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What is the reason for chest pain in a 4 year old with fever and neck pain ?

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Hi, my child is 4 years old. Around 5 days back she had slight chest pain, we went to the doctor who said that it may be because of some gastric problem, the chest pain vanished in the evening but serious fever started from that that, we went again to the doctor who diagnosed a viral infection. The fever lasted for 3 days and now she is having pain in her neck, probably the food pipe, there are 2 -3 boils which we can see just above the place where the tongue ends. Today is the fourth day she is suffering from the neck pain, the boils which we could see are disappearing but the neck pain still persist. Please suggest what could be the reason.
Posted Thu, 3 May 2012 in Child Health
 
 
Answered by Dr. Deepak Anvekar 23 minutes later
Hello and thank you for posting this query.

Chest pain, fever and visible ulcers appear to be probably caused by viral infection that might have resulted in epiglotitis (mucosal inflammation) and pneumonitis.

To help you out, can you specify a few more details :-

1. Is your child able to have solid foods or liquids ? Or does she complain of pain, and hence avoid eating ?

2. Does she have any breathing difficulty ?

3. Does she have cough?

4. Is she being treated with any medications ?

5. Have any blood tests been done ?

6. Has her vaccinations been given on time and are up to date ?


Once the additional information is provided, I shall advice you further.

In the mean time, treating her with crocin or Ibugesic syrup to reduce the pain and inflammation might be helpful.

Regards.

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Follow-up: What is the reason for chest pain in a 4 year old with fever and neck pain ? 50 minutes later
Thanks Dr XXXXXXX following is the information you required:

1. Is your child able to have solid foods or liquids ? Or does she complain of pain, and hence avoid eating ?
Ans : She is not able to eat and complaint of pain, we are giving her liquid diet .. like Milk, Dal soup, crushed Khichri etc. but still she resist eating.

2. Does she have any breathing difficulty ?
Ans: No

3. Does she have cough?
Ans: No

4. Is she being treated with any medications ?
Ans: Yes, Flexon, Bevon and Moxclav

5. Have any blood tests been done ?
Ans: No

6. Has her vaccinations been given on time and are up to date ?
Ans: Yes

Hope this will help you diagnose better.

Regards,
Rohit
 
 
Answered by Dr. Deepak Anvekar 1 hour later
Hello XXXXXXX

Thanks for the added information.

The details provided confirm my suspicion that your daughter is having epiglotitis, and is being treated with empiric antibiotics (Moxclav) and supportive medications [Flexon (Ibuprofen) and Bevon].

It is due to the pain that, she is resisting eating or drinking foods.

But since no blood tests have been done, it is not clear if the condition is due to viral or bacterial causes.

In case a complete blood count, is done, and it shows presence of lymphocytic predominance, this would be due to viral infection and the inflammatory response might be reduced with a course of low dose steroid therapy, prescribed by your pediatrician. This treatment will help in early resolution of the ulcers in the throat and hence resolve her pain and suffering.

Usually without steroids, such inflammatory changes due to viral infections resolve over a period of one week to 10 days.

But, use of steroids in case of bacterial infections, might not be useful.

In my opinion, the best course of action, would be to do a Complete blood count, to know the source of infection and then your doctor can initiate a course of low dose steroid treatment to heal the ulcers.

The other option would be application of oral application of (Kenacort) triamcinolone acetonide oral paste, on the ulcers. But this would be difficult and uncomfortable to the child, as the ulcers are at the back of the throat.

In the mean time, continue the therapy with the medications Bevon and Flexon, as prescribed by your doctor, give her only boiled water to drink, Salt water gargling three to four times a day and steam inhalation three to four times a day would be helpful.

I hope that the information here would be helpful to decide the further treatment of your child. I shall be available for any follow up questions or doubts that you might be having.

Regards.
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