Question

What would be considered clinically significant about an infant hospitalized for diarrhea that has this for their general appearance

general appearance: irritable when awake, alternates with lethargy once quiet, when awake and crying, and tears are not present

I understand that this indicates pain and discomfort, why would the alternating between lethargy and crying, and no tears present specifically be clinically significant?

Thank you

Answer 1

Sick Newborn

• Your baby is less than 1 month old and has a fever or looks sick. This includes vomiting, cough, or even poor color. Your baby may start to act abnormal if they are getting sick. Examples are poor feeding or sleeping too much. At this age, these symptoms are serious until proven otherwise. During the first month of life, infections can progress very fast.

Lethargy

• Your young child is lethargic if she stares into space or won't smile. She won't play at all or hardly responds to you. Your child is too weak to cry or hard to wake up. These are serious symptoms.
• Note: Sleeping more when sick is normal. When awake, your child should be alert.

Confusion

• The sudden onset of confusion is serious. Your child is awake but says strange things. She sees things that aren't there. She doesn't recognize you.
• Note: Brief confusion for 5 minutes or so can be seen with high fevers. This can be normal. But, if not brief, confusion can have some serious causes.

Severe Pain

• Severe pain keeps your child from doing all normal activities. Your child won't play or even watch a favorite TV show. They just want to be left alone. Your child may cry when you try to hold or move them. Children with severe pain also can't sleep or can only fall asleep briefly.

Inconsolable Crying

• Constant nonstop crying is caused by severe pain until proven otherwise. Suspect this in children who can't sleep or can only fall asleep briefly. When awake, they will not join in any normal activities. They won't play or be distracted. They may be very hard to console. Caution: Instead of crying, severe pain may cause your child to moan or whimper.

Can't Walk

• If your child has learned to walk and then suddenly won't, call your doctor. He may have a serious injury to the legs or a problem with balance. If your child walks bent over holding his stomach, he may have appendicitis.

Vomits Bile

• Vomiting that is bright green is most often bile. Unless your child drank a green liquid, this is not normal. It can mean the intestines are blocked up. This is a surgical emergency.
• Note: Vomiting some yellow fluid is normal. The yellow color is from stomach acid.

Tender Belly

• Press on your child's belly while she is distracted by a toy or book. You should be able to press in an inch or so without a problem. If your child winces or screams, it suggests a serious cause. If the belly is also bloated and hard, it's more urgent.
• Note: If your child just pushes your hand away, you haven't distracted her enough.

Trouble Breathing

• Breathing is essential for life. Most childhood deaths are caused by severe breathing problems. Breathing problems can be caused by throat or lung infections. Parents need to learn to recognize trouble breathing. If your child has tight croup or wheezing, they need to be seen now. Other bad signs are fast breathing, grunting with each breath, bluish lips, or retractions. This means the skin pulls in between the ribs with each breath. It is a sign of trouble breathing in younger children. Children with severe breathing problems can't drink, talk or cry. If your child is struggling to breathe, call 911.

Bluish or Gray Lips

• Bluish lips, tongue, or gums can mean not enough oxygen in the bloodstream. Call 911.
• Note: Bluish skin only around the mouth (not the lips) can be normal. It can be caused by being cold or being afraid.

Trouble Swallowing with Drooling

• The sudden onset of drooling or spitting means your child is having trouble swallowing. Most often, this is from severe swelling in the throat. The cause can be a serious throat infection. A serious allergic reaction can also cause trouble swallowing. Swelling in the throat could close off the airway.

Dehydration

• Dehydration means that your child's body fluids are low. Dehydration often is caused by severe vomiting and/or diarrhea. Suspect dehydration if your child has not urinated in 8 hours. Crying no tears and a dry inside of the mouth (tongue) are also signs. In young babies, the soft spot in the head is sunken. Dehydrated children are also tired and weak.
• Note: If your child is alert, playful and active, he is not yet dehydrated. Children with severe dehydration become dizzy when they stand. Dehydration needs extra fluids by mouth or vein.

Bulging Soft Spot

• The soft spot in your baby's head is tense and bulging. This means the brain is under pressure.

Stiff Neck

• A stiff neck means your child can't touch the chin to the chest. To test for a stiff neck, lay your child down. Then lift his head until the chin touches the chest. If he fights you, place a toy or coin on the belly. This makes him have to look down to see it. Older children can simply be asked to look at their belly button. A stiff neck can be an early sign of meningitis.
• Note: Without fever, a stiff neck is often from sore neck muscles.

Neck Injury

• Talk to your child's doctor about any neck injury, regardless of the symptoms. Neck injuries carry a risk of damage to the spinal cord.

Purple or Blood-Red Spots or Dots

• Purple or blood-red spots or dots on the skin need to be seen. When present with fever, they could be a sign of a serious bloodstream infection. The color of these serious rashes will not change when you press on them. The color of normal viral rashes will fade with skin pressure.
• Note: Bumps and bruises on the shins from active play are different.

Fever (over 100.4°F or 38 °C) in the First 3 Months

• Fevers in newborns and young babies are treated differently than fevers in older children. Bacterial infections are more common at this age and can get worse quickly. A fever is a rectal or forehead temp of 100.4 F° (38.0° C) or higher. All babies under 3 months of age with a fever need to be seen now. They need tests to decide if the cause is viral or bacterial.

Fever over 105° F (40.6° C)

• A fever tells you that your child has an infection. Serious infections can occur with low-grade fevers as well as higher fevers. All the above symptoms are stronger signs of serious illness than the level of fever. Research shows fevers alone are a risk factor only when very high. That means levels above 105°F (40.6°C). So, call your doctor if your child's fever goes above 104° F (40° C). This is a safe rule.

Chronic Diseases

• Most active chronic diseases can have some serious complications. If your child has a chronic disease, learn what those complications are. Find out how to recognize the early changes. Diseases at highest risk for serious infections are those that weaken the immune system. These include sickle cell disease, HIV, cancer, organ transplant, or taking oral steroids. If you are talking with health workers who don't know your child, speak up. Always tell them about your child's chronic disease (such as asthma). Never assume the doctors and nurses already know this.