A3-A4 Common paediatric conditions Flashcards
age window of a neonate
less than 28 days old
age window of an infant
1 month to 1 year
age window of a child
1-18 years
age window of an adolescent
12-18 years
when does a baby have to be born to be considered premature?
before 37 weeks
how do paediatric patient differ in communication to adults?
- babies and young children can’t explain pain
- teens may be embarrassed
what must be considered in regards to formulations for children?
dose availability (consider strengths)
palatability
excipients (are they safe for the age?)
with children, what can get in the way of their adherence to medication?
- spit out, refuse, taken with interacting food, concealment
- time constraints of busy household
what are red flags?
- warning signs indicating a more serious condition
- will usually need referral or special consideration
- can be general or specific
- raise suspicions of something more severe going on
what ages do vaccinations occur from and to in childhood?
from 8 weeks to 14 years (boosters later in life)
what are the pharmacist’s roles surrounding vaccinations?
- promotion of vaccination
- advice on missed vaccinations
- answering queries / concerns / signposting
- post-immunisation care (advice and antipyretics)
when can febrile convulsions occur?
- when a child has a high temp, maybe after a vaccination
- potentially during an illness
what is a pharmacist’s role if a patient has had febrile seizures?
- direct parents to NHS website for useful info
- reassure
- ALWAYS refer
which vaccination has a particularly high risk of high temperature and therefore febrile convulsions? how can this risk be lowered?
- meningitis B vaccine
- given with a dose of paracetamol because the risk of temperature increase is so high
what is RSV?
- common cause of coughs and cold in small children after vaccinations
- not usually serious and normally gets better by itself in 1-2 weeks
- symptoms starts 4-6 days after a vaccination
state the mild symptoms of RSV in most children
- runny nose
- sneezing
- fever
- wheezing (can be distressing for children and parents)
- cough
what may the symptoms for RSV be in very young infants?
- irritability
- decreased activity
- breathing difficulties
what patients may be at higher risk of serious illness from RSV?
- babies under 6 months
- young children born prematurely
- immunocompromised
what is the most common complication of RSV?
bronchiolitis
what hygiene measures can be taken to prevent / reduce RSV?
- hand washing
- cleaning / disinfection
- use a tissue!
- don’t touch face / mouth / nose
- stay at home if unwell (don’t send kids to school!)
symptoms of bronchiolitis
runny nose
wheezing
persistent cough
reduced feeding
difficulty breathing eg. nasal flaring
community pharmacy treatment for bronchiolitis
- nasal saline drops
- paracetamol / ibuprofen (product license and age should be considered)
- non-pharmacological advice: keep upright and take on fluids
hospital role in treatment of bronchiolitis
- less than 3 months paracetamol if required
- oxygen support
red flags of bronchiolitis
cyanosed
tracheal tug
exhaustion
parental concerns
what is the risk of infants getting reflux and what may cause higher risk?
- reflux is very common (around 40% of infants)
- higher risk if premature or complex neuro-disabilities
what could reflux in infants be a sign of?
CMPA (cows’ milk protein allergy)
what is some non-pharmacological advice you could give to parents to help with reflux of their infant?
feed upright
smaller and more frequent feeds
what are some OTC options that can be given for reflux in infants?
- thickener to mix with feeds
- Gaviscon sachets
what is an example of thickener that could be used to thicken feeds for infants struggling with reflux?
carobel
what can GPs prescribe for infants suffering with reflux? give an example
- protein pump inhibitor
- eg. omeprazole
what are some red flags to look for in infants with reflux?
failure to thrive
chronic cough
refusing feeds
choking
what is colic?
- when a baby cries a lot for no obvious reason but they are otherwise healthy
- more than 3 hours a day, 3 days a week for at least a week
when does colic usually get better by in infants?
by 3-4 months old
what is the helpline you can refer parents to if their baby has colic and when is it open? why is this helpful?
- Cry-sis helpline (7 days a week, 9am-10pm)
- helpful for parents with crying and / or sleepless babies
- colic can be very distressing for both parent and baby and is very common
common symptoms of colic other than crying
- hard to soothe or settle baby
- clenched fists
- they go red in the face
- bring their knees up to their tummy or arch their back
- their tummy rumbles or they are very windy
what can a pharmacist do / recommend for colic?
