




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