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lip_swelling

Q:  I have 19 month old baby girl.  A week ago she caught the cough bug from me. She ran a mild fever but her appetite was still good.  Hence, her minder (grandmother) monitored her closely and only gave her fever meds as and when her fever came up. After a few days, she refused to eat. She has developed some rash/spots on her tongue. We took her to the clinic and the Doctor gave some oral gel for the mouth & cough syrup. Yesterday she had red, inflammed patches on her hands. Today it has subsided but now her lips are slightly swollen. Despite all this, she is still active, talkative and in good spirits but i feel she is feeling some discomfort as she has not used her pacifier for 24 hours ! The pacifier follows her everywhere and it is a MUST when she feels sleepy and when she wants comfort. 

What shall i do? Should I bring her to the child specialist to let him have a look at her condition? I’m guessing she may have eaten / touched something to cause some allergy reaction and so far it only happens when she is at her grandparents house. (In the evening she returns home with us & her older siblings) Btw, if say it is an allergy, how long does it take for the body to react to an allergic item? Hope you can help shed some light here. Thanks.  ( Sharon )

A: Your child was having fever associated with some rash/spot on her tongue, she is likely having viral infection with oral ulcer. In the context that she remains active with good oral intake, home observation and oral aid (drops or gel) would be sufficient.

When you mentioned that she has red inflamed patches on her hand which resolved the next day and some slight lip swelling, I suspect that she may be having some mild form of what we call ‘urticaria‘ or commonly known as ‘hives’ or ‘gegata’ in malay (explaining the rash) associated with mild ‘angioedema‘ (explaining the lip swelling; which is commonly associated with swelling of both eyes as well). In children, urticaria with angioedema is still largely caused by infection. In view that this is her first episode and it is during this time of a febrile illness, the current viral infection is likely the triggering factor.  If this is so, she should be improving pretty soon. The only thing against it is urticaria rash is usually more extensive involving whole body and usually very itchy; but they resolve within 24 hours.

This is just based on the provided information as I am not able to assess your child personally. The rash on the hand could also be what we call ‘viral exanthem‘, which is the rash induced by viral infection, which resolves spontaneously without any sequelae.

However, if she still gets similar recurrence of rash and lip swelling, despite of being well and not associated with fever, you should watch out for other possible triggering factors, eg allergic reactions, insect bites, chemicals in foods and medicines. To answer your question, if the lip swelling is caused by an allergy, it should take to 1-3 days to subside.

I would suggest that if her lip swelling worsens; recurring and worsening skin rash, reduction in oral intake and/or she becomes less active and not her normal self, please get consultation as soon as possible.

( answered by Dr Aileen Wee )

Related sites:

http://www.ruh.nhs.uk/patients/patients_leaflets/paediatrics/PAE034_Urticaria_angioedema.pdf

http://www.dermnetnz.org/reactions/angioedema.html

http://www.bad.org.uk/site/740/default.aspx

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