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# Mometrix ## Presence of an Abrupt Increase in Fever - May manifest with headaches, nuchal rigidity and pain, and positive Kernig and Brudzinski signs - **Positive Kernig's sign:** Flex each hip and then try to straighten the knee while the hip is flexed. Spasm of the hamstrings makes this pai...

# Mometrix ## Presence of an Abrupt Increase in Fever - May manifest with headaches, nuchal rigidity and pain, and positive Kernig and Brudzinski signs - **Positive Kernig's sign:** Flex each hip and then try to straighten the knee while the hip is flexed. Spasm of the hamstrings makes this painful and difficult. - **Positive Brudzinski sign:** With child lying supine, flex the neck by pulling head toward chest. The neck stiffness causes the hips and knees to pull up into a flexed position. ## Croup Syndromes - Croup is not a disease in itself but rather a syndrome of disorders characterized by a distinctive, harsh, "barking" repetitive cough and hoarseness, resulting from inflammation in the area of the larynx. - Croup syndromes may affect all areas of the upper respiratory system. - Because the larynx is very small in infants and small children, inflammation may become obstructive. - **Acute spasmodic laryngitis (ASL)** occurs in children from 3 months to 3 years and usually appears suddenly at night with severe cough, dyspnea, and restlessness that awakens the child. - Fever is absent. - The symptoms usually are not evident in the daytime but do tend to recur. - ASL may be related to allergies. - **Treatment includes:** - Cool humidifiers are often used in the child's room, but acute attacks may be relieved by the warm steam of hot running water (such as a running shower) in a closed room. - Some children may stop coughing if exposed to cold air - Corticosteroids may be used occasionally to reduce inflammation. ## Symptoms - **Acute epiglottitis** (supraglottis) occurs in children primarily from 1-8 years of age although it can occur at any. - Acute epiglottitis requires immediate medical attention as it can rapidly become obstructive. - The onset is usually very sudden and often occurs during the night. - The child may awaken suddenly with a fever, but usually does not have a cough. - The symptoms include: - **Tripod position:** Child sits upright, leaning forward with chin out, mouth open, and tongue protruding - **Agitation:** The child appears restless, tense, and agitated - **Drooling:** Excess secretions combined with pain or dysphagia and mouth open position cause drooling - **Voice:** No hoarseness, but voice sounds thick and "froglike" - **Cyanosis:** Color is usually pale and sallow initially but may progress to frank cyanosis - **Throat:** On examination, the epiglottis appears bright red and swollen. NOTE: the child's throat should not be examined with a tongue blade unless intubation and tracheostomy equipment is immediately available as the examination can trigger obstruction ## Pediatric Manifestations of Acute Respiratory Infections - **Nasal and respiratory symptoms include:** - **Nasal:** May include swelling of nasal passages, causing obstruction that can interfere with feeding in small infants. Exudate may be thin and watery or thick and purulent, depending upon the type of infection. Irritation about the nares and upper lip related to exudate is common in infants and small children. - **Sore throat:** Usually a complaint of older children. Small infants and children may have an inflamed throat but appear to suffer less discomfort.