1. THE CHILD WITH A SKIN RASH key points for approach dr Gerlant van Berlaer Pediatric section of the Department of Emergency and Disaster Medicine UZ Brussel

2. Quiz Only 3 possible answers 1) not okay 2) okay 3) don’t know 2 2-4-2015 het kind met vlekjes

3. Ill children are ‘not okay’ Parents:  More worried than usual: “ this is not my child ” or “ my child is different than otherwise when sick ” Signals of:  serious bacterial infection  Meningitis  Dehydratation

4. Not okay criteria I age < 3 months fever >3 days, ‘high’ fluid balance:  less drinking  dry diapers  vomiting /diarrhea general physical examination:  fast, weak pulse  tachypnea

5. Not okay criteria II behaviour: crying:  continuously, not able to comfort  weak, grinding Consciousness:  apathic, lethargic, somnolent ‘beware of the quiet baby’

6. Not okay criteria III Neurological:  Meningeal irritability (‘diaper pain’!)  Convulsions  typical hyperthermic convulsions Skin:  colour: pale, spotted, grey, cyanotic, marbled  Skin rash: May be transient May be transient petechiae [under nipples, extremities, pressured spots] petechiae [under nipples, extremities, pressured spots]  blanket away, clothes off, diaper open!

7. Flowchart questions in case of rash Sick? Vesicles? (hairy scalp, palms & soles, age, mouth, intake) Bullae? (mechanical, burns) Skin spots?  Colour? Congenital?  Coherent history with lesions? Child abuse?  Travels? Pruritus? Skin dihescence?  Petechiae?  Petechiae? Localisation?  Vaccinations? Contaminated? Recently ill?  Associated symptoms? Drug use? titel 7 2-4-2015

8. ‘never okay’ Worried parents, incoherent parents Very young child < 4 months Quiet child Extreme pallor, greyness, cyanosis, purpura Signals of:  serious bacterial infection  meningitis, lethargy  dehydration  fast, weak pulse  tachypnea