A GP is the first port of call for parents concerned about their child’s health. Almost always, the diagnosis is straightforward, and the child’s illness is easily resolved.
“The vast majority of what we see in children are fairly minor, easily managed illnesses,” says Dr Máire Finn, a general practitioner in Ennis.
Some children do develop serious illnesses, however, and being aware of the ‘red flags’ for some of these puts you in the best position for early diagnosis and better outcomes.
Ireland has the tenth highest incidence worldwide of type 1 diabetes in children and young people.
“About 370 children under 15 are diagnosed each year, approximately 30 a month,” says Prof Edna Roche, consultant in paediatrics, paediatric endocrinology, and diabetes at Tallaght University Hospital. “Type 1 is the primary diabetes type in children — 95% of young people attending our clinic have it.”
Symptoms can be subtle. The acronym, TEST, highlights red flag symptoms:
-
“Parents might explain it away — it’s a hot day, they’ve been exercising. Pay attention: Are they drinking more? Is their water bottle constantly refilled?”;
-
Tiredness and lethargy, falling asleep where they wouldn’t have before;
-
Unintentional weight loss;
-
“They’re going to the toilet a lot, peeing large volumes, getting up at night. A previously toilet-trained child starts wetting the bed. A younger child has very wet nappies — they’re bursting or leaking at night.”
More minor type 1 symptoms may include increased appetite, poor concentration, constipation, mood swings, and frequent infections.
Early diagnosis improves long-term outcomes and prevents the life-threatening complication of diabetic ketoacidosis (DKA) — rates are high in our population. “In 2020, 46% of people diagnosed with type 1 diabetes presented with DKA,” warns Roche, who confirms the TEST campaign has seen a slight reduction in this.
Prof Edna Roche, consultant in paediatrics, paediatric endocrinology and diabetes at Tallaght University Hospital.
If the child has DKA when diagnosed, it is dangerous — and complicates things hugely. “The child’s in hospital, in high-dependency care. There’s a lot of intense treatment. Whereas if you [catch] type 1 diabetes up, they sometimes don’t even need to go on a drip.”
Type 1 diabetes occurs because the body stops producing insulin. As a result, in untreated diabetes, glucose levels get too high. A finger prick test by GP or pharmacist will show current glucose levels — a urine test will dispel confusion around whether this could be a UTI.
Different cardiac conditions manifest in children at different time points, says Prof Orla Franklin, paediatric cardiologist in CHI, Crumlin.
Congenital heart disease is typically present at the baby stage and in the first weeks of life. “In five out of six cases, children are diagnosed before birth,” says Franklin.
Babies present with breathlessness and difficulty feeding, particularly in the context of a heart murmur.
Cardiac disease in middle childhood is not common. “We see 20 to 30 new presentations of heart muscle disease — cardiomyopathy — a year. The muscle begins to malfunction. A young child won’t have enough energy, won’t be able to exercise. They get a minor illness and can’t cope — the cardiac problem escalates, with fast heart rate and breathlessness.”
Another issue in middle childhood is inflammation of the heart caused by viral infection — most common is Kawasaki disease. “We saw a lot of problematic inflammation of the heart muscle during covid — following covid infection — particularly before [children] were vaccinated,” says Franklin adding that cases have reduced since vaccination.
In teenage years, chest pain is surprisingly common as children stretch and grow.
“Sharp, severe sudden-onset pain at front of the chest, typically when the teen is at rest, that lasts a couple of seconds — usually there’s nothing sinister about it.”
What’s more worrying is chest pain while exercising, along with an episode of collapse or with family history of sudden unexplained death.
“It can be nothing, but it certainly demands investigation.”
Teen fainting can alarm parents but it is very common. “One in six teens faint — peak age is 15. It’s often associated with growth spurts. Typically it’s benign. But fainting brought on by stress — fright, in the heat of anger, diving into cold water, at peak of physical activity — is a red flag. Sinister causes need to be excluded.”