- reassure parent
- cuddle or hold the baby, rocking may help
- hold the baby upright when feeding and wind them after
- hold the baby upright when cuddling (on shoulder)
- warm bath
- white noise
- feed as normal
what products have no evidence as to whether they work to help with colic?
no evidence that colic drops / products help
when should a parent seek medical attention in regard to their baby having colic?
- high-pitched cry or cry sounding different to normal
- they are struggling to cope
- nothing seems to work
- baby is over 4 months old
how common is constipation in infants?
- common
- 8% of infants
- boys affected more commonly than girls
what are some causes of constipation in young children?
- insufficient dietary fibre and fluid intake
- stresses of ‘toilet training’
non-pharmacological management of constipation
diet
fluid
good toilet hygiene
what OTC laxatives are used for children suffering with constipation?
- 1st line osmotic (eg. Laid / Movicol)
- some children may also use lactulose
other than OTC laxative treatments and non-pharmacological advice, what else may be needed to help children suffering with constipation?
- dis-impaction regime
- this means to give a large quantity of laxatives all at once to ‘clear out’ the backlog of poo
red flags to look out for in children with constipation
- persistent symptoms
- severe abdominal pain
- distended abdomen (swollen)
- blood in stool or rectal bleeding
causes of diarrhoea in young children
- viral
- change in diet
- contaminated / undercooked food
- medication (eg. antibiotics)
- children put things in their mouths
what things must be considered if a young child is suffering from diarrhoea?
- any recent travel?
- regular medications
- rotavirus vaccine at 8 weeks old can cause diarrhoea as can having rotavirus itself
management for diarrhoea in young children
- oral rehydration solution
- eg. Dioralyte sachets
what oral medication is not licensed to treat diarrhoea in young children?
- Loperamide
- not licensed under 12 years OTC
what treatment may hospitals use if a young child presents with diarrhoea?
- IV fluids to combat dehydration
- other medication
what advice can a pharmacist give to a parent with a young child presenting with diarrhoea?
- lots of fluids
- hygiene measures
- don’t make formula weaker, feed as normal (could give smaller feeds less often if vomiting - only as a very temporary measure)
- stay away from childcare / school until 48 hours after last symptoms
red flags to look for in young children with diarrhoea
- less than 6 months of age
- more than 6 months of age lasting for more than 48 hours
- unable to tolerate ORS (oral rehydration solution)
- pain
- blood or mucus
- signs of dehydration
when does teething typically start in children?
- around 6 months of age
- may be earlier or later
symptoms of teething in young children
- sore, red gums
- mild temperature of less than 38 degrees C
- 1 flushed cheek
- rash on face (may be caused by excess dribbling)
- dribbling more than usual - wipe gently and regularly if possible
- gnawing and chewing on things a lot (toys, hands etc.)
- more fretful than usual (anxious, grumpy, hard to settle)
- not sleeping very well
what can a pharmacist recommend for young children that are teething?
- teething rings / toys
- if over 6 months and weaning, can give them healthy things to chew on
- teething gels
- homeopathic products
- analgesics (paracetamol or ibuprofen)
what can be done to teething rings / toys to help soothe gums?
- they can be chilled in the fridge
- do not freeze them!
what healthy things can be given to young children that are over 6 months and weaning to chew on when teething?
- raw fruit
- raw veg
- soft fruits like melon can soothe gums
explain why teething gels are not currently our go-to treatment for young children that are teething
- lack of evidence - non-pharmacological methods should be used first
- age suitability should be checked
- not currently recommended
give an example of a homeopathic product that can be used for teething in young children and state what must be done before recommending them
- eg. teething powders
- check they are licensed
- no evidence that they work
symptoms of coughs, colds and ear infections in young children
- similar to adults
- runny nose
- sneezing
- cough
- fever
what do treatments for colds or coughs in young children depend on?
symptoms and age
what treatment for colds in young children is safe from birth and what does it help to do?
- saline nasal drops safe from birth
- relieve nasal congestion
- improve feeding in babies
what can be used for fever caused by colds or coughs in young children?
ibuprofen or paracetamol depending on WWHAM
what can be good for symptomatic relief of coughs in young children? what must be checked before these are recommended?
