Hesperian Health Guides
Health Problems of Children
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Sometimes despite our best efforts at prevention, children get sick. Sickness in children can become serious very quickly. It is important to notice early signs of sickness and attend to them right away.
|A child with one of these signs needs quick treatment and constant attention. With care, she should steadily get better. If she has more than one of these signs or if any of these signs get worse, the child is in danger:
Dehydration is a lack of water in the body. Most children who die from diarrhea die from dehydration. The treatment is simply replacing lost fluid by drinking more. This is rehydration. Rehydration will treat dehydration from diarrhea, vomiting, or working too long in hot weather or in a hot building. Because dehydration from diarrhea is so dangerous to young children, always be on the lookout for:
- Diarrhea even if there are no other signs of dehydration
- Thirst (but children do not always say they are thirsty)
- Dry mouth and tongue (when you touch the inside of the child’s cheek, it feels dry)
- Urinating less often and the urine is dark-colored
Start treatment right away, before the signs get any worse.
Signs that dehydration is getting worse
- Lethargy: tired, low-energy
- Fast heartbeat
- Breathing more deeply
- Sunken, tearless eyes
- Skin stays in a pinched shape when you pinch it
When dehydration becomes severe like this, the child is in serious danger. Quick treatment can save the child’s life.
Treatment and prevention
The treatment for dehydration is simple: give fluids to drink. See the recipe for life-saving rehydration drink. If the child does not start to improve quickly, get help.
If you are breastfeeding a dehydrated child, continue to nurse and also give rehydration drink. Breastfeed the child more often — at least every 2 hours. Let the child breastfeed for as long as she wants.
Loose, watery stools are called diarrhea. Children get diarrhea for many reasons, most often from germs spread by bad sanitation and because of poor nutrition. Most of the time diarrhea will get better without medicines. But there is one treatment that is essential for everyone with diarrhea, and that is giving fluids to replace the liquid lost in the stool. Without drinking fluids, a child with diarrhea can lose so much fluid she can die.
To save a child’s life, give fluids to replace what she has lost.
Do you believe that giving a child something to drink will make diarrhea worse? It is easy to think this as you watch liquid diarrhea come from a child. But fluids do not cause diarrhea.
|Holding back fluids does not make the diarrhea better. It puts the child in danger.||Drinking fluids keeps you healthy when you have diarrhea.|
See more information on diarrhea. The treatment information below is especially for children.
- Give rehydration drink. For a child under 2, give at least ¼ cup after each watery stool. For a child of 2 or older, give ½ to 1 cup after each watery stool. Rehydration drink is water mixed with a little salt and some sugar or cooked grain. Some people add a little lemon juice for flavor.
- Give food. Often the child will not say he is hungry, but if he does not eat he will get weaker and sicker. Be patient. Give just a few spoonfuls, 6 times a day or more. Give bigger portions as the child improves. Enrich the child’s porridge with high-energy foods like groundnuts (crushed), eggs, dried fish, yogurt, avocados, or bananas. At times when you have no protein or vegetables, add a spoon of oil to the porridge.
- Avoid anti-diarrhea medicines. They just act like plugs and keep the diarrhea and infection inside the child. Antibiotics are only useful for certain cases of cholera and bloody diarrhea.
- Prevent diarrhea from happening again by improving sanitation and nutrition.
Malnutrition and diarrhea
Poorly nourished children get diarrhea more often. And they have more difficulty recovering from it. That is because these 2 diseases work together in a harmful cycle.
Stopping this terrible cycle will prevent a child from dying of diarrhea and malnutrition, or from one of the many infections that attack children who are weakened from constant diarrhea and hunger.
If you have only a little money, spend it on food for your child. Food will strengthen the child so he will recover faster and will be less likely to get diarrhea again.
See ways to treat severe malnutrition.
|Zinc helps stop diarrhea|
|Zinc (a mineral) helps lessen diarrhea in children. For this reason it should be given to children with diarrhea if you can get it.
For a baby up to 6 months old: Give 10 mg zinc each day for 10 days. Grind up the tablet and mix with a little breast milk.Over 6 months: Give 20 mg a day for 10 days.
Some children vomit more often than others. But when a child vomits a lot or shows signs of dehydration, give rehydration drink. At first, give just a spoonful every 15 minutes, even if he continues to vomit. If the drink stays down, give a spoonful every 5 minutes. Then give larger sips. By giving more fluids and food as soon as possible, you can help the child regain his strength.
