Monsoon illnesses: dengue, typhoid, and keeping children well in the rains

The mosquito-borne fevers

Dengue: high fever with severe body and joint pain, headache, pain behind the eyes, and often a rash. The dangerous phase begins as the fever falls, around days three to seven — this is when to watch most closely, not to relax.

Dengue warning signs, all needing immediate hospital: severe abdominal pain, persistent vomiting, bleeding from the gums or nose, blood in vomit or stool, black tarry stools, extreme lethargy or restlessness, cold clammy hands and feet, and a child who is not passing urine. Never give aspirin or ibuprofen in suspected dengue — they increase bleeding risk; paracetamol only.

Malaria: fever with chills and rigors, often cyclical, with headache and vomiting. Chikungunya: fever with severe joint pain that can persist for weeks. Both need testing rather than guessing — any fever lasting more than two days in the monsoon deserves a blood test.

The prevention that works: mosquito nets over cots (including for daytime naps — dengue mosquitoes bite during the day), screens, full-sleeved clothing at dawn and dusk, repellents appropriate to the child's age, and — most importantly — emptying standing water weekly from coolers, plant trays, tyres, buckets and roof tanks. The dengue mosquito breeds in clean water inside your home.

Waterborne illness

Typhoid: prolonged fever that steps up over days, abdominal pain, poor appetite, and sometimes diarrhoea or constipation. It needs testing and a full course of prescribed antibiotics — stopping when the fever settles causes relapse. Typhoid vaccination is available and worth discussing with your paediatrician for Indian children.

Hepatitis A: fever, fatigue, poor appetite, vomiting, then yellowing of the eyes and skin with dark urine. It spreads by contaminated food and water; vaccination is available and effective, and is on most private schedules.

Diarrhoea and gastroenteritis: peak in the monsoon. ORS plus zinc is the treatment, and our diarrhoea guide covers it in detail. Cholera outbreaks still occur in parts of India during floods.

Prevention: boiled or properly filtered water, freshly cooked hot food, no street food or cut fruit for small children, handwashing with soap, and washing vegetables well. Rotavirus and typhoid vaccination reduce two of the biggest risks.

The rest of the season

Colds, flu and viral fevers rise as children spend more time indoors together. The flu vaccine, given yearly, is worth asking your paediatrician about — particularly for children with asthma or other chronic conditions.

Skin: fungal infections thrive in damp — keep skin folds dry, change out of wet clothes immediately, dry shoes and feet properly, and treat any itchy, spreading, ring-shaped rash with a doctor's antifungal rather than a steroid cream from the chemist, which makes it worse.

Leptospirosis: spread through water contaminated with animal urine, and a real risk where children wade in flood water. Keep children out of stagnant water, and see a doctor for fever after such exposure, especially with red eyes and severe muscle pain.

Also seasonal: snake and scorpion encounters in rural areas after heavy rain, and electrocution risks from waterlogged wiring — both worth a household check.

When to see a doctor

Immediately, at any age: severe abdominal pain, persistent vomiting, any bleeding (gums, nose, stool, vomit), cold clammy skin, extreme drowsiness or restlessness, difficulty breathing, a fit, no urine for six to eight hours, or a rash that does not fade under pressure.

Same-day: any fever in a baby under three months; fever lasting more than two days in the monsoon (get tested for dengue, malaria and typhoid); fever with severe headache or neck stiffness; jaundice; diarrhoea with dehydration; or a child who is drinking poorly.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: My child's platelet count is falling in dengue. How worried should I be? — The count alone does not decide severity — the warning signs and the child's condition do. Doctors watch the trend along with hydration and the haematocrit. Follow the advice on fluids closely, and return immediately for any warning sign.

Q: Are mosquito coils and vaporisers safe for babies? — Burning coils produce smoke that irritates small lungs — avoid them in a baby's room. Plug-in vaporisers should be used in a ventilated room and never close to the cot. Nets and screens are the safest protection for babies.

Q: Is papaya leaf juice useful in dengue? — It is widely used and the evidence remains limited. It is not a substitute for medical monitoring, and the things that actually matter in dengue are fluids, paracetamol only, and watching for the warning signs. Discuss any home remedy with the treating doctor.

Q: Should children be kept home from school during monsoon outbreaks? — Not routinely, but keep a sick child home until fever-free for 24 hours, and follow school or municipal advisories during a local outbreak. Prevention at home — mosquito control, safe water, handwashing — matters more than avoiding school.