Recommendation

What are the symptoms and complications of chicken pox /varicella/ ?

Chicken pox (Varicella) is a highly communicable disease caused by the varicella-zoster virus. Varicella virus, stays in the body for life once acquired. For most people, one infection confers lifelong immunity. One can get it at any age.

Symptoms - fever, severe itching, uncomfortable rash. Rash is noticed on face, trunk, scalp, or in mouth, later on arms and legs. Rash will go through three stages: initially, it will be a red spot, next a blister (vesicle), and finally a scab. There are "old" spots that are healing and "new" spots that are just beginning to blister. The rash will probably be itch. The skin may begin to itch before the rash. "Red spots" may be noticed in the end of the disease. These spots are not scars and will fade usually within a few weeks.
The infection is usually transmitted through inhalation of infectious respiratory secretions from an infected person (droplet infection), direct physical contact with vesicular lesion and by vertical (mother to baby) transmission during pregnancy. It is contagious two days before the onset of the rash and may be spread until all blisters have formed scabs. After you are exposed to the disease, it may take from ten days to three weeks before you notice a rash.
To avoid spreading the illness, the patient should stay in the apartment until all lesions have dried up (approximately five to seven days). The patient should avoid friends who have not had the disease.
For adolescens and adults who do not have a known history of varicella, a blood titer is recommended, followed by the live varicella vaccine if the titer is negative. Research indicates the vaccine is 85% effective in preventing disease, and, if a vaccinated person gets varicella, it is usually a very mild case. For details see service-vaccines-chicken pox on our website. Immunization after exposition is also possible ask your pediatrician for details.
Serious complications from chicken pox include bacterial infections which can involve many sites of the body including the skin, bone, lungs (pneumonia), joints and blood. Other serious complications are due directly to the virus and include viral pneumonia, bleeding problems, and infection of the brain (encephalitis).
If a fever lasts long than four days, call your pediatrician. Take note of areas of the rash or any part of the body which become very red, warm, tender, or is leaking pus (thick, discolored fluid) as this may mean there is a bacterial infection. Call pediatrician immediately if the patient with chicken pox seems extremely ill, is difficult to wake up or is confused, has difficulty walking, has a stiff neck, is vomiting repeatedly, has difficulty breathing, or has a sever cough.
Acyclovir (a medicine that works against herpes viruses) is recommended for persons who are more likely to develop serious disease including persons with chronic skin or lung disease, otherwise healthy individuals 12 years of age or older, and those persons receiving steroid therapy. In order for Acyclovir to be effective it must be administered within 24 hours of the onset of the chicken pox rash. Patients or parents of the child with weakened immune systems from disease or medication should contact their pediatrician immediately if they are exposed to or develop chicken pox.

The following measures may help the patient feel more comfortable:
Scratching the blisters may cause them to become infected. Therefore, keep fingernails trimmed short.
Cool compresses and cool to tepid baths can help soothe itching.
Using a humidifier, sleeping with head elevated, and taking decongestants can help relieve stuffy nose.
Paracetamol - Acetaminophen can help relieve body aches and fevers.
Cool liquids can soothe throat. The patient should avoid spicy foods, citrus drinks, chocolate and hot sauces, sharp foods such as potato chips or crackers.
The patient should wear cotton T-shirts or gowns. Polyester can be too warm and other fabrics can irritate lesions.

Acute diarrhoea and vomiting

A full examination is necessary in all children. The child can be infectious to others.

Most episodes of vomiting and diarrhoea are short, 1 to 3 days. They are usually caused by viruses or unrecognized food poisoning. The biggest danger to your child with vomitting and diarrhea is dehydration, specially if your child has fever. Generally the illness starts with vomitting and it can be impressively frequent during the first 6 hours, then the frequency usually slows down. Diarrhea may come at any time. During the first 4 hours offer sips of oral rehydration solution – ORS – cold, in small amounts frequently. There are over the counter medicines recommended for the management of diarrhea and vomitting. We recommend ORS – Kulíšek or Kulíšek forte for this purpouse. Use 1 sachet from the box an add 250ml of cold water (for infants use PET bottles for infant). Give your child 5-10ml by syringe or teaspoon every 2- 5 min until the cup is empty. Give your child 30 min to rest, then repeat. This labor is an intensive process, but it works. If your child is old enough to voluntary sips, just monitor that the fluid is going down. If the child hates the rehydration fluid call your doctor. As first help try to alternate the ORS with water. Babies should be allowed to breast feed as tolerated, also during the first 4 hours of therapy. Artificially fed infants and older children on complementary food should take just ORS during the first 4 hours. We recommend 30-50ml of ORS/kg + 10ml of ORS/kg and lose motion for the first 4 hours of therapy, nothing else. For breasted children continue with breastfeeding ad libitum (interval of 1hr) + 10ml of ORS/kg per lose motion. The next re-feeding fase should go slowly. The priority is on fluid not on food. Try a little first and increase it if tolerated. Many children will be fine starting with bananas, rice, boiled carrots or crisp bread. Dairy products may contribute to gas and diarrhea, so add them later. Bottom skin care is important to prevent breaking down.