Children often get fevers as their bodies fight an illness, and their fevers can get quite high. A severe fever in a young child can lead to a seizure. Help the child feel better with paracetamol (acetaminophen) or ibuprofen. Cool wet cloths or a cool (but not cold) bath can also help. Give plenty of fluids to prevent dehydration. Most importantly, try to find and treat the cause.
Danger signs and causes of fever
|Fever and problem below||Could be…|
|Stiff neck or severe headache||Meningitis|
|Stomach ache and diarrhea or constipation, sometimes with pink spots on the belly or sides. (In typhoid, the fever usually increases gradually over about a week, then the stomach ache starts.)||Typhoid.
See Some Serious Infectious Illnesses (in development).
|Chills or any fever if you live where malaria is common||Malaria|
Malaria is explained in detail in Illness from Mosquitoes (in development). It is one of the main causes of death for children in places where it is common.
- Chills or sweats
- Headache, sore muscles, belly ache
- Vomiting or diarrhea
Whenever possible, test before you treat malaria. But if you cannot give a test, and malaria is common where you live, and you cannot find another cause of the fever, start malaria medicines right away.
Anemia is common in children with malaria, so they should also take iron supplements.
- Trouble breathing
- Seizures, unclear thinking, loss of consciousness, or any other signs of brain infection (see meningitis).
These are life-threatening signs that the child needs urgent medical help. Inject artesunate on the way. If you do not have artesunate, inject quinine. See Illness from Mosquitoes: Medicines (in development).
See Illness from Mosquitoes (in development) for many ways to reduce malaria for your family and community.
Seizures are sudden, usually brief, periods of unconsciousness or changes in mental state, often with jerking movements. Sometimes the child is very still instead.
A young child can have seizures because of high fever, dehydration, an injury, malaria, or for other reasons. Seizures that recur are called epilepsy. Recurring seizures are explained in Head and Brain Problems (in development).
During a seizure, clear the space around the child so he does not hurt himself. Turn him on his side so he does not choke if he vomits. Do not hold a seizing child down or try to hold his tongue.
- For seizure from malaria, get medical help. On the way, give diazepam. Treat with malaria medicines (see Illness from Mosquitoes - in development).
- For seizure from dehydration, get medical help. After the seizure is over, give rehydration fluids.
- For a seizure from meningitis, get medical help.
If none of these dangerous causes of seizure seem likely, a single seizure may not be a problem (although they are very frightening to watch). If seizures recur, see a health worker.
The spasms of tetanus can be mistaken for seizures. The jaw shuts tightly (lockjaw) and the body suddenly bends back. Learn to spot early signs of tetanus.
Meningitis is a rare but very serious infection around the brain and spinal cord. Most often, it starts with no clear cause and fever is the first sign. Sometime it comes as a result of another illness such as tuberculosis, measles, or mumps.
Meningitis from tuberculosis may take weeks to develop.
- Very bad headache
- Stiff neck — the person cannot put his head between his knees
- The person does not want to be touched — trying to hold a child makes him cry
- Sensitive to light
- Irritable, sensitive, and upset
- Lethargy: weakness, sleepiness, or losing consciousness
Signs in a newborn
The soft spot (fontanelle) on top of the head may bulge out. The child may have vomiting or diarrhea. There may be a fever or the temperature may be unusually low.
A healthy baby’s neck bends when you lift his head.
The neck of a baby with meningitis is stiff. When you lift his head, his back follows.
If the meningitis came after tuberculosis, treat those diseases as well. See Some Serious Infectious Illnesses (in development).
Pneumonia (lung infection)
Coughs, colds, and breathing problems can be mild or severe. One of the most serious is pneumonia, a lung infection. Pneumonia is described in more detail in Problems with Breathing and Coughing (in development). It is one of the most common causes of death in young children.
- Breathing fast is the most important sign of pneumonia. Fast breathing means:
In a newborn baby until 2 months: more than 60 breaths a minute.
From 2 months to 12 months: more than 50 breaths a minute.
From 12 months through 5 years: more than 40 breaths a minute.
All children breathe fast when they are crying. Try to calm the child. When she is no longer crying, rest a hand on her belly to feel it rise and fall. Watch and feel how many breaths she takes each minute.