- cough medications (eg. syrup) to soothe
- age must be checked first
what aged children cannot use decongestants and what type?
no decongestants under 6 years (oral or nasal drops)
what are some non-pharmacological treatments for coughs or colds in young children?
- mentholated products (check age suitability)
- suction devices
- be more upright when sleeping
what must be looked out for in children with coughs or colds?
- croup
- distinctive barking cough
- make a harsh sound (stridor) when breathing in
- may also have runny nose, sore throat and high temperature
- REFER depending on symptoms (GP, 999 or A&E)
what can ear infections in young children be associated with?
a cold
what treatments can be used for ear infections in young children?
- paracetamol or ibuprofen (only advised by HCP)
- no drops
what are ear infections in young children usually caused by?
usually viral
how can Pharmacy First be used for ear infections in young children?
pharmacists can assess children to see if antibiotics are indicated
what age can hay fever present at in children?
any age
what is hay fever?
- allergy to pollen
- different types of pollen affect different people
symptoms of hay fever
- runny and / or itchy nose
- itchy, runny or red eyes
- sneezing
what OTC treatments are there for hay fever? (these are age dependent)
- eye drops (sodium cromoglicate 2%)
- nasal drops (saline)
- oral (chlorphenamine, cetirizine)
red flags to look out for in young children with hay fever
- failed OTC treatment
- short of breath / wheeze
- pain in head, ear, sinuses
- less than 2 years old
symptoms of atopic eczema
- red, itchy skin creases
- dry skin
who can initially diagnose atopic eczema?
GP
non-pharmacological advice for management of eczema
- emollients and soap substitutes (soap can be quite drying on the skin)
- prescribed or purchased
what must be considered before giving someone with atopic eczema topical steroids?
- age / usage restrictions (eg. never to be used on the face)
- side effects
red flags to look out for in children with eczema
- signs of infection
- no response after 7 days of steroid
what age of children is head lice common in?
primary school age children
are head lice harmful?
no, they are harmless
symptoms of head lice
- head scratching
- visible lice
non-pharmacological management of head lice in children
- reassure children that it is not a sign of poor hygiene
- keep hair short or tied back
- wet combing
pharmacological treatment of head lice
- OTC products available
red flags to look out for in young children with head lice
less than 6 months old
symptoms of threadworm in young children
- itching around anus
- worst at night
- sometimes visible in faeces
is threadworm rare or common in young children?
very common
non-pharmacological advice for threadworm in young children
- hand washing
- strict hygiene
pharmacological advice for threadworm in young children
OTC products eg. mebendazole
red flags to look out for in young children with threadworm
- weight loss
- persistent stomach ache after 2 weeks
- persistent symptoms after 2 weeks of treatment
what is tonsillitis?
- infection of the tonsils (back of the throat)
what is the average for tonsillitis to occur?
5-15 years
signs and symptoms of tonsillitis
- sore throat / pain on swallowing
- raised temperature
- difficulty eating (and drinking)
red flags to look out for in children with tonsillitis
- severe symptoms
- difficulty swallowing
- ongoing pain / inflammation despite analgesia (more than 4 days)
- no improvement within 48 hours of antibiotics if given
- unable to tolerate oral fluids
management methods of tonsillitis
- analgesia
- fluids
- rest
- antibiotics (if signs of bacterial tonsillitis)
- tonsillectomy if recurrent
what should children NOT do to treat tonsillitis?
gargle with warm salt water
what analgesics can be used in children with tonsillitis?
- paracetamol or ibuprofen
- NOT aspirin in anyone under 16
- topical sprays
what is meningitis?
the infection of the meninges around the brain and spinal cord
general symptoms of meningitis in children
fever
headache
cold hands and feet
vomiting
confusion
rapid breathing
pale, mottled or blotchy skin
rash
aches and pains
extra symptoms (along with the general ones) for babies with meningitis
- refuse feeds
- be irritable
- have a high-pitched cry
- have a stiff body or be floppy or unresponsive
- have a bulging soft spot on the top of their head
what may happen if meningitis is considered a medical emergency?
- urgent referral of suspected cases
- will require hospital diagnosis and management
- may be given antibiotics if bacterial meningitis suspected BEFORE confirmation
- treatment is with high dose antibiotics
which strains of meningitis are in the UK vaccination schedule and at what age?
