Dengue in Children: 7 Warning Signs Parents Should Never Ignore
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Dengue typically progresses through different phases. A falling temperature does not always mean that a child has completely recovered.
According to the World Health Organization, symptoms of severe dengue frequently develop after the fever has gone away. The CDC also advises that warning signs often begin during the 24 to 48 hours after the fever subsides.
This is why parents should continue observing their child closely even when the thermometer appears reassuring. Pay attention not only to the temperature, but also to how your child is behaving, drinking, breathing and passing urine.
A child with fever may occasionally complain of mild discomfort, but severe or persistent abdominal pain should not be dismissed, particularly if dengue has been diagnosed or is suspected.
Abdominal pain or tenderness is recognised as an important warning sign of severe dengue. Younger children may not always be able to explain where or how much it hurts. Look for signs such as:
If abdominal pain becomes severe or continues to worsen, seek medical attention promptly.
One episode of vomiting may occur with many childhood illnesses. Repeated or persistent vomiting is different and requires attention.
Persistent vomiting is one of the recognised warning signs associated with severe dengue. Repeated vomiting can also make it difficult for a child to maintain adequate fluid intake, increasing the risk of dehydration. Contact a doctor urgently if your child:
Do not wait simply because the fever has already reduced.
Any unusual bleeding in a child with suspected dengue needs medical assessment. Watch carefully for:
Bleeding from the nose or gums and blood in vomit or stool are among the recognised warning signs of severe dengue. Parents should not attempt to judge the seriousness of bleeding based only on the amount seen. If unusual bleeding appears, particularly when accompanied by weakness, abdominal pain, vomiting or drowsiness, seek urgent medical advice.
Pay close attention to changes in your child's breathing. Rapid breathing or difficulty breathing can be a serious warning sign and requires prompt medical attention.
WHO lists rapid breathing among the symptoms associated with severe dengue. Severe disease can involve fluid leakage and respiratory distress, which is why breathing difficulty should never be treated as a symptom to simply observe at home.
Seek urgent medical care if your child:
Breathing difficulty in any sick child warrants medical assessment.
Parents often expect an ill child to sleep more than usual. There is, however, an important difference between a tired child who responds normally and one who is unusually drowsy, difficult to wake, confused or extremely restless.
Lethargy and restlessness are recognised dengue warning signs. Altered mental status, including significant drowsiness or irritability, is also highlighted in clinical dengue guidance. Watch for changes such as:
Parents know their child's normal behaviour better than anyone else. A significant change should never be ignored.
A child's skin can give parents important clues about how unwell they may be.
Cold, pale or clammy skin, particularly when accompanied by weakness, restlessness or unusual sleepiness, can indicate that the child needs urgent medical attention.
WHO includes pale and cold skin among symptoms associated with severe dengue. Do not assume that cold skin simply means the fever has broken.
If your child suddenly appears pale, feels unusually cold or clammy, or seems significantly weaker as the temperature falls, seek medical help promptly.
Hydration is extremely important when caring for a child with suspected dengue. Fever, poor appetite and repeated vomiting can reduce fluid intake and contribute to dehydration. Reduced or absent urine output is also highlighted in WHO dengue case-management guidance as a sign requiring careful attention.
Parents should watch for:
If your child cannot drink adequately or is passing significantly less urine, contact a doctor rather than trying to manage worsening dehydration at home.
This is perhaps the most important point for every parent to remember. In dengue, a falling temperature does not always mean the danger has passed.
The period immediately after the fever settles can be particularly important, because this is when severe dengue warning signs may develop. Continue monitoring your child carefully. Look at the whole child, not just the thermometer.
Ask yourself:
• Are they drinking?
• Are they passing urine?
• Are they alert and responding normally?
• Are they breathing comfortably?
• Are they vomiting repeatedly?
• Is there abdominal pain or bleeding?
If something does not look right, seek medical advice.
If dengue is suspected, arrange medical assessment and follow your paediatrician's advice closely.
Encourage adequate fluids as advised by the treating doctor. Water and suitable fluids can help maintain hydration, particularly while the child has fever. If your child is vomiting repeatedly or unable to retain fluids, seek medical attention rather than repeatedly forcing large quantities of fluid.
Paracetamol may be used for fever and discomfort when advised in the appropriate dose by your child's doctor. Never guess a child's medicine dose based on an adult dose or another child's prescription.
Do not give aspirin or ibuprofen to a child with suspected dengue unless a doctor has specifically determined otherwise. WHO advises that aspirin and non-steroidal anti-inflammatory medicines such as ibuprofen should be avoided in dengue because of the risk of bleeding. If you are unsure what medicine your child can safely take, speak to a paediatrician before giving it.
Do Not Wait for Dengue Warning Signs to Become Severe
When a child has dengue, careful observation can be just as important as monitoring the fever. A child who was talking, drinking and responding normally earlier in the day but suddenly becomes unusually sleepy, starts vomiting repeatedly, develops severe abdominal pain or shows any sign of bleeding needs prompt medical assessment.
Most importantly, never assume that your child is out of danger simply because the fever has come down. Early recognition of warning signs and timely medical care can make an important difference.
If you suspect dengue or notice any warning signs in your child, consult the Paediatrics team at Neotia Bhagirathi Woman and Child Care Centre, Guwahati promptly.
Give your child the right care at the right time.
Important warning signs include severe abdominal pain, persistent vomiting, unusual bleeding, rapid or difficult breathing, extreme sleepiness or restlessness, cold or pale skin and reduced urination or other signs of dehydration. Warning signs require prompt medical assessment.
Yes. This is one of the most important facts parents should know. Severe dengue warning signs can appear after the fever has settled, often during the following 24 to 48 hours.
Seek urgent medical care if your child develops severe abdominal pain, persistent vomiting, bleeding, breathing difficulty, marked drowsiness or confusion, unusually cold or pale skin, significantly reduced urination or other concerning deterioration.
Persistent vomiting is a recognised warning sign of severe dengue and can also contribute to dehydration. A child who vomits repeatedly or cannot keep fluids down should be medically assessed.
Ibuprofen and aspirin should be avoided when dengue is suspected because these medicines can increase the risk of bleeding. Paracetamol is generally used for fever, but in children it should be given in an age and weight-appropriate dose according to medical advice.
Reduced urination, dry mouth, excessive thirst, unusual weakness and difficulty taking fluids may indicate dehydration. Persistent vomiting or significantly reduced urine output requires medical attention.
