What to Expect the Toddler Years (202 page)
Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
APPENDICITIS WARNINGS
An inflamed appendix is very rare in young children. When it does occur, it is exceedingly difficult to diagnose, partly because symptoms often seem to mimic an ordinary stomach upset. In the typical case, pain begins around the umbilicus (the belly button) and several hours later may move to the lower right abdomen (or elsewhere in the abdomen or even the back, if the appendix is in the “wrong” place). There may be tenderness in the area of the pain, and the pain may cause the toddler to limp or walk bent over. After the pain begins there may be a loss of appetite and then vomiting. (Vomiting
before
the pain begins is more likely gastroenteritis, or a stomach ache.) There may be a low-grade fever of 100°F to 101°F (38°C to 38.5°C), and, sometimes, frequent bowel movements (they are gassy, scant, and not watery like diarrhea). If your child’s symptoms lead you to suspect appendicitis, even slightly, call the doctor. If the pain stops after several hours don’t assume all is well. It could mean a burst appendix and a call to the doctor is still in order.
Behavior.
Is there any change from the norm in your toddler’s behavior? Would you describe your child as sleepy and lethargic, cranky and irritable, inconsolable or unresponsive? Can you elicit a smile?
Sleeping.
Is your toddler sleeping much more than usual, or unusually drowsy, or difficult to arouse? Or is he or she having trouble sleeping?
Crying.
Is your toddler crying more than usual? Does the cry have a different sound or unusual intensity—is it high-pitched, for instance?
Appetite.
Has there been a sudden change in appetite? Is your toddler refusing fluids and/or solids? Or eating or drinking everything in sight?
Skin.
Does your toddler’s skin appear or feel different in any way? Is it red and flushed? White and pale? Bluish or gray? Does it feel moist and warm (sweaty) or moist and cool (clammy)? Or is it unusually dry or wrinkly? Are lips, nostrils, or cheeks excessively dry or cracking? Are there spots or other lesions anywhere on your toddler’s skin—under the arms, behind the ears, on the extremities or trunk, or elsewhere? How would you describe their color, shape, size, texture? Is your child scratching or rubbing them?
Mouth.
Is there swelling on the gums where teeth might be trying to break through? (Molars, particularly, can cause a lot of discomfort.) Any red or white spots or patches visible on the gums, inside the cheeks, or on the palate or tongue? Any bleeding?
Throat.
Is the arch framing the throat reddened? Are there white or red spots or patches? (See page 613 for how to examine your toddler’s throat.)
Eyes.
Do your toddler’s eyes look different than usual? Do they seem glazed, glassy, vacant, sunken, dull, watery, or reddened? Do they have dark circles under them, or seem partially closed? If there’s a discharge, how would you describe its color, consistency, and quantity? Do you notice any “pimples” on the eyelids?
Ears.
Is your toddler pulling or poking at one or both ears? Is there a discharge from either ear? If there is, what does it look like?
Lymph glands.
Do the lymph glands in your child’s neck seem swollen? (See illustration for how to check them.)
Digestive system.
Has your toddler been vomiting? How often? Is there a lot of material being vomited, or are your toddler’s heaves mostly dry? How would you describe the vomitus—like curdled milk, mucus-streaked, greenish (bile-stained), pinkish, bloody, like coffee grounds? Is the vomiting forceful? Does it seem to project a long distance? Does anything specific seem to trigger the vomiting—eating or drinking, for example, or coughing? Do you know, or suspect, that your toddler has ingested a toxic substance?
Has there been any change in bowel movements? Does your toddler have diarrhea, with loose, watery, mucousy, or bloody stools? Are color and odor different than usual? Are movements more frequent (how many in the last 24 hours?), sudden, explosive? Or does your toddler seem constipated? Is there an increase or decrease in saliva? Excessive drooling? Or any apparent difficulty swallowing?
Urinary tract.
Does your toddler seem to be urinating more or less frequently? Is the urine different in color—dark yellow, for example, or pinkish—or have an unusual odor? Does urination seem to be painful or burning? (This discomfort could cause a toddler to “hold it in” or to cry on wetting.)
Abdomen.
Is your toddler’s tummy flatter, rounder, more bulging? When you press on it gently, or when you bend either knee to the abdomen, does your child seem to be in pain? Where does the pain seem to be—right side or left, upper or lower abdomen?
The lymph glands are part of the body’s protection against disease. When there is an infection nearby, they often swell and may sometimes become tender and hot. You can feel for them with your fingertips.
Motor symptoms.
Has your toddler been experiencing chills, shakes, stiffness, convulsions, or neck stiffness (can he or she bend chin to chest without difficulty)? Does he or she seem to have difficulty in moving any other part of the body?
Pain.
Is your child complaining of pain in the arms, legs, abdomen, head, ears, or anywhere else? Or is he or she indicating pain nonverbally—by tugging at an ear, for instance?
Other unusual signs.
Do you note any unpleasant odor emanating from your child’s mouth, nose, ears, vagina, rectum? Is there bleeding from any of these?
PARENT’S INTUITION
If your toddler just doesn’t seem “right” to you, but you can’t put your finger on any specific symptom, give the doctor a call anyway. Most likely you’ll be reassured, but it’s possible that your intuition may have picked up on a subtle problem that needs evaluation. At any rate, it’s better to call than to worry.
No matter what the illness, there is some general information in addition to the symptoms, that you should have ready when calling the doctor—or when taking your child to the doctor’s office or the emergency room:
When did the symptoms first appear?
What, if anything, triggered the symptoms?
What worsens or alleviates the symptoms (sitting up decreases the coughing, for example, or eating increases vomiting)? Are symptoms affected by the time of day (are they worse at night)?
If pain is a symptom, where exactly is it located (if your child can tell you or you can figure that out).
Which over-the-counter or home remedies, if any, have you already tried?
Has your toddler recently been exposed to a virus or infection—a sibling’s stomach virus, strep throat at day care, or conjunctivitis at play group?
Has your toddler recently been involved in an accident, in which an unnoticed injury could have occurred?