Dengue in Children: What Parents Need to Know

Dengue Classifications and Phases

Dengue is a viral infection caused by carrier mosquitos. Before we discuss the dengue symptoms in a child, let’s first take a look at the classifications and phases of this condition.

According to the Department of Health, dengue fever has three classifications:

There are three phases of dengue fever in children and adults: 

Febrile Phase

Stage 1: Febrile Phase runs anywhere between 2 to 7 days. 

Critical Phase

Stage 2: The Critical Phase lasts 1 to 2 days, and runs the risk of bleeding or plasma leakage and this requires close monitoring.

Convalescence Phase

Stage 3: Convalescence Phase lasts up to 3 to 5 days. 

Before things get too serious, warning signs are present even though there are asymptomatic cases of dengue. 

All forms of dengue may require hospitalization and close monitoring, but severe dengue are the more fatal or severe cases of dengue, and they need the most critical care and attention from the doctor and nurses. 

The dengue symptoms in a child can also be more dangerous as their bodies are more frail than that of adults. Infants in the pediatric group pose the highest risk of all. In any case, early detection is key to a more successful and less painful dengue treatment or therapy.

Causes and Risk Factors

According to Pediatric Infectious Disease of Elsevier, a single mosquito bite from a type that breeds in stagnant water (species Aedes aegypti and Aedes albopictus) can cause serious problems in the body, especially in active children. 

Globally, 75% of dengue cases every year come from the Asia Pacific region according to the Philippine General Hospital. This viral disease thrives in tropical and subtropical areas. 

In 1970, there were only nine countries that had reported cases of dengue fever. Today, there are more than 100 countries infected with the disease. Worldwide, there are around 50 to 100 million dengue cases reported annually. Dengue has become so widespread that Indonesia proposed to assign June 15 as Dengue Day for all ASEAN countries. Indonesia consequently has the highest incidence of dengue fever in Southeast Asia.  

Here as some fast facts on the incidence of dengue:

• Globally, 75% of dengue cases every year come from the Asia Pacific region according to the Philippine General Hospital. This viral disease thrives in tropical and subtropical areas.
• In 1970, there were only nine countries that had reported cases of dengue fever. Today, there are more than 100 countries infected with the disease.
• Worldwide, there are around 50 to 100 million dengue cases reported annually.
• Dengue has become so widespread that Indonesia proposed to assign June 15 as Dengue Day for all ASEAN countries. Indonesia consequently has the highest incidence of dengue fever in Southeast Asia.

Signs and Symptoms

As with any childhood illness, awareness and early intervention is key. The dengue symptoms in a child are as follows.

• Fever. Dengue without fever is also possible, but fever is one of the hallmark signs of the disease. If a child experiences non-stop or intermittent fever for 2 to 3 days, it may point to infection. Consult your  pediatrician.
• Severe Headache. If your child complains of a severe headache, this is another hallmark symptom that you can relay to their pediatrician.
• Bone pain or arthralgia
• Muscle pain or myalgia
• Redness and some pain behind the eyes (also known as Retro-Orbital Pain). Pain behind the eyes, sometimes accompanied by redness.
• Rashes. The rashes usually take a while to come out in some children. But some children have it as early as the Febrile Phase. They may also appear during convalescence phase.
• Nausea or vomiting occasionally occurs in some cases, but it is not considered a classic symptom. Poor appetite and general malaise may also be observed in most cases of dengue fever in children

Aside from knowing the dengue symptoms in a child, it’s also important to be aware of the warning signs of dengue.

The warning signs of dengue should be monitored as they could lead to more severe complications.

The warning signs of dengue are:

• abdominal pain or tenderness
• persistent vomiting
• clinical signs of fluid accumulation (ascites)
• lethargy or restlessness
• liver enlargement
• increase in hematocrit and/or decreasing platelet count
• Bleeding gums or bleeding anywhere in the body. Any form of bleeding or a positive tourniquet test is also a warning sign of dengue fever in children. This includes mucosal bleeding, such as bleeding gums, nose bleeding, hematuria, melena.

Diagnosis & treatment

When observing the dengue symptoms in a child, laboratory tests can further help confirm diagnosis. These are some of the most common tests, which can also be prescribed for adults.

Diagnostic Tests for Dengue

• NS1/Ag test. This test provides quicker results, but is less reliable due to false negative results. This test may confirm Dengue, but is usually done on day 2- 7 at the onset of fever. However, some test have false negative results, must rely on the diagnosis clinically
• IgG/IgM test. This can be done five days after the onset of a fever.
• CBC. A complete blood count is usually done as part of routine procedure during close monitoring. This checks for white blood cell levels and platelets.
• Hematocrit test. A hematocrit concentration test is also done to measure the proportion of red blood cells present in the blood. Our hematocrit concentration levels measure the ratio of the volume of red cells compared to the volume of whole blood in our bodies.

The platelet count of the body is also monitored closely, as one of the dengue symptoms in a child (and adults) include reduce platelet values. They may also occasionally need blood plasma transfusion during treatment.

A platelet count of less than 100,000/mm2³ is typically considered as a top criteria for hospital admission.

How is dengue treated?

Typically, dengue symptoms in a child will run their course, and treatment is usually supportive in type, depending on what phase of the dengue fever the patient is in.

At this point, constant hydration by regular intake of fluids and avoidance of taking steroids or NSAID medication will help.

As part of treatment, the medical team may also use an IV drip containing a saline solution to help the patient recover faster, like in most hospital admission cases.

Keep monitoring dengue fever, especially if the fever is gone (critical phase). If there are no warning signs and complication in the patient, recovery will only need rest and hydration.

Dengue fever recovery is spontaneous, especially in children, once the fever has passed or has finished running its course in the body.

Good nutrition, fever reduction, and daily complete blood count are common procedures done as part of monitoring. 

In more severe cases, however, stabilizing the patient from shock is essential as well as watching out for plasma leakage and liver enlargement.

This may need more medical attention than the usual strain of dengue fever in children. 

Prevention

there is no specific diet necessary for dengue. Patients who are able to tolerate oral intake should be encouraged to drink rehydrating solutions/ water to prevent dehydration. Bed rest may also be recommended.

With regards to lifestyle changes/ prevention to avoid dengue is to avoid getting bitten by a mosquito.

1. Apply mosquito repellant
2. Wear protective clothing
3. Stay in well-screened or air conditioned places
4. Eliminate accumulation of stagnant water around human habitats

Some anecdotal evidence indicates that capsules or infusions of the Euphorbia hirta plant, locally known as tawa-tawa, helps in the recovery of a dengue patient’s platelet count. Further study of this is needed and the practice of consuming the plant as a treatment is not guaranteed to have any benefits whatsoever.

In most cases, a child with dengue symptoms should just be kept comfortable and allowed to recover from the disease in time.