Key Questions for History Taking in an 11-Month-Old with Rash, Cough, and Runny Nose
When evaluating an 11-month-old with a rash that developed after cough and runny nose without fever, focus on questions that help distinguish between viral illnesses, allergic reactions, and other potentially serious conditions.
Symptom Characteristics
About the Rash:
- Timing and progression: When exactly did the rash appear in relation to the respiratory symptoms? How quickly did it spread? 1
- Appearance and distribution: What does the rash look like (maculopapular, vesicular, petechial)? Where did it start and where is it now? Does it involve palms and soles? 1
- Associated symptoms: Is the rash itchy? Painful? Does it blanch with pressure? 1
- Changes over time: Has the rash changed in appearance since onset? 1
About the Respiratory Symptoms:
- Duration and progression: When did the cough and runny nose begin? Are they improving, worsening, or unchanged? 1
- Characteristics of cough: Is it dry or productive? Worse at night? Associated with wheezing? 1, 2
- Characteristics of nasal discharge: Is it clear, colored, thick, or thin? 1
- Associated symptoms: Any sneezing, nasal itching, eye symptoms, or throat clearing? 1, 2
Medical History
- Past medical history: Any history of atopic conditions (eczema, food allergies)? Previous similar episodes? 1
- Immunization status: Is the child up-to-date with vaccinations? 1
- Recent illnesses: Has the child been sick recently or exposed to anyone who was ill? 1
- Medication use: Any current or recent medications, including over-the-counter drugs? 1
Environmental Factors
- Exposures: Any new foods, medications, soaps, detergents, or other potential allergens? 1, 2
- Environmental changes: Any recent changes in the home environment? New pets? 1, 2
- Potential tick exposure: Any outdoor activities in wooded or grassy areas? 1
- Daycare attendance: Does the child attend daycare or have contact with other children? 1
- Household contacts: Is anyone else at home sick with similar symptoms? 1
Systemic Symptoms
- Feeding and hydration: Any changes in appetite or fluid intake? 1
- Activity level: Any changes in behavior, irritability, or lethargy? 1
- Sleep patterns: Any disturbances in sleep? 1
- Gastrointestinal symptoms: Any vomiting or diarrhea? 1
- Respiratory distress: Any difficulty breathing, rapid breathing, or noisy breathing? 1
Red Flag Questions
- Petechial or purpuric rash: Does the rash look like tiny red or purple dots that don't blanch when pressed? 1
- Respiratory distress: Any signs of labored breathing, retractions, or cyanosis? 1
- Altered mental status: Any changes in responsiveness or unusual irritability? 1
- Unilateral symptoms: Are the nasal symptoms one-sided only? 1
- Severe headache or ear pain: Any signs of discomfort suggesting complications? 1
Differential Diagnosis Considerations
- For viral exanthems: Questions about contacts with specific illnesses, progression of symptoms 1
- For allergic reactions: Questions about timing related to exposures, family history of atopy 1, 2
- For sinusitis: Questions about duration of symptoms (>10 days), worsening pattern, or severe onset 1
- For tickborne illness: Questions about outdoor exposure, progression of rash 1
Remember that in children this young, respiratory viruses commonly present with associated rashes, and allergic rhinitis can begin in infancy but typically has a more persistent pattern rather than acute onset 1, 2.
The absence of fever is noteworthy but doesn't rule out infectious causes, as many viral exanthems can present without significant fever, especially in partially immune children 1.