Too quiet

The child with a fever (or a reported fever, as in this case) has a wide range of potential illnesses that must be considered. The pediatric community approaches children in three age groups: those younger than three months, those between 3-24 months, and those over 24 months. Those under three months of age are most at risk for serious problems, and the physical examination of the child is most unreliable. Infants most at risk for infection have smaller birth weights, mothers with infectious diseases such as chlamydia or HIV, and labor following premature rupture of membranes. Infants cannot offer complaints; have poorly functional muscles that do not allow the demonstration of neck stiffness or stiff joints; and cannot cough productively to demonstrate pneumonia. The most strenuous activity for an infant is eating, so ill infants will often feed poorly. The emergency physician or pediatrician will want the prehospital emergency provider to observe the behavior of an ill child to gain an indication of the seriousness of the illness. The Yale Observation Scale uses six criteria to stratify the ill child. The ill child will have poor color, a weak or high-pitched cry, poor hydration (dry diaper and mucous membranes), little reaction to parental stimulation, little arousal or continuous sleeping and no smile. This child demonstrated many criteria of an ill child. Her temperature was likely high at the onset of illness (while in her crib), which was not detectable by the time the EMS crew did its evaluation. Difficulty breathing is a common observation in ill infants by their parents, and the child had a dry diaper. A quiet child is not to be considered a healthy child, and like many EMS situations, the crew was appropriately "worried most about the quiet one."