Dengue in Children – Signs, Diagnosis & Treatment

More than 700 million people are affected by mosquito-borne illnesses, of whom more than one million die. The most dangerous ones are malaria, zika virus, chikungunya, yellow fever and dengue fever. Dengue is especially common in India, with epidemics constantly emerging around the country. Luckily, this disease is treatable and has a rather low mortality rate. This article will help you understand Dengue fever, its symptoms, treatment and prevention methods.

What Is Dengue & How Does It Spread?

Dengue fever is carried by the female Aedes mosquito. This mosquito species can be identified by a striking striped pattern on its abdomen, giving them the name tiger mosquitoes. Usually found in warm, tropical and humid climates, these mosquitoes thrive in the presence of stagnant water. This makes dengue far more prevalent at the peak of the monsoons. Interestingly, the Aedes mosquito attacks during the day, which is unlike other disease-carrying mosquitoes. These mosquitoes usually bite in the early morning and the evening right before sunset.

It is important to note that the mosquito is simply a carrier, known as the disease vector. The cause of dengue in children as well as adults is not the mosquito itself, but rather a viral pathogen known as the dengue virus. There are five strains of dengue viruses, any of which can cause the disease. However, dengue caused by one of the strains will grant total immunity to the disease caused by that particular strain, but only partial resistance to the other viruses.

The prevalence of dengue is tricky to calculate, as most cases of the disease are unreported. According to WHO, around three million dengue people are infected with dengue every year, but the actual number might be upwards of 400 million. The disease spreads when the mosquito bites an individual, transferring the dengue virus into the bloodstream. The viruses then attach themselves to the white blood cells, slowly penetrating them as they are carried throughout the body. After replicating inside the white blood cells, they emerge and infect other organs such as the liver, bone marrow, skin and so on. The disease usually passes in two to ten days as the body sets off an immune response that kills all the viruses. However, in around five percent of all cases, a more dangerous version of dengue fever can arise, known as Dengue Haemorrhagic Fever. This case has far more complications and requires immediate treatment.

It is believed that nearly twenty percent of all dengue patients were toddlers and babies. While dengue is not usual in newborns, mothers with the disease are liable to pass the infection during labour. The disease can also be transmitted through blood transfusion and organ transplants. Luckily, in most cases, dengue cannot spread from one person to another.

Signs and Symptoms of Dengue In Children

Dengue fever is usually asymptomatic in nearly eighty percent of all cases, even babies and small children. However, the younger the child, the more severe the symptoms, which usually materialise around four days after the infection. Here is a list of dengue symptoms in babies you should keep an eye out for.

• Flu-like Illness

In most cases, dengue fever in infants begins with the symptoms associated with viral influenza, such as high-temperature fever, runny nose, cough, and fatigue. In some cases, there can be a drastic drop in temperature as well.

• Change In Behaviour

Your child might be exhibit more agitation and irritability than usual, even without any apparent reason. They are also likely to cry often and throw tantrums. Children infected with dengue will also show a drop in appetite as well as sleep.

• Physical Discomfort

Affected children might experience muscle and joint aches, dull throbbing pain behind their eyes, back pain, splitting headaches, and so on. Due to the pain, which feels like bones being broken, dengue used to be known as “Breakbone fever”.

• Gastrointestinal Problems

Your child might complain of shooting pains in the abdomen along with nausea, vomiting and diarrhoea, which can be mistaken for symptoms of gastroenteritis.

• Skin Problems

A common symptom is an itchy skin rash that appears in patches. It has been described as a measles-like rash which looks like white islands in seas of crimson. Also, it becomes easier for the skin to get bruised from even moderate contact. Another symptom to look out for is a constant itch that appears on the soles of the feet.

• Bleeding

Children experience bleeding from their gums or nose due to a drop the platelet count. This is caused by the virus. This slows down the clotting rate of blood, making blood loss much easier. Bleeding can also occur in the gastrointestinal tract.

As mentioned above, in rare cases dengue can turn into far more dangerous conditions such as the Dengue Haemorrhagic Fever and the Dengue Shock Syndrome. The symptoms associated with these diseases are listed below.

• Abrupt and excess blood loss due to tears in the blood vessels.
• A rapid shock that occurs due to the bleeding.
• A drastic fall in blood pressure.
• Possible organ failure leading to coma.

What if Your Child Shows Symptoms of Dengue?

There are several things to keep in mind if you observe any of the described symptoms in your children.

• Put your child to bed, so they don’t get fatigued. They might need to be on bedrest for at least a week and up to a month depending on the harshness of their symptoms.
• Feed them light meals that will not strain their digestive system, such as soups, steamed vegetables, peeled fruits, and so on.

