Sepsis in children: Know the signs

When a child or adult has an infection, the body’s immune system kicks into gear to fight it off. When faced with a viral infection (like a cold or flu) or a bacterial infection (like strep), a child may experience symptoms like fever, sore throat, body aches and headache. Those symptoms are usually manageable and a healthy immune response ensures the child will recover fully within a few days.

Sometimes, when the immune system releases chemicals into the bloodstream to fight an infection, those chemicals can attack normal organs and tissues. This immune overreaction is called sepsis and can cause inflammation, blood flow problems, low blood pressure, trouble breathing and vital organ failure. Sepsis in children – and adults – can be life-threatening.

Who is at risk for developing sepsis?

Sepsis is rare, but it can develop in children or adults of any age. It is most common in:

• Newborns and infants under 3 months of age whose immature immune systems can’t fight off overwhelming infections
• Children not vaccinated for the two bacteria that most commonly causes sepsis, Streptococcus pneumoniae (also called pneumococcus) and Haemophilus influenzae 
• Children or adults with chronic medical conditions
• Children or adults with HIV, cancer or other conditions that weaken the immune system
• Elderly people

A note about sepsis in infants:

Sepsis that affects newborns is nearly always caused by bacteria in the blood. Common culprits include group B streptococcus (GBS), Escherichia coli (E. coli), Listeria monocytogenes, Neisseria meningitis, Streptococcus pneumoniae, Haemophilus influenzae type B and salmonella.

Premature babies, especially those who must spend time in the NICU, are most at risk for sepsis because they have underdeveloped immune systems and may be exposed to bacteria through procedures involving long-term intravenous (IV) lines, catheters or tubes, and breathing tubes attached to a ventilator.

Occasionally, infections passed from mother to baby can causes sepsis. The following issues can raise a newborn’s risk of infection:

• Maternal infection/fever during labor
• Infection of the uterus or placenta
• Rupture of the amniotic sac before 37 weeks
• Rupture of the amniotic sac 18+ hours before delivery

Up to 30 percent of pregnant women carry group B strep (GBS), which can be passed to a baby during delivery. Women are tested for this bacterium late in pregnancy through a simple swab and if it’s present, a mother is treated with IV antibiotics during labor to prevent transmission. Group B strep is harmless to the mother.

What are the symptoms of sepsis in a child?

Newborns or infants with sepsis can show these symptoms:

• Bulging soft spot
• Changes in heart rate
• Decreased urination
• Difficulty waking from sleep
• Disinterest in or difficulty feeding
• Fever (rectal temperature) of 100.4 degrees or greater
• Inability or unwillingness to make eye contact
• Irritability or inconsolable crying
• Jaundice (yellowish skin and/or eyes)
• Lethargy
• Pauses in breathing for more than 10 seconds (apnea)
• Rash
• Sickly appearance
• Skin color changes (pale, patchy, bluish)
• Trouble breathing or rapid breathing

Symptoms of sepsis in babies older than 3 months and children may include:

• Confusion
• Difficulty breathing
• Difficulty waking from sleep
• Existing infection (like pneumonia) with symptoms that are getting worse instead of better
• Fever of 102 degrees or greater
• Inability or unwillingness to make eye contact
• Irritability
• Lethargy
• Racing heart
• Rash
• Skin color changes
• Trouble breathing

If you notice any of these symptoms, call your child’s doctor immediately. Infants with a high fever – or any child with severe symptoms – may require emergency medical attention.

What is septic shock?

Sepsis is considered severe if someone exhibits at least one of the following symptoms, which may indicate organ failure:

• Abdominal pain
• Abnormal heart activity
• Change in mental status
• Decreased platelets
• Difficulty breathing
• Significantly decreased urine output

Septic shock is characterized by these severe symptoms and very low blood pressure that doesn’t respond to typical treatment.

How is sepsis in children diagnosed?

If your child’s doctor suspects sepsis or wants to rule out a severe infection, he or she may order:

• Blood tests. By examining a sample of blood, your child’s doctor can look for infection, abnormal liver or kidney function or poor oxygen levels, which could indicate sepsis.
• Urine tests. By examining a sample of urine, your child’s doctor can look for bacteria that could indicate sepsis.
• Lumbar puncture. By examining a sample of spinal fluid, your child’s doctor can check for infection, including meningitis.
• X-rays. X-rays can show pneumonia or other conditions that can cause sepsis.

The doctor may start your child on antibiotics right away, even before these tests come back. If your child has sepsis, he or she will need to be treated in the hospital with antibiotics and IV fluids as well as blood pressure medication and equipment to help the child breathe, in some cases. Early treatment is critical to prevent organ damage.

How to protect your child from sepsis.

There is no way to prevent all cases of sepsis. But there are ways you can protect your child from many infections that can lead to sepsis:

• Make sure your child receives vaccinations for Streptococcus pneumoniae (also called pneumococcus) and Haemophilus influenzae at the ages and dosages recommended by the Centers for Disease Control and Prevention .
• If you’re pregnant, make sure you’re tested for GBS between week 35 and 37, and follow up on your results to ensure you’ll know if you need antibiotics during labor. If you experience premature labor, ask your doctor if you should receive antibiotics. If you know you are GBS positive, head to the hospital soon after labor symptoms begin or if your water breaks.
• Make sure you, and others coming in contact with your kids, are up to date on vaccinations and wash hands frequently to help prevent infection. Don’t allow sick visitors near young babies and children.
• If your child needs medical devices like catheters or long-term IV lines, follow the doctor’s directions for cleaning and accessing the device.
• Call your child’s doctor right away if you notice any of the symptoms mentioned above or other symptoms or behaviors that concern you.