Picky Eaters

Actually, children with insufficient calorie intake for growth are rare. The trick in nutrition for children is controlling the quality not the quantitiy of what they eat. If your child rearelly does eat much, look at how much he/she drinks. Children can drink an enormous quantity of calories in milk and juice on daily basis. Big drinkers tend to be picky in terms of quantity and variety of foods they eat.

Milk is convenient source of protein, and calcium. However it has little or no iron. Three dairy servings a day of milk, cheese and yogurt will cover the calcium needs of growing children. A child filling up too much on dairy products may not have a good appetite for the other food groups and may be at risk for iron deficiency anemia. Children who will not take milk /it is not dietary essential/ should get their calcium from other sources and supplements.

Juice is not dietary essential. It has relatively little nutrition value and plenty of calories. Its sweet taste is notorious for destroying appetite for anything other than sweets. We think of juice as a snack and prefer it be limited to 200ml per day. The pediatrician may recommend grater quantities of juice if the child has constipation.

Most children will drink water if they are truly thirsty and nothing else is available. It may také some time getting used to it if they have been on diluted juice previously. We prefere children have water if they are thirsty and eat fruit if they need a snack. Diluted juice is sensless.

When absolutely nothing else is available to drink, i.e. on extremely rare occasions, child can have soda. Children have no business getting caffeine and they do not have any profit from iced tea.

Caloric requirement for growth depend on a child’s age, general health and activity level. Luckily as parents, you do not need to worry about that number. Children seem to know how much they need. For reassurance look at your childš diet on a weekly, rather than a daily basis. They tend to get all the food groups in, if they are offered and if they are snacking responsibly. Some children do this on three meals a day, others snacks. We recommend offering a protein, fruit or vegetable and a starch with each meal. A child may only take one or two of the three this meal, but they will probably make other choices the next time or the next day.

Always offer a healthy food such as fruit, vegetables, seeds or nuts (if your child is old enough) whenever possible. Avoid prepackaged foods when possible, as they are often high in fat and low in fiber. Never offer juice within 1 hour of mealtime. Plan ahead. Cookies and cakes are fine for an occasional snack but try to offer a healthier snack first, so the child is not eating quite so much.

Some kids are truely finicky. Do not make meals a power struggle. Offer a default meal you know your child will eat, for example banana. Offering an incentive always discuss with your pediatrician. Avoid coercion. Children who taste novel foods are more likely to later incorporate them into their diets than children who do not even see novel foods. Avoid offering sweet food just so they will have something. A hungry child will eventually eat. And remember what a children likes and dislikes changes regulary, so keep trying foods they may have rejected in the past.

In general, vitamins are not recomended for healthy children /we are not speaking about infants and vit K + D supplementation/. As long as a parent is offering a balanced diet, the child will get the nutrients he/she needs. If the child is truely limited in diet, despite the best efforts, a multivitamin is probably not a bad idea. The righ dose and type discuss with your pediatrician.

Fever

Fever is defined as > 38,5°C rectally, > 38°C in the armpit.

Mild elevations in temperature can occur with exercise, hot weather or excessive clothing, so it is sometimes helpful to correct any of these issues and rechecked the temperature in 30 minutes.

Fever is the body’s normal response to infection. It is probably helpful in fighting the infection. The usual fevers that children get range from 38-39,5 and are not harmful to the child. Most are due to viral illnesses, some are due to bacterial illnesses. Most fevers due to viral illness last 1 to 3 days. Your pediatrician will ask you several questions about your child’s overall condition when helping you to decide how to best manage the fever. While high fevers or rapid changes in temperature can cause convulsions in a few children, these are generally harmless. It is important to note the other symptoms associated with the fever.

Always call the physician for fevers associated with the following symptoms of conditions:

Call immediately:

If your child is under 2 months of age
Fever over 40 degrees
Inconsolable crying
A child who cries if moved or touched
Your child is difficult to awaken
A child with stiff neck (can not touch his chin to his chest)
Purple spots on the skin
Difficult breathing after cleaning the nose
A convulsion has occurred
The child is acting extremely sick

Call:

If your child has burning with urination
If the fever lasts more than 72 hours
If the fever is gone for more than 24hr but then returns
If your child is between 2-6 months old
There are other symptoms such as ear pain or sore throat that concern you

You may give your child paracetamol/acetaminophen or ibuprofen to relieve discomfort associated with fever, but be aware that the illness will not resolve with these medicines. We recommend treating a temperature over > 38,5°C rectally and 38° in the armpit to keep the child more comfortable so they will keep drinking fluids. Children can become dehydrated with a fever if they are not drinking. It is ok if they do not have an appetite. Children must stay at home from school and daycare at least until their temperature has been under 37,5°C rectally and 37 in the armpit without mediation for 24hr. Be careful to follow dosage instructions carefully as these medicines may be very harmful if given too frequently or in high doses.

Why to use STREPTEST?

Rapid test for the detection of Group A Streptococcal infection
Streptococcus pyogenes can cause serious infections such as pharyngitis, respiratory infection, impetigo, endocarditis, etc. Left untreated, these infections can lead to serious complications, including rheumatic fever and peritonsilla abscess. Traditional identification procedures for group A Streptococci infection require 24-48 hours or longer. STREPTEST is a rapid test to qualitatively detect the presence of Strep A antigen in throat swab specimens, providing results within 5 minutes.