Many seemingly harmless situations can be significant signs of serious problems in children.

My 2-year-old daughter just got into the laundry room and drank a little bleach. I gave her some water to dilute it. She should be all right, shouldn’t she?

Bleach, cleansers, dishwasher detergents, and drain cleaners are caustics that can cause immediate and severe burns to mucus membranes in the mouth, esophagus, or stomach. Even a seemingly small quantity of bleach can significantly burn the esophagus when swallowed and any child who is thought to have ingested any of these substances should be brought to medical attention immediately, preferably in a children’s hospital where appropriate children’s specialists can look for those burns. Appropriate therapy can be instituted and hopefully prevent any dangerous scarring of the esophagus. If untreated, surgery could be necessary to replace the esophagus as a ruptured esophagus can lead to an air-leak around the lungs or heart as well as infections. Under no conditions should an emetic (like Ipecac) be given to a child who ingests a caustic to induce vomiting. Bleaches, etc., can cause burns as easily coming up as they do going down.

My 1-month-old caught a virus from her brother and is running a 101oF (38.2oC). What is the dose of Tylenol?

The age of the child is the issue with this question, not the Tylenol dosage. We worry about ANY fever in an infant less than 2 months old. Those of you who know me know that I try to help people to overcome “fever phobia,” i.e., exaggerated fears about fever in children. Fever, taken rectally, is considered any temperature above 100.6oF (38.0oC). Most of the time, fever is benign and just a sign of frequently insignificant infections. In a newborn before her 2-month birthday, however, a fever can be the only sign of a significant, life-threatening infection. Just because her brother had a “virus” should not reassure us that that is all that the baby has. Immediate medical attention should be sought, tests done, and possibly IV antibiotics instituted until the tests reassure us that it’s “just a virus.”

My 4-year-old just vomited and there was some green liquid in it. Is that OK?

I frequently remark to parents that a child throwing up once or twice is no cause for concern by itself. However, when there is bile in the vomit (greenish yellow liquid), a red flag should go up. Bile comes from the small intestine, which could mean that there is an obstruction farther downstream. Obstructions could be caused by a twisting of the bowel, an appendicitis, or a telescoping of the bowel inside itself (intussusception). These conditions require immediate attention, so when the vomit is green, call the doctor right away.

My son has a peculiar rash consisting of bruises and blood spots. Is this one of those “summer viruses”?

The enteroviruses, or “summer viruses,” can cause peculiar rashes but nothing that resembles bruises or blood spots. This type of rash (bruises or blood spots) can be the first sign of a serious infection called meningococcemia. Meningococcoccus is a bacteria which, when it infects the blood, can cause shock and death in a few hours. Treatment with antibiotics and other medications must be begun immediately and the child should be brought to the emergency room as soon as possible. Children with meningococcemia frequently run a fever and look very pale. Any abnormal bruising (bruises where there is no injury) or petechiae (blood spots) should prompt the parent to seek immediate medical attention. Although there are other causes of these symptoms (low platelet counts, Henoch-Schoenlein Purpura, capillary hemorrhages due to coughing or holding the breath, etc), caution dictates that one assume that it is meningococcemia until proven otherwise.