10 MO OLD C POX SOAP

 A

SOAP Note

S – Subjective

• Presenting complaint: Fever, decreased oral intake, pruritic rash

• History of Present Illness:

  • 10-month-old girl, ex-preterm (33 weeks gestation)

  • Presents with low-grade fever, malaise, and ↓ oral intake for 3–4 days

  • Pruritic rash for 2 days: began on torso, spread to face and body

• No known sick contacts

• Up to date with immunizations

• Past history includes failure to thrive

---

O – Objective

• General: Alert but irritable; mild lethargy noted

• Vitals: (assume normal limits unless specified)

• Hydration: Mildly dry mucous membranes, normal cap refill

• Growth: Weight and height percentiles to be plotted (monitoring for FTT)

• Skin:

  • Diffuse erythematous rash involving torso, face, limbs

  • Rash is pruritic; appears vesicular in places with some crusting

  • No signs of bacterial superinfection (e.g., oozing, warmth, swelling)

• ENT/Chest/Abdomen: Normal findings

• Neuro: Alert, no focal deficits

---

A – Assessment

• Likely viral exanthem, most likely Varicella (chickenpox) given the vesicular pruritic rash pattern and systemic symptoms

• Ex-preterm (33 weeks) with history of FTT – potential vulnerability, but now 10 months old

• Differential diagnoses:

  • Varicella (primary concern)

  • Viral exanthem (e.g., roseola, non-specific viral)

  • Drug eruption (if recent medications)

  • Measles (less likely if vaccinated)

  • Bacterial superinfection (to monitor for)

---

P – Plan

1. Investigations (if needed):

• Clinical diagnosis likely sufficient

• Consider:

  • Skin swab or PCR if diagnosis unclear

  • FBC, CRP if febrile/toxic-appearing

  • Weight check for growth monitoring

2. Management:

• Supportive Care:

  • Paracetamol for fever

  • Oral hydration support (small frequent feeds or ORS)

  • Cetirizine for itch or calamine lotion

• Monitor for complications:

  • Superimposed bacterial infection

  • Respiratory signs, poor feeding, altered mental status

• Infection control:

  • Home isolation until all lesions crusted (usually ~5–7 days after onset)

  • Advise caregivers to avoid contact with pregnant women/immunocompromised individuals

3. Admission?

• Consider if:

  • Inadequate oral intake/dehydration

  • Signs of respiratory compromise or sepsis

  • Concerns related to FTT or prematurity

  • Parental concern or poor home support

4. Follow-Up:

• Review in 48–72 hrs or sooner if deterioration

• Continue monitoring growth and nutrition

• Community health nurse or paediatric FTT clinic as needed