Child Dengue Warning Signs: Paediatrician Doctor at Behala

The rains stop, Puja shopping begins, and somewhere in between a child comes home from school with a high fever. In Kolkata at this time of year, that fever could be dengue, malaria, typhoid or an ordinary viral illness, and on day one they look much the same. Here is what to watch for, which signs mean a hospital emergency, how to care for your child at home, and when to see a paediatrician doctor at Behala for an examination and blood tests.

Monsoon fevers: when to see a paediatrician doctor at Behala

Dengue in children in Kolkata usually rises after the monsoon, when rainwater collects in pots, buckets, rooftops and construction sites. Malaria is also seen in the city, and typhoid spreads through contaminated water and food.

All three can begin with sudden high fever, headache, body ache and tiredness. Some clues:

• Dengue: high fever, pain behind the eyes, strong body aches, a rash, nausea or vomiting. Younger children may simply be feverish, cranky and off their feed.

• Malaria: fever with chills or shivering, then sweating; the fever may come and go.

• Typhoid: fever that climbs over several days, tummy pain, constipation or loose motions.

None of these can be confirmed at home. In the dengue season, show a feverish child to a doctor within the first day or two rather than waiting for the fever to settle. Tell the child specialist doctor if someone at home or in class has dengue, or if your child waded through waterlogged streets. For fevers in general, read when a child's fever needs a paediatrician.

Dengue warning signs: the risky days come as the fever falls

Dengue usually has three stages: a few days of high fever; then, often around the third to seventh day, the fever comes down and some children get worse because fluid leaks out of the blood vessels; then recovery. So a falling temperature is not the all-clear. Watch your child most closely on the day the fever breaks and for at least 2 days after. A second dengue infection can be more serious, so tell the doctor about any past dengue.

Go to a hospital emergency now if your child has:

• Severe or persistent tummy pain, or a tender, swollen tummy

• Vomiting again and again, or cannot keep fluids down

• Not able to drink, or a baby refusing breastfeeds or bottle feeds

• Any bleeding: gums, nose, blood in vomit, black or bloody stools, new red or purple spots, or unusually heavy periods in a teenage girl

• Unusual sleepiness or difficulty waking, or marked restlessness or irritability

• Cold, clammy hands and feet, or pale, blotchy skin

• Feeling dizzy or faint on standing up, or a baby who is floppy or unusually quiet

• Very little urine, or none (a dry nappy) for 4 to 6 hours

• Fast or difficult breathing, fainting, or a fit (seizure)

• A temperature of 38°C (100.4°F) or more in a baby under 3 months old

Do not wait for a clinic appointment, whatever the day or time. Go straight to the nearest hospital emergency department.

Home care: fluids, rest and paracetamol only

If the doctor has examined your child and found no warning signs, most dengue care happens at home. Go back for a check-up and repeat blood test as often as the doctor advises, usually every day from about the third day of fever until the risky days are over, even if your child seems better.

Tell the doctor if your child is under one year old or has a long-term illness such as a heart, kidney or blood disorder, diabetes or obesity, because these children may need closer watching or a hospital stay.

Fluids. Offer small amounts often: ORS made exactly as the packet says, coconut water, dal water, rice water (kanji), soups, milk and fresh fruit juice, along with water. Do not rely on plain water alone: a child with dengue also needs the salts and sugar in these drinks. Breastfed babies should feed more often. Avoid fizzy and energy drinks. Less urine than usual is a reason to call the doctor.

Rest. Keep your child home from school and tuition, with light, home-cooked food.

Paracetamol only, if needed, at the dose your doctor sets for your child's weight, and no more often than the doctor advises. In dengue that is usually not more often than every 6 hours, and never more than 4 doses in 24 hours. Too much paracetamol can harm the liver, which dengue can already affect. Do not give it alongside any other medicine that also contains paracetamol, as many cold and cough syrups do. Paracetamol is for comfort, so it is fine if the temperature does not come all the way down.

No other painkillers. Do not give ibuprofen, aspirin, mefenamic acid, nimesulide, diclofenac or any other anti-inflammatory painkiller while dengue is possible. These make bleeding more likely in dengue. Aspirin should not be given to children at all. Check the label of every fever syrup or tablet: many combine paracetamol with ibuprofen or mefenamic acid, and these must not be used. Do not accept painkiller or "fever" injections from a chemist.

Sponging with lukewarm (not cold) water can add comfort. Never use ice, cold water or alcohol, and stop if your child starts shivering.

Please do not give antibiotics on your own. Dengue is a virus and antibiotics do not treat it; typhoid needs antibiotics only after a doctor has assessed your child. Skip leftover medicines and forwarded messages promising to "raise platelets". Keep a note of temperatures, fluids taken and urine passed to show the doctor.

Dengue NS1, CBC and platelet tests: what the doctor may advise

Blood tests help the doctor tell dengue apart from other fevers and track how your child is doing. The right test depends on the day of illness, so let the doctor decide:

• Dengue NS1 antigen: most useful in the first few days of fever.

