Dangerous mistakes made by parents of children diagnosed with dengue

By Dr. Ajith Amarasinghe
MBBS, M.D., DCH (COL) MRCP, MRCPCH (U.K) MBA (Healthcare) (Manipal), DAA (Vellor) Consultant Pediatrician

With the monsoon rains flooding the streets, parents are on edge about dengue and are quick to assume that their child has dengue at the first sign of a fever. As the end of the monsoon season is approaching soon, the onset of dengue will begin. Therefore, you should take the necessary precautions to minimise the risk of breeding dengue mosquitoes in and around your house. Additionally, public places such as schools, hospitals and government institutions should be cleaned to control the breeding of dengue mosquitoes. Also, cover your child’s bed with mosquito nets and ensure that they wear long-sleeved shirts and trousers while playing outside.

With the monsoon rains flooding the streets, parents are on edge about dengue and are quick to assume that their child has dengue at the first sign of a fever. As the end of the monsoon season is approaching soon, the onset of dengue will begin. Therefore, you should take the necessary precautions to minimise the risk of breeding dengue mosquitoes in and around your house. Additionally, public places such as schools, hospitals and government institutions should be cleaned to control the breeding of dengue mosquitoes. Also, cover your child’s bed with mosquito nets and ensure that they wear long-sleeved shirts and trousers while playing outside.

1. Inferring the antigen test results without consulting a doctor

Dengue fever usually begins as a regular fever with additional symptoms such as severe headache and continuous vomiting. If a fever begins with these symptoms, then it is safe to start treatment for dengue fever. However, during the first three days of the fever, the symptoms of dengue fever and dengue hemorrhagic fever will not be visible. A dengue antigen test needs to be carried out, when prescribed by a doctor, to confirm the presence of the virus in your child’s body.

It is not advisable for parents to make decisions based on the antigen test results without consulting a doctor as the results could be misleading. A positive result of the dengue test does not necessarily mean the child needs to be admitted, and a negative test result doesn’t indicate the absence of the virus in your child’s body. To accurately infer from the antigen test results and decide if hospitalisation of the child is required, blood tests need to be done to measure the decrease in platelet count. Antigen tests done within three days of onset of the fever may also give a false-negative result as it may take more than three days for the virus to surface. Therefore, it is dangerous to analyse the antigen test results without consulting a doctor.

2. Not giving sufficient liquid food

The first three days after being diagnosed with dengue are crucial. Firstly, the necessary dose of Paracetamol needs to be given, and if needed a dose of anti-vomiting medication can be added. Like adults, children tend to have less appetite for dry food while having a fever. Therefore, provide the child with more liquid food sources such as soups, porridge, fruit juice, oral rehydration solutions (Jeewani) etc.

3. Sending your child to school

Do not send a child diagnosed with dengue to school, no matter what. Most parents are tempted to send their child for examinations and sporting events even when the child is unwell. Lack of rest can severely worsen the health of the child. Resting at home is essential for a child with a fever and can drastically reduce the risk of dengue fever as well. By not sending the child to school, the school administration can assure that the dengue fever doesn’t spread across to other students by ensuring the teachers take necessary actions to send children with fever back home. 

Only 10% of the children with dengue fever proceed to the state of dengue hemorrhagic fever. The rest of the 90% will lose their platelet count with a severe fever and can be treated with the right amounts of fluids.

 Children with dengue hemorrhagic fever will require hospitalisation and treatment from a specialised doctor. The doctor will ensure to measure the blood pressure and platelet count frequently and provide treatment for any side effects that may arise.

4. Attempting to increase the platelet count through varying drugs

Upon the onset of dengue, the platelet count continues to drop for seven days, and there are no medically proven method to increase the platelet count. However, there are local medical methods that have brought forth the idea that papaya leaf juice and red onions drink can increase the platelet count naturally. However, this hypothesis has not been proven by the western medical sciences through experimentation and parents should be aware of this. Parents need to understand that the continuous drop in the child’s platelet count is not due to the medication failing to perform but rather due to this being the main characteristic of dengue fever. Therefore, parents must act with patience during the first seven days of the fever.

5. Not allowing your child to rest sufficiently

The first and most critical step is to identify dengue fever as early as possible. After that, the most important step is to take the prescribed medications properly and provide the patient with the required rest. It is not necessary to be hospitalised merely due to dengue fever.

6. Expecting the doctor to admit your child to take better care

One of the most common misconceptions about dengue is that everyone who has been diagnosed with dengue should immediately be hospitalised. Another misconception is that Paracetamol should not be given to the patient. In fact, children with fever should be given Paracetamol in the correct dosage. Some doctors might prescribe Ibuprofen, Mefenamic acid and even Diclofenac, which is to be administered rectally, but this is an incorrect prescription as these drugs can increase the likelihood of a normal dengue fever worsening to dengue hemorrhagic fever. Parents should not pressure the doctor to provide prescriptions to decrease the fever of the child. Instead, the parents should provide the necessary dosage of Paracetamol and wet the child’s body to reduce the fever.

7. Waking up a sleeping child

By waking a child up at night, to provide liquids, you will make the child lose the rest that they require to recover. 

Abiding by the prescribed methods and providing the child with the required rest and hospitalisation when necessary can prevent the dengue from worsening and save the child.

8. Assuming you can get dengue only once

There are four types of dengue viruses; therefore, there’s a chance that a person can catch the dengue fever four times. In some cases, the dengue virus enters and leaves the body without causing a fever or in some cases; it might cause just a slight fever. The immune system of the body is the main factor behind it. There is a misconception that after having dengue fever, the next fever that follows will be quite severe. This is not entirely accurate as the dengue virus behaves in different patterns in different years.

10% of dengue patients proceed to the dengue hemorrhagic state and from which, 1% die from dengue fever. 

 

The main symptom of dengue hemorrhagic fever is the loss of blood pressure. Other issues arise from this main symptom, and this situation is called ‘a shock’ by doctors. It is dangerous if the blood pressure is dropping at a rate higher than the rate at which the platelet count is decreasing. The blood pressure can be controlled by intravenous fluids. In such cases, the doctor will decide and take the necessary step to provide a liquid such as saline to the patient. 

 For some dengue patients, the recommended amount of liquid cannot be taken in due to vomiting and lack of appetite. Parents should notify the doctor in such cases so the doctor can provide the necessary prescription through other means to reduce the risks. Therefore, nighttime rest is crucial for a child recovering from or hospitalised with dengue fever.

9. Not giving sufficient rest to the child upon recovery.

Rest is essential for a child that has survived the dengue fever. It would be best if the child is not sent to school for a few days after being cured of the fever. Also, parents should make sure that the children do not engage in sports for a short amount of time. The dengue virus affects the organs in the body in various ways, therefore, parents should try to make sure not to exhaust their children for a couple of weeks.

Discussed with and compiled by Rasi Weerasinghe.
This article was first published in the Divayina newspaper and is reproduced here with the permission of Dr. Ajith Amarasinghe.