Paediatric Emergencies 361FEBRILE CHILD(ii) A slower rehydration rate still is preferred in an infant <6 months
of age, when co-morbidities are present or if a child has
significant abdominal pain (seek senior doctor advice).7 Treatment of mild dehydration
Oral rehydration:
(i) Continue milk and solid food during the diarrhoeal illness unless
there is documented lactose intolerance. Continue breastfeeding,
and supplement with extra water or glucose-electrolyte solution
between feeds.
(ii) Oral glucose-electrolyte solutions:
(a) give 1–1.5 times the volume of their usual feed in infants
(b) give 200 mL of solution after each loose motion in older
children, or enough to quench the thirst, given in frequent
small amounts
(c) aim to replace the normal maintenance fluid requirement
plus deficit volume over 24 h.
(iii) Discharge the child if they are tolerating oral fluids, have no
clinical signs of dehydration, only occasional vomiting and a
satisfactory social situation
(a) give the parents a letter for the GP, and instruct them to
return if the child’s condition deteriorates.
FEBRILE CHILD
Fever is the most common ‘emergency’ presentation in childhood. The normal
oral temperature is 37°C, and the normal rectal temperature is 37.5°C. A fever is
defined as a rectal temperature above 38°C. Tympanic measurements are inaccu-
rate, particularly in children <3 mont hs.
DIAGNOSIS1 A careful history and examination will identify the source of infection in the
majority of cases. Look for the following common causes of fever in children:
(i) Respiratory: upper and lower respiratory tract infection.
(ii) Abdominal: gastroenteritis, appendicitis, UTI.
(iii) ENT: otitis media, tonsillitis.
(iv) Exanthematous skin rash (see Table 2.9 on p. 116).
2 No obvious focus of infection is found following preliminary history and
examination in a small number of children presenting with fever; e.g. a ‘fever
without focus’. Most will have a viral infection, but the potential for signifi-
cant bacterial infection must be evaluated.