by Aislinn McDonagh
Jeremy Hunt has come under fire from the medical profession practically every day recently, so one story which might have been lost under the pile of protest stories was his advice to parents to ‘google’ their child’s symptoms before seeking medical attention. He stated “If you’re worried about a rash your child has, an online alternative – where you look at photographs and say “my child’s rash looks like this one” – may be a quicker way of getting to the bottom of whether this is serious or not.”
Now, officially advising people to google their symptoms when you’re the health secretary is probably not the best idea. However, with A&E attendance rising, staffing falling, and the NHS under strain, people do need ways of determining what is an ‘emergency’, and NHS online materials are often referred to as reliable methods of doing this.
So, why all the backlash? Well, its because rashes in particular are notoriously ubiquitous in children and difficult to diagnose. Children usually have rashes on and off for most of their development; nappy rash, sweat rashes and cradle cap being among the more harmless, and impetigo, scabies or eczema more problematic. However, these are all very common problems which one would consult a pharmacist or GP about at most. But, rashes can also be indicators of serious diseases – anyone who has seen House more than six times will have heard of the distinctive ‘target’ rash caused by Lime disease, but, other than that, many rashes look the same regardless of severity.
George Reid, a doctor from Leamington Spa, made a Facebook post, which went viral showing the near indistinguishable rashes presented by a child with a normally harmless condition “Henoch–Schönlein purpura”, and one with meningococcal septicaemia who was in a life-threatening position.
This uncertainty and variability is true of almost all rashes in children. You only have to look at the range of presentations in meningitis, possibly the best known and most feared childhood rash. NHS choices itself does not provide a photograph, but only suggests the well-known glass test where one presses a glass against the skin to see if the colour fades, indicating a ‘normal’ rash, or stays, indicating something more serious, and reputable sites are few and far between which might provide actual help for an anxious parent.
Also, while the pressure on emergency departments and the NHS in general is an important issue for the entire nation, Meningitis Now, a charity which campaigns for meningitis awareness, as well as providing funding and resources around meningitis, branded Mr Hunt’s advice as “potentially fatal”, suggesting that parents should always seek medical advice if they suspect meningitis. They emphasise that rashes are often the last symptom to appear in this notorious disease, and delaying treatment could have dire consequences.
The same problems of waiting to see if your child’s rash matches one on the internet could be said of other childhood diseases like scarlet fever or measles – these can usually be treated by a GP but used to be major causes of death, and can be extremely serious if left untreated.
As Dr Reid stated in his viral post, if a doctor cannot differentiate rashes or determine their cause on sight alone, how can a parent of an infant or child, partially blinded by worry, be expected to make the correct diagnosis. More helpful advice might have been to look at the real resources the NHS provides – a rash questionnaire for parents or adults, and “does my child have a serious illness” FAQ online. Even more helpfully, people should be made aware of the accurate information out there about other signs of infection, such as fever and swelling, or pressure under the fontanel in infants.
Rash-gate has been short lived in the media, swallowed under the pressures of the many other NHS stories which fill our papers. However, whether concerned for yourself or your child, rashes remain a difficult balance between harmless irritation and klaxon for infection.