- Skin on chest visibly sucks in with each breath
- Loss of appetite (not wanting to eat)
Give plenty of fluids to drink and food to eat.
The child should start to get better within 2 days. If she does not, there may be another cause, like tuberculosis, asthma, or a worm infection that has spread to her lungs. If the child’s health worsens, if she has serious trouble breathing, loses consciousness, or has a seizure, get medical help. The child will likely need injections of ampicillin and ceftriaxone (or ampicillin and gentamicin if under 1 month).
Anything that irritates the lungs makes it easier for them to get an infection. Smoke weakens the lungs and makes pneumonia more common. If there are smokers in the house, they should always smoke outside and away from children.
A stove with a chimney will pull smoke out of the house and protect the lungs of the girls and women who do the cooking, and other children who are near.
Pneumonia and malnutrition
Most children who die from pneumonia are malnourished. Malnutrition makes them too weak to fight off the infection.
Everyone breathes easier when children
get enough healthy food every day.
A cough is usually caused by a simple cold, and medicines will not be of use. Soothe the child with warm, sweet teas, steam, or just by holding and comforting her. She should get better in a week or so.
Signs of dangerous coughs
|Cough for 2 weeks or more, losing weight, and fever||Tuberculosis.
See Problems with Breathing and Coughing (in development).
|Cough with fast breathing||Pneumonia|
|A dry cough at night when the child does not otherwise seem sick (especially if there is also wheezing).||Asthma.
See Problems with Breathing and Coughing (in development).
Croup (barking cough)
A barking cough or a lasting cough with a hoarse voice might be croup. You may also hear a high-pitched sound as the child breathes in.
Croup is caused by an infection in the breathing tube in the throat. Antibiotics usually do not help. Breathing steam or taking the child outside at night to breathe cool air may help a little.
Sometimes the inside of the throat becomes so swollen the child has trouble breathing. Listen to her breaths and take her to a health center if you think she may not be getting enough air. There are medicines that can reduce the swelling.
Whooping cough (pertussis)
Whooping cough starts like a cold – with fever, runny nose, and a cough. A week or two later, the cough gets worse. It comes in uncontrollable bursts, with lots of quick coughs in a row. The coughing can be strong enough to make the person vomit.
After a burst of strong coughing, the person gasps to get air. When she breathes in, there may be a high-pitched “whoop” sound. Whooping cough can last for months.
Whooping cough is miserable for anyone but is hardest on children. A baby under 1 year old can die from the constant coughing. Babies do not always have the typical "whoop," so it can be hard to know if they have this infection.
- Rest to avoid triggering the cough.
- Breastfeed more or give extra fluids and food.
- If a child loses weight or seems to have trouble breathing, get medical help.
The best way to protect against whooping cough is to make sure children get the pertussis (DPT) vaccine. See Vaccines (in development).
Tuberculosis affects children more quickly than adults. For a child with a cough lasting 3 weeks or more, especially if there is fever or if someone in the house might have tuberculosis, see Problems with Breathing and Coughing (in development).
Wheezing is a high-pitched whistling sound when breathing. It is caused by tightness inside the lungs or throat and can come with a cold or a more serious problem. If wheezing keeps coming back again and again, it is probably asthma. It could also be a sign of tuberculosis, especially if the wheezing is heard more on one side of the chest. See Problems with Breathing and Coughing (in development).
A runny nose, sore throat, or cough in a child will go away with rest, plenty of fluids, and enough food. The child will get better on her own without medicines. Antibiotics are useless for a cold. Colds sometimes lead to ear infections or strep throat.
If the baby or child is rubbing her ear and crying, an ear infection may be the cause. Ear infections are very common in children, especially after a cold or runny nose. The inside of the nose is connected to the inner part of the ear and germs easily pass the short distance between the two parts.
- An older child can tell you that his ear hurts.
- Babies cry, or rub their ears or the sides of their heads.
- There may be fever, lack of appetite, difficulty sleeping, or just general fussiness.
An ear infection may be very painful and cause children a lot of tears. But if the child is generally healthy and well-nourished, it will most often go away on its own. Paracetamol (acetaminophen) can help with the pain.
You can also try garlic oil, a home remedy that may help. Soak a garlic clove in vegetable oil overnight. Then drip a little of the oil into the ear a few times a day.
