Dengue Fever in Children: All You Need to Know

Dengue fever is one of the most common viral infections in India. The infections typically start to spread during summer, starting from April, and peaks during the rainy season, between July and November. While dengue disease is common across all age groups, children in particular are more susceptible to the disease due to their weak immune system and outdoor activities in dengue prone areas. Parents should, therefore, be extra careful around their children during these months, and must be aware of the early dengue symptoms in kids. Read on as we walk you through the common types and symptoms of dengue in children, available treatments, and preventive measures. Let’s start with understanding the infection.

What is Dengue Fever?

Dengue fever is a flu-like disease caused by the dengue virus, which is transmitted through the bite of an infected female Aedes mosquito, commonly called, “Tiger mosquitoes”, characterised by white stripes on the body. These mosquitoes generally breed in warm and humid conditions, especially in stagnant water. Aedes mosquitoes can lay eggs even in shallow water, such as puddles, old car tyres, buckets, etc. Unlike other disease-carrying mosquitoes and insects that get into action after dark, Aedes mosquitoes bite during the day, especially 2 hours after the sunrise and just before the sunset. The silver lining is that dengue is not contagious and doesn’t get transferred from person to person.

Note: The first time a child contracts the dengue virus, it is caused by one of the four strains of dengue virus (DENV) - that belongs to the family Flaviviridae, genus Flavivirus. Once a child is infected with one strain of the virus; although they develop lifelong immunity against that particular strain of virus, they can still be infected with any of the remaining 3 strains of dengue virus, which can result in more severe symptoms. 

What are the types of dengue fever in children?

Dengue fever in kids can range from mild to severe, depending on how their immune system responds to the infection. There are, however, three main types of dengue fever that are common in children.

Mild Dengue Fever

Mild dengue fever, also known as “classic dengue fever”, is the most common and least severe form of dengue that results in flu-like symptoms, such as high fever, fatigue, nausea, vomiting, headache, skin rashes, and mild nose/gum bleeding. This type of fever usually doesn’t require hospitalisation. 

Dengue Hemorrhagic Fever (DHF)

DHF, also known as “break-bone fever”, is a more severe form of dengue fever, and requires immediate medical attention and hospitalisation, as it could be fatal if not treated in time. It is a type of acute febrile illness characterised by severe abdomen pain, persistent vomiting, change in body temperature from fever to hypothermia, irritability, confusion, and haemorrhagic manifestations (bleeding from nose, gums, or under the skin). 

Dengue Shock Syndrome (DSS)

DSS is the most severe form of dengue fever characterised by abnormal haemostasis, wherein the blood pressure drops to dangerously low levels, often leading to organ failure. Various symptoms of DSS include low blood pressure, severe abdominal pain, weak and rapid pulse. This type of fever is life-threatening and requires immediate medical attention and care in an intensive care unit. 

How can Dengue affect your Child?

Once a kid is bitten by a dengue mosquito, its effect can vary from mild discomfort to severe life-threatening conditions. Here are some ways in which Dengue can affect children. 

Mild illness 

In mild cases, dengue often shows flu-like symptoms, such as high fever, headache, muscle pain, joint pain, nausea, vomiting, loss of appetite, and rashes, making kids feel fatigued and restless for a couple of days to a week. Even after the fever subsides, kids may still feel fatigued and weak during the recovery phase. 

Severe Dengue Fever 

Severe forms of dengue fever, such as dengue hemorrhagic fever (DHF), can cause internal bleeding due to leakage in blood vessels. Children may also experience intense abdomen pain, low blood pressure leading to dengue shock syndrome (DSS). These are all serious conditions that require immediate medical attention. 

Hospitalisation and intensive Care

In severe cases, children with dengue may require hospitalisation, especially if they are at the risk of developing dengue hemorrhagic fever or dengue shock syndrome. Children may also be hospitalised for IV fluid to prevent dehydration and manage blood pressure. While mild dengue fever symptoms may not require hospitalisation, severe cases may require immediate hospitalisation and intensive care. 

Emotional and Psychological Effects

Hospitalisation and medicines may take a toll on the mental health of both kids and parents making them fearful and anxious about the treatment. As kids suffering from dengue have to miss school and activities until recovery from the illness, the whole isolation period can have a huge impact on a child’s social and emotional life, making recovery challenging. 

What are the Symptoms of Dengue Fever in Children?

