Hair loss is distressing to a child. If associated with itch, it
is often due to tinea capitis; with a history of preceding illness,
Skin symptoms can be acute or chronic. Acute-onset rash
is common in children and can be described using the same
terminology as for adults (p. 286). Most rashes are viral and
Rash with blisters is often itchy. It may be urticaria (with an
environmental, viral, food or medicine trigger) or an insect bite.
Blisters with associated yellow crusting may be infected bullous
impetigo (most commonly caused by Staphylococcus aureus).
Red, circular lesions with a pink centre are most often erythema
multiforme (target lesions). Petechial or purpuric rashes that do
associated with Differential diagnosis
Vomiting *** Low: a very non-specific
Acute gastritis/gastroenteritis, any infection (otitis media,
pneumonia, urinary tract infection, meningitis), head injury,
Diarrhoea *** Moderate Fever, dehydrationa Acute gastroenteritis/colitis, appendicitis
** Moderate Fever, bloody stools Acute gastroenteritis/colitis, acute surgical causes, e.g.
Vomiting *** Moderate Failure to thrivec
Gastro-oesophageal reflux (rare in older children compared
with infants), raised intracranial pressure, food allergy
Diarrhoea *** Moderate Failure to thrivec Commonly toddler’s diarrhoea, also lactose intolerance. If
failure to thrive, consider coeliac disease, inflammatory
*** Low Pain that is not periumbilical
If isolated and periumbilical, non-specific abdominal pain
is common and other diagnoses include abdominal
migraine, renal colic. If associated with other symptoms
and/or failure to thrive, consider coeliac disease,
inflammatory bowel disease, constipation
Symptoms of dehydration include dry mouth, foul-smelling breath, anuria and lethargy. b
Abdominal pain can be difficult to identify in young children who are not able to
Coexisting failure to thrive or weight loss always increases the significance of any symptom.
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