When to give antibiotics
Treating with amoxicillin or cotrimoxazole may be a good idea for a child who is already in poor health. These children have a hard time fighting off infection, so ear infections tend to last a long time. A long-lasting ear infection or getting ear infections often can lead to deafness. Always give antibiotics when:
- pus or blood drains from the ear.
- the ear infection does not start to improve after a few days.
- a baby 6 months or younger has an ear infection.
Get help for any of these signs:
- Pain in the bone behind the ear
- Headaches, dizziness, or a seizure
- Lethargy (very tired or weak)
- Hearing loss, deafness
Sometimes a child gets something inside her ear. Try flushing the ear using a syringe with no needle, and filled with a mixture of half water and half hydrogen peroxide or vinegar. Or, if you are very careful not to poke the inside of the ear, you can take it out with a small pair of tweezers. Otherwise, avoid putting objects in anyone’s ear. You can spread germs into the ear or accidentally puncture the eardrum. Even a tiny scratch can become infected.
Breastfed babies get fewer ear infections.
Sore throats usually come from the common cold. The throat may look red inside and hurt when the child swallows. The tonsils (2 lymph nodes seen as lumps on each side of the back of the throat) may become large and painful or drain pus.
- Give plenty of fruit juices, teas, and other fluids.
- Teach the child to gargle with warm salt water
(½ teaspoon of salt in a glass of water).
- Give paracetamol (acetaminophen) for pain.
For most sore throats, antibiotics will do no good and should not be used. But one kind of sore throat in children – called strep throat – is dangerous and should be treated with penicillin.
Signs of strep throat
- Swelling and pus (little white patches) on the back of the throat
- Swollen or tender lymph nodes in the neck, below the ears
- No cough or runny nose
If a child has 3 or 4 of these signs, the infection is likely to be strep throat and should be treated (with penicillin or amoxicillin for 10 days by mouth, or one injection of benzathine penicillin). A throat culture is the only sure way to know what causes a sore throat, and should be used where it is available.
Left untreated, strep throat can turn into a painful and dangerous disease called rheumatic fever.
Rheumatic fever comes after a strep throat infection and strikes children usually between 5 and 15 years old. If a child has some of these signs 2 to 4 weeks after having a sore throat, rheumatic fever may be the cause:
- Pain in the joints, especially the wrists and ankles
- Swollen, hot, and red joints
- Curved or ring-shaped rashes or bumps under the skin on the body, arms, or legs, but not on the face
- Uncontrolled movements of the face, feet, or hands (this is called chorea, or Saint Vitus’ Dance)
- Weakness, shortness of breath, chest pain
If you think the child may have rheumatic fever, give penicillin to treat the infection. Get medical help. Rheumatic fever damages and weakens the heart. This is called rheumatic heart disease and can disable a person or cause early death.
Diphtheria is a dangerous disease that starts with a sore throat and mild fever. After a few days, a grey or white coating may appear in the back of the throat. Often the child’s voice becomes hoarse, his neck swells, and his breath smells bad. The swelling and the grey or white coating can make it difficult or impossible to breathe.
- Get medical help. There is an antitoxin that may be available.
- Give erythromycin or procaine penicillin.
- Gargle with warm water and a little salt.
- Breathe steam to make breathing easier.
If the coating on the back of the throat becomes so thick that the child has trouble breathing, wipe it away with a clean cloth.
Diphtheria is easily prevented with the DPT vaccine. Make sure there is a vaccination program in your community and vaccinate your children.
The first signs of measles are a fever, runny nose, red and sore eyes, and a cough. These signs start about 10 days after being near a person with measles. Next come a sore mouth and diarrhea. Finally a rash appears behind the ears and on the neck, spreads to the face and body, and then to the arms and legs.
A child with measles can get well in 5 to 10 days if you help her drink, eat, and rest:
- Give plenty of liquids to drink. If the child has diarrhea or any sign of dehydration, give rehydration drink frequently.
- Continue to breastfeed a child who is still nursing. Let her drink as often as she wants and for as long as she wants. If she has trouble taking the breast, give breast milk with a spoon.
- Offer bites of food many times each day. If she has trouble swallowing solid food, try soups, porridges, and juices.
- Give paracetamol (acetaminophen) or ibuprofen to relieve the pain and fever.
- Give vitamin A.
