The prevalence of asthma is increasing in western countries. Over two million Australians suffer with asthma, and one in every four to five children will have some asthma symptoms at some stage. The Federal Government has identified asthma as a national health priority area, and $48 million was recently allocated to support general practitioners in providing high quality care to patients with asthma using the 'Three Plus visit plan'. Asthma is the commonest medical reason for children to be admitted to hospital. Asthma is clearly a major paediatric health problem, and it is important for community nurses to be up to date with current asthma best practice management to be able to advise parents.
There are various ways of defining asthma, but the most practical clinical definition is 'recurrent episodes of cough, wheeze and shortness of breath that respond to bronchodilator therapy'. The most common trigger of an acute episode in children is a viral upper respiratory tract infection (URTI).
Important predisposing factors include a genetic predisposition (unavoidable), allergies to inhaled allergens particularly house dust mite (very hard to avoid), and passive exposure to cigarette smoke (avoidable). About 80% of children with asthma will have symptoms with exercise, which can become an increasing problem in school-age children.
Gastroenteritis a common infection of the gastrointestinal tract, is easily spread amongst young children because of inadequate handwashing, frequent hand to mouth play and eating activities. Although usually benign and self-limiting, it can cause serious illness, especially in the very young.
The most common cause is rotavirus, but a range of other viruses and bacteria may be implicated. Bloody diarrhoea is more likely to be caused by bacterial infection eg. campylobacter. Children may vomit early in the illness, and parents often consider vomiting to be the main problem. However the cardinal feature of gastroenteritis is diarrhoea and the associated fluid loss is the main contributor to dehydration. Early symptoms of nausea, vomiting, cramping abdominal pains and often fever quickly progress to diarrhoea which may persist for up to 10 days.