By clinical nurse specialist Sarah Regan from Great Ormond Street Hospital, London
Parents often worry they won't recognise that their child's heart condition is getting worse when they also have a cold or temperature. It can be difficult to identify signs indicating their heart condition is worse when they also have another illness. Children with heart conditions may get more breathless, especially with a cold, or feel dizzy, faint or compain of a fast heart beat when unwell (a temperature will increase your child's heart rate).
But it is important to seek early advice from your GP who will assess your child and can refer him or her to the local paediatric team who will then contact your cardiology team for further advice. Some children may need admission to their local paediatric ward for observation and fluid management. Your cardiology team will want to know if your child has been admitted as they may want to adjust medication or review your child in clinic following an echocardiogram, blood tests and consultation.
Tackling fevers
If you take a reading in your child's mouth or from the ear, the normal temperature is 36-36.8°C (97.7-99.1°F). If your child has a temperature:
When is a fever critical?
Use common sense when deciding whether to call the doctor. Call for help if your child looks ill and exhausted, is behaving differently, is less than three months old and running a high fever, cries and cries without you being able to comfort them, doesn't wake up easily, has a temperature more than 38C (101.3F) for more than two days, has just had an operation or doesn't seem to be getting better.
If your sick child experiences any of the following at any time, you should also call a doctor: stiff neck, trouble breathing, hallucinations, cramps, continued vomiting or diarrhoea, continued tonsillitis, pain when urinating, or urinating more than before, red rash or blue/purple dots or patches, is affected by bright light or other illnesses.
Vomiting and diarrhoea
Vomiting and diarrhoea can be caused by viruses, bacteria, parasites, foods that are hard to digest (such as too many sweets) and other things. Both can be harmful to children because they can cause too much fluid loss from the body (dehydration). Young babies can become dehydrated quickly but dehydration can occur in a child of any age.
Signs of dehydration
Signs include irritability, not eating well, weight loss, weeing less often, urine darker than normal, fast heartbeat, dry mouth, thirst (babies show thirst by crying and being eager to drink when offered), sunken eyes, no tears when crying, sunken soft spot in babies under 18 months and skin less springy than usual.
Preventing dehydration
Encourage children over two to drink water and other clear fluids. Ask your doctor about giving a baby or toddler an oral rehydration solution (ORS, eg dioralyte), which contains the right mix of salt, sugar, potassium and other elements to help replace lost body fluids. In babies and children on heart medication, for example beta blockers (eg atenolol, propanolol, carvedilol,), ace inhibitors (eg lisinopril, captopril) and diuretics (eg frusemide), dehydration can cause complications. If you think your child is dehydrated seek advice from your GP or cardiology team as medication may need to be changed while your child is unwell.
What can I give my older child to drink?
Children older than two can have drinks such as apple juice, chicken broth, sports drinks (Gatorade) or tea. Drinks containing a lot of caffeine shouldn't be given because it increases the amount of water and salt the body loses.
Should I give my child ORS?
If your child is under two and/or you're worried that he or she is dehydrated, ask your doctor about using ORS. ORS comes as a powder that you mix with water, a liquid that is already mixed and as frozen popsicles. Ask your doctor about which to use.
How should I give ORS if my child is vomiting?
If your child is vomiting, try giving him or her small amounts of ORS often, perhaps one teaspoonful every minute. When your child is able to keep the drink down, slowly increase how much you give. If your child keeps vomiting, wait 30 to 60 minutes after the last bout, and then give a few sips of ORS. Small amounts every few minutes may stay down better than a large amount all at once. When your child stops vomiting, increase how much ORS you give each time and lengthen the time between giving it to three to four hours. Keep giving ORS until your child stops vomiting.
How should I give ORS if my child has diarrhoea?
If your child has diarrhoea and isn't vomiting, give him or her ORS freely. Your doctor may ask you to keep track of how much your child drinks.
Should I feed my child when he or she has diarrhoea?
Yes. Even though eating may cause the amount of diarrhoea to increase, your child will be able to get some nutrients from the food. This may prevent your child from losing too much weight and aid recovery. For babies keep breastfeeding while you're giving ORS. Some doctors suggest switching from formula milk to ORS for up to 24 hours and then switching back. Talk to your doctor. Children should begin eating within 12 to 24 hours after starting to take ORS. Avoid foods with a lot of sugar and fat, such as ice cream, gelatin, pudding and fried foods. It's best to avoid dairy products for three to seven days. Bland foods, such as bananas, rice, apple sauce, toast and unsweetened cereals, are recommended for the first 24 hours. You can then reintroduce other foods over the next 48 hours. Most children return to normal eating about three days after vomiting and diarrhoea stop.
Should I give my child medicine to stop diarrhoea?
Diarrhoea doesn't usually last long. If it's caused by an infection, diarrhoea is a way for the body to get rid of the infection. Giving medicines that stop diarrhoea may interfere with the body's efforts to heal. Antibiotics are usually not necessary either. Talk to your family doctor if you think your child needs medicine.
Will my child need to go to hospital?
Probably not, unless the dehydration is severe. In this case, your child may need to be given fluids intravenously. Children with cardiomyopathy may require an early assessment by their GP or local nursing team. If your child is vomiting and has diarrhoea, call the doctor if he or she is younger than six months, has a fever higher than 1 01.4F, has signs of dehydration, has been vomiting for more than six hours or is vomiting with great force, has stools that are bloody or slimy, has blood or green slime in the vomit, hasn't passed urine for six hours, could have swallowed something that might be poisonous, has a stiff neck, is listless or unusually sleepy, or has had abdominal pain for more than two hours.
Vomiting regular medication
If your child vomits immediately after medication you can repeat their medication. It may be advisable to wait for half in hour in case they vomit again. Try to avoid giving too much to drink when they take their medicine. If your child keeps vomiting it is very important to seek medical advice from you GP who will contact your cardiology team for advice.
Dedicated to Damian McLoughlin, who died age 20 of cardiomyopathy. This site is supported by Damian's family and friends.
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