Symptoms of dengue in children may vary depending on the severity of the infection. While initially the mild dengue fever symptoms may look like the symptoms of a normal flu, parents need to be watchful for the dengue specific symptoms, such as:

Early Symptoms 

• Sudden, High fever - Ranging from 102°F (39°C) to 104°F (40°C) 
• Pain behind the eyes (retro-orbital pain)
• Intense muscle and joint pain
• Skin Rashes (occurs typically a few days after the fever)
• Fatigue and weakness 
• Nausea and vomiting 
• Lack of appetite
• Sore throat and cough 

Warning Signs of Severe Dengue (DHF)

Once the initial fever subsides there may be a risk of developing symptoms of severe dengue illness, which requires immediate medical intervention. Symptoms to look for, include:

• Persistent and severe abdominal pain
• Persistent vomiting 
• Bleeding 
• Cold and clammy skin 
• Restlessness and irritability 

Critical Symptoms of DSS

Although rare, in some cases children may develop critical dengue symptoms of DSS, which can be life-threatening and therefore require immediate hospitalisation and intensive care. Such symptoms include:

• Low blood pressure
• Shallow and rapid breathing 
• Extreme weakness and loss of consciousness 

What are the Risk Factors for Dengue Fever in Children?

While dengue fever in children is caused by the bite of an infected female aedes mosquito, there are certain factors that can increase the risk. These include: 

Living in or travelling to tropical and subtropical regions

Children living in or travelling to tropical and subtropical regions are generally at a higher risk of dengue. As such regions have a warm and humid climate, they provide ideal breeding conditions for aedes mosquitoes. 

Outdoor exposure during summer and monsoon seasons

Children who spend a large amount of time outdoors, especially during the daytime when dengue-causing mosquitoes are active, are at a high risk of contracting the infection. Moreover, children who play in parks, sports fields, and playgrounds that are located near stagnant water, are also at a high risk of mosquito bites.

Poor sanitation and pest control

In areas having stagnant water in puddles and drainages, the Aedes mosquito can thrive. As a result, children living in such areas are at a high risk of the dengue infection. In addition, not taking preventive measures at home, such as installing screens on windows and using mosquito repellents, especially during the peak dengue season, could expose children to mosquito bites that may cause the dengue infection.

Weak immune system 

Children with a weak immune system or any other pre-existing health condition are at a high risk of developing severe dengue diseases when bitten by an infected mosquito. In addition, infants and young children are comparatively at a high risk of developing severe dengue fever due to their immature immune system. 

What are the Stages of Dengue Fever in Children?

Dengue fever in children has three main stages:

Stage 1: Febrile Stage (High Fever)

During this stage, the child may have symptoms such as high fever (often above 102°F), headache, pain behind the eyes, muscle and joint pain, nausea, vomiting, rash, and mild nosebleeds or gum bleeding. This stage can last for 2 to 7 days, during which it is crucial to keep the child hydrated, as there is a risk of dehydration due to high fever and vomiting, which can worsen the symptoms.

Stage 2: Critical Stage (Plasma Leakage)

During this stage, even though the fever subsides, other warning signs may emerge. These include severe abdominal pain, persistent vomiting, rapid breathing, fatigue, and swelling in the abdomen or chest due to accumulation of fluid. This stage typically lasts for 24 to 48 hours and is the most dangerous, as there is a risk of plasma leakage, which can cause low blood pressure, shock, and organ damage. The child, therefore, should be closely monitored during this stage.

Stage 3. Recovery Stage (Reabsorption)

This is the final stage of dengue fever, during which there will be gradual improvement in the child’s health. The child will regain appetite, the blood pressure will stabilise, and the swelling around the abdominal region will reduce. This stage can last for 2 to 5 days. Though this stage is less critical than the last, careful monitoring is still essential to ensure complete recovery and prevent any delayed complications.

How is Dengue Fever Diagnosed in Kids?

Diagnosing dengue fever in kids requires a combination of clinical evaluations, medical history and laboratory tests. 

Clinical Evaluation and Medical History 

In clinical evaluation, the doctor assesses the symptoms for dengue; such as, whether there is any headache, muscle pain, skin rashes, bleeding, and the pattern of fever. The doctor may ask for the travel and exposure history of the kid, whether the child was exposed to areas where dengue is common, and whether the child has had dengue in the past. If the child has had dengue in the past, it raises a concern for the possibility of severe dengue disease in subsequent infections. 

Laboratory Test 

While clinical evaluation and medical history play a significant role in diagnosing dengue, lab tests are used to confirm the diagnosis. These include:

• Tests, such as NS1 antigen test or PCR test, are used in the early stages to detect the presence of dengue virus in the blood. 
• Antibody tests (IgM, IgG) are conducted to identify the stage and type of infection. 
• In addition, blood tests, such as complete blood count (CBC) is conducted to check for low platelet levels and white blood cells, a common aftermath in dengue. 

