Hair loss is distressing to a child. If associated with itch, it

is often due to tinea capitis; with a history of preceding illness,

alopecia is a likely cause.

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

resolve spontaneously.

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

15.8 Gastrointestinal system

Symptom Frequency

Diagnostic

significance

Significance heightened if

associated with Differential diagnosis

Acute

Vomiting *** Low: a very non-specific

symptom in children

Fever, drowsiness,

dehydrationa

Acute gastritis/gastroenteritis, any infection (otitis media,

pneumonia, urinary tract infection, meningitis), head injury,

encephalitis

Diarrhoea *** Moderate Fever, dehydrationa Acute gastroenteritis/colitis, appendicitis

Abdominal

painb

** Moderate Fever, bloody stools Acute gastroenteritis/colitis, acute surgical causes, e.g.

appendicitis, intussusception

Chronic

Vomiting *** Moderate Failure to thrivec

Headache

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

bowel disease

Abdominal

painb

*** Low Pain that is not periumbilical

Headaches

Diarrhoea and vomiting

Failure to thrivec

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

a

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

express themselves. c

Coexisting failure to thrive or weight loss always increases the significance of any symptom.

Symptom Frequency

Diagnostic

significance

Significance heightened if

associated with Differential diagnosis

Acute

Headache ** Low

Vomiting, fever, neck stiffness,