• Dengue IgM antibody: usually more useful later in the illness.

• CBC (complete blood count): platelets, white cells and haematocrit (how concentrated the blood is), often repeated to see the trend. A falling platelet count with a rising haematocrit is a warning sign, because it can mean fluid is leaking out of the blood vessels.

• Malaria and typhoid tests: chosen by the doctor according to the symptoms and how long the fever has lasted.

A negative NS1 or IgM result does not always rule out dengue, so keep watching for warning signs and follow the doctor's advice on repeat tests.

A single platelet number does not tell the whole story; the doctor also looks at how your child looks, drinks and passes urine.

MCR has its own pathology lab in the same building, so the blood and urine tests your paediatrician advises can be done there after the consultation. Bring earlier reports for comparison. See also child consultation and blood tests in Behala.

Mosquito-proofing your home and your child's school

The Aedes mosquito that spreads dengue breeds in small amounts of clean, still water and bites mainly by day, especially early morning and late afternoon, so children are often bitten at school, tuition and the park. Malaria mosquitoes bite mostly at night.

At home, whether in Behala, Sarsuna, Thakurpukur or Parnasree:

• Once a week, empty, scrub and dry vases, buckets, plant saucers, cooler trays and fridge and AC drip trays.

• Cover water drums and tanks. Throw out tyres, coconut shells and broken pots from roofs and balconies.

• Use window mesh, and mosquito nets at night and for daytime naps.

• Dress children in light-coloured, full-sleeve clothes.

• Use a repellent suited to your child's age, following the label; ask your doctor before using one on a baby.

• Let a child with dengue rest under a net, even by day, so mosquitoes cannot carry the virus to others at home.

At school, ask whether full sleeves and repellent are allowed this season, point out water collecting on campus, and tell the class teacher if dengue is confirmed. With Puja outings coming, see our Durga Puja health tips for families.

Paediatricians at MCR, Behala, and how to book

Looking for a child specialist or pediatrician near Behala Tram Depot for your child's fever? Two of the paediatricians at MCR are:

• Dr. Agnik Chattopadhyay: 13 years of paediatric experience, focused on preventive and acute care. Languages: Bengali, Hindi, English. Fee: Rs 800.

• Dr. Debangshi Ghosh: MBBS, MD. In clinic on Thursday and Saturday, 11 AM / 6 PM; please confirm the session time when you book. Fee: Rs 500.

Other paediatricians also consult at MCR, some online; see the full list on our paediatrics department page. After the risky days are over and the doctor has confirmed your child is recovering, online consultation can help with follow-up questions. During the fever and the 2 days after it settles, your child needs to be seen in person and have the blood tests the doctor advises, and online consultation never replaces emergency care.

How to book at MCR. Call or WhatsApp 9830525004, or tap Book Now on our paediatrics page.

MCR Super Speciality Polyclinic & Pathology is at 11A, Sourin Roy Road, near Behala Tram Depot, beside Ellora Cinema Hall, Behala, Kolkata 700034, within reach of Barisha, Silpara, Joka, Taratala, New Alipore and Tollygunge.

Clinic hours: Monday to Saturday, 8 AM to 8 PM; closed on Sunday. Consultation days and times differ between doctors, so confirm the time when you book. If any warning sign appears, on any day and at any time, go straight to a hospital emergency department. Do not come to the clinic or wait for an appointment.

Frequently asked questions

Can I tell at home whether my child has dengue, malaria or typhoid?

No. They often start the same way. A paediatrician will examine your child and advise tests based on the day of illness. Until then, give fluids, paracetamol only if needed, and watch for warning signs.

When should the dengue NS1 test be done?

It is most useful in the first few days of fever. Later, the doctor may advise a dengue IgM test instead, along with a CBC. A negative NS1 or IgM result does not always rule out dengue, so keep watching for warning signs and follow the doctor's advice on repeat tests.

My child's fever has come down. Is the dengue over?

Not necessarily. The riskiest period often begins as the fever falls. Watch closely for at least 48 hours (2 days) after the fever settles without paracetamol. Keep up fluids, go back for the check-up and blood test the doctor advises, and go to a hospital emergency if any warning sign appears. A temperature that comes down only because of paracetamol is not the same as the fever breaking.

What platelet count is dangerous for a child with dengue?

No single number fits every child. The doctor looks at how the platelet count and haematocrit are changing and at your child's condition. Any bleeding needs a hospital emergency.

When can my child go back to school after dengue?

Only after the risky days are over. That usually means at least 48 hours (2 days) with no fever and no paracetamol, your child is eating, drinking and passing urine normally, and the doctor has checked them (often with a repeat platelet count) and agrees. Tiredness can linger. Avoid contact sports, cycling and rough play until the doctor confirms the platelet count has recovered, and keep protecting your child from mosquito bites.

This article is general information, not a substitute for a consultation with your child's doctor; if you notice any warning sign, go to a hospital emergency.