• If your child is still being breastfed, make sure you do not skip feedings. Breast milk is both nutritious and provides replacement fluids for the baby. Older kids will need enough fluids in their diet, ensure they get enough water. Oral Rehydration Therapy is also recommended to help balance their electrolytes; you can feed them solutions of oral rehydration salts which are available at most pharmacies.  Other natural ways to rehydrate include tender coconut water and citrus fruit juices.
• Soak a cloth in cool water and place it on their head; this will help reduce their temperature and calm the fever.
• Avoid medicating your child with over-the-counter pain tablets like ibuprofen or similar drugs that work to reduce swelling. This is because these medications can reduce the platelet count further, which can potentially lead to more blood loss.

Diagnosis of Dengue in Children

If you feel like your child is exhibiting any of the signs or symptoms as described above, consult with their paediatrician as soon as possible. This is especially important if your child shows signs of fatigue, fever, joint pains and rash. The doctor will conduct a physical examination to identify the symptoms. They might ask for your child’s medical history such as vaccinations. Further, they will ask about your child’s travel history. This is because several regions in the country or the world are known to be hotbeds of dengue. If your child has travelled in these areas, your doctor will be able to evaluate the situation better. After this, a sample of blood will be sent to a diagnostic lab to test for the presence of the dengue virus. If dengue is confirmed, the doctor will be able to begin a treatment protocol.

How to Treat Dengue in Children?

Currently, there is no cure for dengue fever; however, dengue has a very low mortality rate and tends to resolve in a few days to a month. Here are some tips on how to help your child feel minimal discomfort through the course of the disease.

• Make sure your child gets enough water and fluids as well as regular healthy meals. Consistent sleep is also quite important, so try to keep them on a sleep schedule, so they don’t get worn out. These steps are one of the most important to follow in fighting dengue as they will help strengthen their immune system to destroy the virus.
• If the muscle and joint aches get unbearable, they can cause unnecessary distress. Ask your child’s doctor to prescribe analgesic medications like acetaminophen, which do not pose any risk towards lowering the blood platelet count, unlike ibuprofen.
• If your child’s symptoms do not improve even after rest, your doctor needs to be notified. There is a chance that it could be Dengue Haemorrhagic Fever. In this case, your child might have to be admitted to a hospital where they will receive IV therapy, which constitutes an intravenous supply of fluids and salts to replace those lost due to vomiting and diarrhoea.
• If the symptoms of dengue do not resolve even after hospital treatment, the paediatrician might recommend a series of blood transfusions which will compensate for the blood lost during the disease.

How Can You Prevent Your Child From Dengue?

Prevention is better than cure in the case of dengue fever. Even though the dengue virus itself cannot be avoided, there are several ways by which you can avoid getting bitten by mosquitoes. Here are a few methods to implement to protect both yourself and your family:

• Mosquitoes prefer stagnant water so get rid of any still water lying around your house or locality. Join forces with your neighbours if necessary as this is a public hygiene matter. This will help avoid other mosquito-borne illnesses as well.
• Remove any objects like mugs, buckets, basins, pots and so on that could hold water. This includes draining sinks and bathtubs of all the water and wiping them dry.
• For standing water that cannot be removed, such as drains, fountains and ponds, you can add small amounts of kerosene over the water surface. This will prevent the mosquitoes from laying eggs in the water as the kerosene is toxic to them. Also, any hatched larvae under the water will be killed as the kerosene prevents oxygen from entering the water.
• You could have your house and neighbourhood fumigated by pest control professionals. Take care that you and your family are not around when this is being done as the fumes could be harmful. For a natural alternative, burning coconut husks and shells or neem leaves have been known to drive mosquitoes away.
• For personal safety, have your child wear clothing that covers their bodies entirely. This includes long-sleeved shirts, pants, socks and even gloves if the weather permits.
• Ensure your family performs basic hygiene practices such as showering as body odour is believed to attract mosquitoes.
• Use mosquito nets while sleeping, even if during the day. They are a safe alternative to mosquito sprays and vapourisers, which may negatively affect breathing and even cause problems with the functioning of the nervous system.
• Mosquito repellent creams are a good choice if protective clothing and nets are unavailable. Ensure they are safe for children before applying them on exposed skin.
• You can also install screen meshes on your window and door frames to keep the mosquitoes out. Buy good quality ones that are less likely to rip as mosquitoes can enter through the smallest openings. Remember to fix any tears in the mesh as soon as possible.
• Reduce their outdoor time during the rainy season; instead introduce them to fun activities in the house like board games, video games and so on. If they do go out to play, teach them to avoid areas with bushy foliage and stagnant water. Finally, insist that they return before sunset as this is when mosquitoes are most active.

Dengue epidemics are most common tropical zones whose climates allow mosquitoes to thrive. They are even more likely in third world countries where public sanitation is given little to no importance. Therefore, it is imperative that you take the required precautions to prevent your child from contracting the illness, especially due to the lack of a cure. Interestingly, there is a vaccine available for Dengue fever in some Southeast Asian and Latin American countries, but it remains only partially effective. Research to develop a vaccine for all the five types of dengue viruses is still ongoing.