Franklin says high levels of adrenalin release in children prone to cardiac arrhythmias can be problematic. “Video games where the teen’s in the role of a soldier and is the first-person shooter — studies looking at children who died [playing these games] showed an adrenalin surge brought on by abnormal heart rhythms — but kids would have to have the genetic anomaly that makes it happen.”
Temperature, feeding, colour, and energy are all elements of Finn’s infection checklist:
-
“Anything over 38C is abnormal, 39C is more concerning, as is persistent high temperature”;
-
“Older children won’t eat when ill, but watch out for dry lips and not urinating — signs of dehydration”;
-
“Children will be lethargic, won’t want to play”;
-
“Pale or slightly blue tinge is a sign of respiratory distress.”
Sepsis is when any infection gets out of hand and it is very serious, warns Finn. Watch for mottled skin — indicating “circulation has shut down a bit” — vomiting in older children, high heart-rate and difficulty waking.
“If your child has something new and different you haven’t encountered before, trust your gut — get it checked.”
Urinary tract infections (UTIs) can be difficult to pinpoint — children may not show classic symptoms, says Finn. “They’re not that common — they’re more common if the child is inclined to be constipated. You may see sore belly, vomiting, or wetting the bed, where they’ve been dry before. The only way to be sure is to have their urine checked.”
In children under one, UTI needs hospital follow-up to ensure no structural issue with their kidney.
Dr Jane Pears, consultant paediatric cardiologist at CHI Crumlin.
“Childhood cancer is thankfully rare. One out of 450 children under 15 will be diagnosed with cancer — compared with two out of three adults,” says consultant paediatric cardiologist Dr Jane Pears at CHI Crumlin.
Ireland has 200 new cases of cancer a year in children. The most common diagnosis is leukaemia — 50-plus new patients yearly. The next most common is a tumour of the brain or spine — also over 50 cases annually.
After that comes a mix of cancers, affecting any of the organs. “The most common in the abdomen is neuroblastoma — on average about 12 a year,” says Pears.
Cancer survival rates continue to improve in children. “Survival for all [children’s] cancers together would be over 80%.”
The Grace Kelly Childhood Cancer Trust ( www.gkcct.org/) has the LADYBIRDS signs and symptoms card for cancer in children:
-
Loss of weight, sickness, nausea;
-
Appearance: might look pale or have swollen tummy;
-
Discomfort: persistent pain, new limp, slow recovery after injury;
-
You are concerned: you know your child better than anyone;
-
Bleeding, excessive bruising, blood in urine;
-
Irritability, constant exhaustion;
-
Recurrent high temperature, night sweats;
-
Disturbance in vision, new squint, headaches, unusual white appearance of the pupils (eyes) in photos;
-
Swelling or lump that is persistent. Unusually early or late puberty.
For cancer concerns, contact the Irish Cancer Society support line (1800-200700); supportline@irishcancer.ie
Professor Afif EL-Khuffash, neonatologist.
“Signs of infection can be less specific than in older children and adults,” says Prof Afif EL-Khuffash, neonatologist at the Rotunda Hospital, Dublin, and co-host of The Baby Tribe podcast. “It can be difficult to recognise a sick baby, especially under one year of age.”
Watch for changes in feeding habits. “All of a sudden beginning to refuse food, feeding less, or taking longer than usual to finish their bottle. Watch for vomiting especially if frequent and forceful. They may be excessively crying or irritable, be lethargic, have unusually low energy or lack interest in surroundings.”
He urges being alert to changes in breathing — fast, laboured, grunting, wheezing, and if a blue tinge develops on lips or skin. Watch dehydration — indicated by fewer wet nappies, or persistent dark yellow urine. Be alert to skin changes: rash — especially all-over-body, pale or mottled skin, swelling or bulging of the fontanelle (soft spot on baby’s head), and any unexplained bruises.
