Dengue fever is an acute viral illness caused by four strains of the dengue virus. Endemic in tropical and subtropical countries, dengue in babies and toddlers can be severe, especially for the child born to mothers who had dengue(1). Though dengue can be cured with home care, it is recommended to seek medical attention.
Read this MomJunction post to know more about dengue fever in infants, its signs and symptoms, treatment, and how to protect your baby from dengue fever and other mosquito-borne illnesses.
What Causes Dengue And How Does It Spread?
The dengue virus is mainly transmitted by the Aedes aegypti species of female mosquitoes. These species of mosquitoes are also responsible for Zika virus infection, chikungunya, and yellow fever. Dengue infection can be caused by four serotypes of dengue virus, including DENV-1, DENV-2, DENV-3, and DENV-4.
It is transmitted to humans through an infected female mosquito bite, which feeds only during the daytime. After biting an infected person, female mosquitoes can transmit the dengue virus within eight to 12 days to other humans. It is not a contagious disease that spreads from human to human. There are rare cases of vertical transmission (pregnant mother to baby) (2).
Though there is a case of transmitting dengue virus from breast milk, it is recommended to breastfeed babies due to benefits (3).
After an infected mosquito bite, it may take five to seven days for dengue to develop, and the disease follows three phases (4):
- Febrile phase: Fever may last for two to seven days
- Critical phase: It usually begins after the fever and lasts for 24 to 48 hours.
- Convalescent phase: It is the recovery phase, where health status improves. There is a chance of developing itchy rashes during this phase.
Signs And Symptoms Of Dengue In Infants And Toddlers
Symptoms of dengue can be difficult to recognize in babies and toddlers since it can be similar to those of other common childhood infections. Your child may require immediate hospital admission if any of the following signs and symptoms signs develop (5)(6).
- High temperature (higher than 38°C or 100.4°F) or low temperature (less than 36°C or 96.8°F)
- Refusing to take oral fluids
- Vomiting (at least three times in 24 hours)
- Vomit has ground coffee appearance
- Sleepiness or restlessness/irritability
- Bleeding from the nose or gums
- Vomit or stool has fresh or old blood
- Dark or black coal tar-like stool
- Abdominal pain
- Skin mottling (livedo reticularis — marble-like appearance of skin with patchy or irregular colors, red or purple marks, spots or streaks on the skin)
- Cold sweating skin
- Cold hands and feet
- Absence of urine for six hours
The above mentioned are the warning signs of dengue that require emergency medical attention as they may be indicating the following.
- Severe dengue: It is a serious form of dengue, causing shock and internal bleeding. Organ impairment and respiratory distress are seen in severe dengue (5).
- Dengue shock syndrome: During the critical period, there is a chance for the development of dengue shock syndrome due to the leak of plasma (fluid in the blood) to the abdomen, lung spaces, etc. It may cause respiratory issues. If shock is undetected or left untreated, it can result in severe complications (7).
- Dengue hemorrhagic fever: It is a complicated form of the disease, which causes bleeding from the nose, gum, and skin hemorrhages and hematuria (blood in urine) (7).
Complications Of Dengue Fever In Infants And Toddlers
In addition to the above mentioned conditions, dengue fever in babies and toddlers may result in (8):
- Febrile seizure (6)
- Liver damages
- Cardiomyopathy (heart disorders)
- Encephalopathy (brain disorders)
- Encephalitis (inflammation of the brain)
When To See A Doctor?
- Sunken eyes
- Cold hands and feet
- Dry mouth, tongue, or lips
- Sunken soft spot on the head
- Reduced urination
- No tears while crying
Diagnosis Of Dengue In Babies And Toddlers
It is recommended to test dengue in babies who live in or recently traveled to dengue-endemic areas. The tests include the following (10).
- Complete blood count
- Molecular test to detect dengue virus in the first one to seven days of illness
- NAAT or NS1 antigen test (in the acute stage), ELISA method is more accurate than card test
- IgM antibody test (MAC-ELISA) (it can be positive for three months or longer after infection)
- Platelet count and hematocrit values
- Coagulation profile
- Liver enzymes
A platelet count below 100,000 per microliter can be seen in dengue fever, but common in dengue hemorrhagic fever. After three to eight days of illness, thrombocytopenia (reduced platelet) can be observed. About 20% or more increase in hematocrit value (percentage of red blood cells) suggests that there is plasma leakage (11).
Is There Any Treatment For Dengue?
There is no specific treatment for dengue. Like most viral illnesses, dengue too is usually managed with supportive care through fluids. Antibiotics are not used to treat dengue as it is a viral infection. unless there are signs of secondary bacterial infection.