Lab tests are important to confirm dengue infection and rule out any other infection, and also to assess the severity of the infection. In case of severe dengue, doctors may perform more tests to monitor organs functions and fluid levels to prevent complications. 

How is Dengue Fever Treated in Children?

The treatment of dengue in children primarily aims to manage symptoms, prevent complications, and keep the child hydrated and comfortable until the illness subsides. Here's how dengue fever is treated in kids.

Symptomatic Treatment 

Fever and pain in dengue are usually managed with acetaminophen (paracetamol), which is safe for kids. Do not use aspirin and ibuprofen for children, as they can increase the risk of bleeding. In addition, for proper hydration, especially in kids who experience diarrhoea and loss of fluid due to suppressed appetite; ORS, fruit juices, water, and soups are given. Plenty of rest is also advisable until the infection subsides. 

Hospitalisation for Severe Cases

In severe cases of dengue, such as DHF and DSS, immediate hospitalisation is required, as the child may need IV fluids to manage dehydration or plasma leakage. In addition, continuous monitoring of organs, platelets levels, and WBC is critical in severe cases. Blood transfusion may be required in case of severe bleeding.

How can Dengue Fever be Prevented in Children?

As there is no specific vaccine available for dengue, taking preventive measures becomes all the more crucial. Here are some key steps that you can take to protect kids from dengue. 

• Use mosquito repellents on exposed skin, especially when kids are playing outdoors. 
• Dress children in protective clothing, such as long sleeve shirts, pants, socks and shoes. 
• Use mosquito nets while sleeping.
• Eliminate mosquito breeding sites, such as standing water in puddles, flower pots, containers, unused tires. 
• Maintain a clean environment by disposing of waste properly, timely cleaning of drainage and gutters, and preventing accumulation of water in open containers. 
• Encourage communities to participate in mosquito control programs, such as fogging or spraying insecticides in mosquito-prone areas. 
• Stay informed about dengue outbreaks in your area. 

Frequently Asked Questions about Dengue Fever in Children

1. What is the platelet count of a child with dengue?

In children with dengue, the platelet count often drops significantly. A healthy child typically has a platelet count between 150,000 and 450,000 per microliter. During a dengue infection, platelet counts may drop below 100,000 per microliter, sometimes reaching critical levels below 20,000 per microliter. 

2. What is the WBC count of a child with dengue?

In healthy children, the WBC count is between 4,000 to 11,000 per microliter. In dengue cases, this count can fall below 4,000 per microliter, which weakens the immune response. Therefore, during this period, supportive care, hydration, and close monitoring are essential.

3. What are the best foods for kids with dengue?

The best foods for children with dengue include:

• Hydrating Fluids: Coconut water, electrolyte solutions, fruit juices, and clear broths. These help replenish the body’s fluids and essential electrolytes that are lost due to fever and vomiting.
• Papaya Leaf Extract: Known for potentially aiding platelet production, papaya leaf extract or juice can be given in small, doctor-approved amounts.
• Protein-Rich Foods: Soft-boiled/cooked eggs, chicken soup, and lentil soups provide necessary protein for recovery while being gentle on the stomach.
• Fruits and Vegetables: Vitamin C-rich fruits such as oranges, kiwi, and strawberries, and vegetables such as carrots and spinach help improve immunity and overall strength.
• Whole Grains: Easily digestible grains such as rice and oats are advisable as they offer energy and are also gentle on the digestive system.

4. How long does dengue fever last in children?

Dengue fever typically lasts 7 to 10 days in children. During the first 2 to 7 days, the child may have high fever, headache and joint pain. The next phase is the critical stage, which lasts for about 24 to 48 hours. During this stage, the child requires close monitoring.

5. Can dengue fever recur in children?

Yes, children can contract dengue multiple times, as there are four distinct dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4), and immunity to one serotype does not provide immunity to the others. So, reinfection is possible, sometimes with more severe symptoms due to the immune response.

Conclusion

Dengue fever poses a serious risk to children, but with proactive measures, it can be prevented effectively. Parents must stay vigilant by protecting their children from mosquito bites and seeking immediate medical attention if they see any sign of dengue fever and symptoms. Max Hospitals is committed to safeguarding your child’s health, offering comprehensive care and expert guidance in dengue prevention and treatment. At Max Hospital, we have an experienced team of Pediatricians, Paediatric intensivist and state of the art PICU to manage all cases of complicated and severe dengue with excellent results.