Common childhood illnesses: What’s the difference?
The vast majority of childhood illnesses are viral coughs and colds, however some have more unique features and can require more specific treatment. This month we focus on identifying some of the differences between these illnesses and how they may be treated by your doctor.
Scarlet fever
Scarlet fever is caused by infection with a bacteria called Streptococcus - The same bacteria which causes simple tonsillitis. Unlike tonsillitis, in scarlet fever the bacteria releases a toxin which spreads around the body causing more severe symptoms. The toxin can also cause complications with organs like the kidneys or heart, however due to antibiotic treatment these complications are thankfully very rare nowadays.
It usually causes a high fever, sore throat and other flu-like symptoms. After 1-2 days a pink rash develops on the body, before spreading to the limbs. The rash has a rough texture and is described as feeling like ‘sandpaper’. Sometimes the tongue develops a white coating, followed by a beefy red appearance - Often referred to as a ‘strawberry tongue’.
Scarlet fever is treated with a course of antibiotics, usually penicillin, to eradicate the bacteria.
Hand foot and mouth disease
This is a very common viral illness which typically affects children under 10. It can be quite variable in how it presents, which is why the diagnosis isn’t always clear.
The illness often starts with mild symptoms resembling a common cold such as mild fever, cough and reduced appetite. These last between 1-3 days. After a couple of days painful spots develop in and around the mouth, including on the insides of the lips and gums. A generalised rash can also develop, appearing like flat, red spots - Sometimes with blisters. The hands and feet are most commonly affected but it can also appear on the knees, elbows or nappy area.
Hand foot and mouth usually resolves on its own, however specific care must be taken to monitor for dehydration as painful spots in the mouth can significantly affect feeding.
Glandular fever (Infectious Mononucleosis)
Glandular fever is usually thought of as an illness of teenagers and young adults. Although it typically is more common in this age group, people of any age can get it and younger school-age children are also commonly affected. Exposure to the virus that causes it (Epstein Barr Virus) is difficult to avoid, and around 90% of adults worldwide have been infected at some point in their life - Although many won’t know it.
The most classical symptom is a very sore throat, often with pus on the tonsils and swollen painful lymph glands. It’s difficult to very distinguish these symptoms from tonsillitis, but if a sore throat hasn’t resolved within the usual time frame glandular fever should be suspected. Glandular fever can cause other symptoms such as rashes and severe fatigue. On rare occasions it can cause inflammation of the liver, which might present as dark urine and pale stools, but this is quite rare overall. Infants and younger children tend to have milder symptoms which can be no different to other common childhood viruses.
Glandular fever generally resolves on its own, however medical care is sometimes required for diagnosis and to help with symptom management.
Bronchiolitis
Bronchiolitis is caused by a common virus called RSV - Respiratory Syncytial Virus. It mainly affects very young children aged 1 year or less.
The first 2-3 days of the illness are like a common cold, with a runny nose, cough, and mild fever. Many children don’t get worse symptoms than these and can be managed at home until they get better. Some children however develop breathing difficulties, often observed as rapid breathing with wheezing noises on breathing out, and a persistent cough. The baby has to put more effort in to breathe, which causes the muscles between the ribs to draw in with each breath (intercostal recessions). Poor feeding is also common, because the baby is focussing its energy on breathing and cannot drink at the same time.
Bronchiolitis will resolve on its own, however some babies require admission to hospital for support with their feeding or breathing until the infection passes.
Croup
Croup is usually a viral infection which causes swelling and inflammation in the area of the voice box.
The illness may start with general symptoms such as a runny nose and mild fever for 1-2 days. After this, a classic seal-like ‘barking cough’ begins which can be associated with signs of breathing distress. Symptoms are often worse at night, and increase when the child is agitated or upset. Croup is associated with a breathing sound called ‘stridor’ - A low ‘whoop’ occurring when the child is breathing in. Stridor happens when the airflow obstruction through the upper always becomes more restricted.
Children with croup should usually treated with a dose of an oral steroid called dexamethasone. This helps to shorten the duration of symptoms, and can reduce the length of a hospital stay should it be needed. About 1 in 10 children with croup need hospital treatment and on very rare occasions it can be life-threatening.
Inner ear infections (otitis media)
The majority of ear infections in children affect the inner ear, and can be caused by viruses or bacteria.
Older children complain of pain in the affected ear. In younger children however the symptoms can be quite general, and can include pulling or rubbing of the affected ear, fevers, crying, irritation or reduced feeding. If the eardrum has burst, a yellow or bloodstained discharge may be visible coming from the ear, or on the child’s pillow. It can be difficult to diagnose an ear infection from symptoms alone, and most often a doctor must look in the ear to in order to confirm it.
Subsequent to popular misunderstanding, not all ear infections in children need antibiotic treatment. A doctor’s decision on whether antibiotics could be helpful will be influenced by many factors including the age of the child, and whether one or both ears are affected.
And finally…
Please remember that whilst many common illnesses have typical symptoms, they can all present in variable ways and may require different treatment depending on the specific patient. If you have any concerns about your child’s wellbeing you should always seek timely medical advice from appropriately trained professionals.
Disclaimer: This blog post provides general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor. The medical information is the personal opinion of the stated author(s). It is based on available evidence or, where no published evidence is available, on current medical opinion and practice. Every effort is taken to ensure that the information contained in this website is accurate and complete. However, accuracy cannot be guaranteed – rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate. The author(s) is/are not responsible for the results of your decisions resulting from the use of the information, including, but not limited to, your choosing to seek or not to seek professional medical care, or from choosing or not choosing specific treatment based on the information. You should not disregard the advice of your physician or other qualified health care provider because of any information you read on this website. If you have any health care questions, please consult a relevant medical practitioner.