The main danger of measles is that it can lead to other, more serious illnesses. This is most common for children who are malnourished or sick with HIV or another illness. Watch for these problems and treat quickly:
- Diarrhea: Treat with rehydration drink. Get help if the child does not improve within a day or two.
- Ear infection: Ear infections from measles can cause deafness. Treat any ear pain right away with amoxicillin or cotrimoxazole.
- Worsening vision: Measles can lead to blindness. Prevent this by giving all children with measles vitamin A.
- Pneumonia: If a child with measles breathes faster than normal, or if breathing is difficult, treat for pneumonia.
- Meningitis: Get medical help if the child acts confused, has a bad headache, has a seizure, or loses consciousness.
All children should be vaccinated against measles (see Vaccines - in development). If one child gets measles, you may be able to protect the other children in the family and school if you can get them vaccinated quickly. Keep a child with measles at home and, if possible, away from her brothers and sisters if they are not sick. However, her siblings may also be infected even if they have no signs of measles yet. So it is best to keep them at home as well until you know they are all healthy. This will prevent infecting others in the community. You can only get measles once, after that you are immune.
Rubella (German measles)
- Mild fever, under 38.3° C (100° F)
- A mild rash that starts on the face and spreads down the body
- Swollen lymph nodes behind the ears and in the back of the neck and head
In children and young adults, rubella is mild compared to measles. It gets better on its own after 3 or 4 days.
In adult women, rubella can cause sore knees, wrists, and fingers.
The only reliable way to protect pregnant women from rubella is to vaccinate all children in the community.
Chickenpox causes a low fever and small, red, itchy spots. The spots usually start on the body and spread to the face, arms, and legs. Later they turn into pimples or blisters that pop and scab.
Chickenpox usually goes away in about a week. But scratching the itchy spots lets germs and dirt get under the skin and can lead to skin infections. Distract the child and help her to not scratch too much. Keep her fingernails short and her hands clean. Or put mittens or socks over her hands. Relieve the itching with cloths soaked in cooled, cooked oatmeal and water. An antihistamine like chlorpheniramine can also help lessen the itching.
Chickenpox can be prevented with a vaccine (see Vaccines - in development). If you have had the vaccine or have already had chickenpox, you are immune.
Scabies causes an itchy rash on the sides, hands, arms, legs, or penis. It is common in children. For more on scabies and other skin problems, see Skin, Nail, and Hair Problems (in development).
Mumps starts with fever, tiredness, headache, or loss of appetite. It may hurt to open your mouth or eat. In 2 days, a soft painful swelling appears under the ears at the angle of the jaw.
It may start on one side and then spread to the other.
Mumps goes away on its own after about 10 days. If the swelling does not go away, it may be something else. Both malnutrition and HIV (see HIV and AIDS - in development) can cause long-lasting swelling of the lymph nodes under the ears which looks a lot like mumps.
Rarely, mumps infection spreads to the ears or the brain. Get medical help right away if someone with mumps has any signs of meningitis or hearing problems.
Mumps can be prevented with a vaccine (see Vaccines - in development).
Polio is a serious illness. It starts like a cold, with fever, diarrhea, vomiting, and sore muscles. Usually the child gets well quickly. But for a few children, polio harms the muscles.
These children get weak, usually in one leg. Sometimes the leg becomes paralyzed. If it stays paralyzed, it will remain thin and small while the other leg grows. If you see a child has trouble moving all or part of her body (paralysis), get medical help right away.
Polio can be painful. Paracetamol (acetaminophen) or ibuprofen can help. So does soaking the limb in warm water. Regular exercise of the affected limbs is important and limits the disabling effects of the disease. See Chapter 7 of Disabled Village Children.
Vaccinate all children against polio. Vaccination campaigns are so successful that polio has disappeared from many parts of the world. If all children are vaccinated, the disease will eventually disappear.
HIV and AIDS
HIV weakens the body’s defenses against illness, making it easier to get sick with pneumonia, tuberculosis, diarrhea, and other diseases. It is important to find out as soon as possible if a child has HIV.
If you answer “yes” to any of these questions, please read HIV and AIDS (in development).
- Is HIV common where you live?
- Are you a mother or father who might have HIV?
- Do you care for a pregnant woman who might have HIV?
- Do you care for a child who might have HIV?
- Do you care for a small child who is not growing well, and gets sick more than other small children?
HIV medicines can help a child with HIV live a long, healthy life.