- One of the main aims of treatment is to bring the high temperature down to below 39°C. High fever may lead to fits, also called febrile convulsions in young children.
- Sponge the child with a cloth soaked in water and give acetaminophen (paracetamol) to control fever. Consult a pediatrician before giving any medicine to the baby.
- Aspirin and NSAIDs (non steroidal inflammatory drugs such as ibuprofen) should not be given since it may worsen platelet problems leading to bleeding (6).
- Oral or intravenous route fluid administration is the mainstay treatment. Intravenous fluids are administered in the cases of hospitalization.
- You may increase the oral fluid intake if your baby is able to drink. Intravenous fluid administration is required if there is an inability to maintain oral intake and/ or the baby is in shock.
- It is advised to observe your baby during the critical period for warning signs.
Your baby may require blood products in the case of bleeding from nose, gums, or gut. It may take a while to have a normal platelet count after the illness.
Is It Possible To Treat Dengue Fever At Home?
If there are no warning signs and the baby can take oral fluids, then home treatment might help. However, it is recommended to visit a pediatrician for proper guidance and to identify the illness. Hospitalization is mandatory if your child has severe fever and complications of dengue. Home treatment steps include (1).
- Medication to control fever: Acetaminophen is given for fever.
- Hydration: Adequate fluid and electrolyte intake to cope with the loss of fluid from the body during fever or vomiting.
Can Dengue Fever Be Prevented?
If you are living or traveling to a country with a risk of dengue, then you should take precautions to keep your baby away from mosquito bites.
You may use mosquito repellents for babies older than two months. If your child is younger than two months, then use mosquito nets (1). The following methods can keep mosquitoes away from your baby (13).
- Have mosquito net to the crib, stroller, infant carrier, doors, and windows
- Use loose clothing to cover arms and legs
- Avoid stagnant water around the house
- Keep wet dustbins covered
- Keep windows and doors closed in dusk and dawn
Frequently Asked Questions
Is Mosquito Repellent Safe For Babies And Toddlers?
Mosquito repellents can be used for babies older than two months. You should read the manufacturer’s instructions to ensure your baby’s safety. Apply repellent to your baby’s exposed skin after spreading it on your hands. Below are a few recommended ingredients in mosquito repellents, along with their popular brands (1).
- Up to 30 % DEET (Sawyer, Cutter, OFF!)
- Picaridin (Autan, Avon Skin So Soft Bug Guard Plus)
- IR3535 (Skin smart, Avon Skin So Soft Bug Guard Plus Expedition)
The Centers for Disease Control and Prevention does not recommend the use of insect repellents containing lemon eucalyptus oil or P-menthanediol (PMD) for infants and toddlers.
Are There Any Vaccines To Prevent Dengue?
There is no licensed vaccine for dengue for infants and toddlers. The first vaccine to prevent dengue is Dengvaxia (CYD-TDV). It is presently licensed only in a few countries for people aged nine to 45 years, who had a confirmed prior dengue infection (14).
Is It Possible To Get Another Episode Of Dengue Infection?
It is possible to get dengue infection again. Usually, it is caused by other strains of the dengue virus, and the second infection can be severe than the previous one. It is possible to get dengue infection four times from four different strains of the dengue virus (2).
Though there is no approved vaccination to prevent dengue fever in babies and toddlers, it can be prevented by avoiding mosquito bites. It is important for expecting and breastfeeding mothers to stay away from mosquito borne-illnesses since it may increase the risk of your baby having a severe infection.
Do you have any tips to avoid mosquito bites on babies? Do share them in the comment section below.
2. Dengue and severe dengue; The World Health Organization
3. Dengue; Transmission; The Centers for Disease Control and Prevention
4. Dengue; Clinical Presentation; The Centers for Disease Control and Prevention
5. Dengue; Symptoms and Treatment; The Centers for Disease Control and Prevention
6. Dengue fever; The United States National Library of Medicine
7. Dengue and Dengue Hemorrhagic Fever ; The Centers for Disease Control and Prevention
8. Timothy J. Schaefer et al., Dengue Fever; National Center for Biotechnology Information
9. Your Infant has Dengue; The Centers for Disease Control and Prevention
10. Dengue; Diagnosis; The Centers for Disease Control and Prevention
11. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition.; The World Health Organization
12. Dengue Fever; The National Organization for Rare Disorders
13. Dengue Fever; Johns Hopkins All Children’s Hospital
14. Dengue Vaccine; The Centers for Disease Control and Prevention