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Pediatric Case study: 6-Month-old fever and diarrhea

Samantha L. Heaton

United States University

MSN 593

Dr. Jennifer Collinsworth

Pediatric Case study: 6-Month-old fever and diarrhea

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Introduction:

The patient presented in this case study is a 6-month-old male whose mother states he has

been having diarrhea and fever for the past several days. The mother also thinks he is not feeding

as much. The mother’s delivery is stated as uncomplicated at 39 weeks and 5 days. The baby’s

physical exam was unremarkable, as he is warm and quiet with clear lungs and normal heart

beat. He is fully vaccinated and has not missed any physical exams.

HPI

For the 5 questions the general place to start would be with what is occurring in the

moment regarding what is most concerning to the patient/parent.

1. When did the symptoms start for your child?

The onset of symptoms, particularly fever, is particularly important due to discover this

aspect in viral infections in children due to the natural timeline of a virus in the child and if it is

evolving into something more serious. Some viral illnesses can be treated if the onset is within a

couple of days and this is also helpful to know. (Olchawa-Czech, 2020)

2. Does the patient have normal wet diapers or making tears?

The normal way to tell if the child is dehydrated is the by weight. With infants the weights

should be expenitially accelerating with their rapid growth. So weight when the technician

checks the infant in would be one thing to evaluate. The other is to ensure the baby is making

enough urine. It would be difficult to determine with diarrhea, so the lack of tears might be an

efficient back up question. (Prisco, et. Al., 2021)

3. Is the stool dark and tarry or red and bloody?

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Shigella is the most frequent type of diarrhea with blood. The manifestation of this type of

infection usually diappears within a few days. Even though it usually moves through the system

quickly in healthy individuals, it is important to note that acute diarrhea is one of the major

causes of mortality in children under the age of 5. (Gouveia, et., al., 2020)

4. Is your baby teething?

The most common side effects of teething are diarrhea, vomitting, and fever. Fever is the

most common followed by diarrhea and lastly was the vomitting. (Oziegbe, et. Al., 2009) Loss of

appetite has also been linked to an infant breaking in new teeth, so it would not be abnormal to

see the symptoms this child is showing in the clinic. (Butt, et. Al., 2022)

5. Have you given any medication for the fever?

Antipyretics for fever should be given according to weight and not according to age. It

can be easy for parents and gardians to overdose or underdose these small patients. This can

create havoc in their little bodies. (Ward, 2019)

Signs of an Emergency

Most of the time diarrhea and other viral gasterointestinal issues can be resolved at home

under the supervision of a parent. There are certain signs that if noticed should be addressed by a

health care provider. These include

 Fever lasting over 48 hours

 Bloody stools

 Vomiting lasting over 24 hours

 Vomiting that looks green

 Abdomen that is swollen

 Will not eat OR drink

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 Severe abdominal pain

 Sudden devolopment of jaudice or rash (American Academy of Pediatrics, 2020)

Dehydration can create situations of possible mortality for infants. This is usually

caused by diarrhea or vomiting. Some of the signs of dehydration include listless,

lethargy, sunken fontenelles, thready pulse, tachycardia, tachypnea, fewer tears, or

decreased minimal urine output. (Vega & Avva, 2022) Loss of fluid can also cause

electrolyte imbalance which can create cardiac irregularities and these can also be lethal.

Chronic and severe inflammation of the colon can lead to toxic mega colon which is very

rare, but extremely deadly due to the high risk of bowel perferation. The major sign for

toxic megacolon is severe bloody diarrhea. (Desai, et. Al., 2020) Parents should also be

on the lookout for intussecption which can occur during or after a viral infection of the GI

system. These babies are fussy and draw up their legs and vomit and pass a stool. There

may be a sausage shaped mass which is palpaple on exam. The stool may appear like

currant jelly. (Patel & Kay, 2021)

Differential Diagnosis

Infective gasterointeritis (A08.4)

Gasteroenteritis accounts for 1.5 million office visits and over 300 deaths of children a

year in the United States. Acute gasterointeritis is identified by abrupt onset of diarrhea

with or without nausea and vomiting and accompanied by fever and abdominal pain.
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(Hatman, et. Al., 2019) This particular diagnosis checks all the boxes and seems to be the

leading diagnosis. The baby is dealing with diarrhea and fever and not feeding much.

With gasteroenteritis being accompanied by abdominal pain, the baby is not going to

want to eat much if he is in pain.

Teething (K00.7)

Teething generally starts around the age of 6 months and teething is one of the bains of

infancy as any parent will tell you. This is why education for the parent of infants is

particularly important. These symptoms coincide with teething and gasteroenteritis so

severity of the fever and diarrhea as well as the presentation in the clinic is very

important. If the parent was so brush off the symptoms because they thought the infant

was just teething and did not know the emergent signs of dehydration this could be a

problem.

The most common side effects of teething are diarrhea and fever. Loss of appetite can

also reside in the realm of teething since the pain of the teeth erupting can create swelling

of the gums and irritation in the mouth. (Prandan, et. Al., 2020)

Food sensitivities (Z91.01)

Although not as likely sometimes even breastfed babies can be sensitive to the food the

mother eats and can create inflammation of the gut tissue creating diarrhea and fever. If

this is identified as an issue, an elimination diet of the mother would be helpful to

identify triggers. (Ranjani, et. Al., 2020)

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Conclusion:

While gasteroenteritis is the most likely culprit with this infant, the other two could be

overlapping and it is important to not rule anything out unless absolutely definitive with

testing. Education helps parents to understand the importance of when to seek help and

when it is important to follow up if the fever goes away and then suddently reappears.

Taking care of infants can be intimadating, but with the knowledge at hand can save

lives. Dehydration and sepsis can be killers in cases such as this. If providers arm

themselves and the parents with knowledge, poor outcomes can be mitigated.
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References

American Academy of Pediatrics., (2020) Health issues: Diarrhea in Children, what Parents

need to know., https://www.healthychildren.org/English/health-

issues/conditions/abdominal/Pages/Diarrhea.aspx

Butt, R. T., Janjua, O. S., Butt, W. T., & Qureshi, S. M. (2022). All about Teething–Myths to

Evidence-Based Treatment. Foundation University Journal of Dentistry, 2(2), 122-132.

DOI:10.33897/fujd.v2i2.302

Desai, J., Elnaggar, M., Hanfy, A. A., & Doshi, R. (2020). Toxic megacolon: background,

pathophysiology,management challenges and solutions. Clinical and experimental

gastroenterology, 13, 203.

Gouveia, M. A. D. C., Lins, M. T. C., & Silva, G. A. P. D. (2020). Acute diarrhea with blood:

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