- meningitis B: 8 weeks, 16 weeks, 1 year
- ACWY: 14 years
red flags to look out for in children with meningitis
- confusion
- tachypnoea
- muscle and joint pain
- stiff neck
- pale, mottled or blotchy skin
- non-blanching rash
- photophobia
what is type 1 diabetes?
- autoimmune condition with unknown cause
- insufficient insulin produced resulting in an accumulation of glucose in blood
- life long condition
average age of diagnosis of type 1 diabetes
13 years
long term complications of type 1 diabetes
neuropathy
retinopathy
nephropathy
symptoms of type 1 diabetes
- polydipsia (being thirsty)
- polyuria (weeing more)
- weight loss
- fatigue
red flags to look for in children that may have type 1 diabetes
4Ts
- toilet
- tired
- thirsty
- thinner
management of type 1 diabetes in children
- patient education
- monitoring blood sugars
- insulin - subcutaneous injections
what is a risk with children that have type 1 diabetes surrounding adherence?
- risk of poor compliance
- particularly in adolescents / young adults due to embarrassment
how can blood sugars be monitored in children with type 1 diabetes?
- finger prick test
- continuous glucose monitoring
- flash glucose monitoring
what is the ideal blood glucose level in those with type 1 diabetes?
4-7 mmol/L
pharmacist roles for children with type 1 diabetes
- ensuring supply of medication
- support with equipment
- practical advice
- signposting and advice
- supporting lifestyle modifications
- identification of complications
- appropriate referral
explain the pharmacist role for children with type 1 diabetes of ensuring supply of medication
- managing shortages
- keeping adequate stock (insulin is kept in the fridge)
explain the pharmacist role for children with type 1 diabetes of supporting them with equipment
- patient counselling on use
- advice around waste disposal
give an example of the pharmacist role for children with type 1 diabetes of giving practical advice
eg. for travelling with medicines such as insulin
explain the pharmacist role for children with type 1 diabetes of signposting and advice
support organisations and reputable sources
explain the pharmacist role for children with type 1 diabetes of supporting lifestyle modifications
- diet advice
- exercise
- smoking / vaping in older children?
explain the pharmacist role for children with type 1 diabetes of identifying complications
hyperglycaemia
hypoglycaemia
what is acne?
- common skin condition
- can affect adolescents through all of adulthood but most common in teenagers (based on hormonal changes)
describe the presentation of acne
- open and closed comedones (spots)
- papules, pustules and nodules (resulting from ruptured comedones)
- mild, moderate or severe
what areas are commonly affected by acne?
- face (affects almost everyone with acne)
- back (affects more than half of people with acne)
- chest (affects about 15% of people with acne)
aims of acne treatment and advice
- heal existing lesions and prevent occurrence of new lesions
- prevent scarring
- relieve psychological distress (improve self esteem)
- reassurance
- signpost for support
OTC management of acne
- topical agents
- can bleach clothing or bedding, can cause skin irritation
example of OTC topical agent that can be used to manage acne
benzoyl peroxide
self help advice for acne
- wash affected areas of skin twice a day maximum
- use mild soap or cleanser and lukewarm water
- do not squeeze blackheads or spots
- avoid make-up, skincare and sincere products that are oil-based
- completely remove makeup before bed
- use water-based fragrance-free emollient for dry skin
- regular exercise
- shower asap after exercise
- wash hair regularly
POM management for acne
- oral antibiotics
- oral isotretinoin (specialist use)
example of an oral POM antibiotic that can be used for acne
a tetracycline
red flags to look out for in those with acne
- severe acne
- OTC treatment failure
- concerns regarding mental health / psychological condition
what are inflammatory bowel disorders and when may they present in life?
- life-long autoimmune conditions, cause not fully understood
- may present in later teenage years (15 and over)
what are the 2 types of inflammatory bowel disorders and what areas of the GIT do they affect?
- Crohn’s disease (anywhere from mouth to anus)
- Ulcerative Colitis (large intestine only)
red flags / symptoms of inflammatory bowel disease
- symptoms are all the red flags below, if persistent
- abdominal pain
- abdominal bloating
- bloody diarrhoea
- unexplained weight loss
- extreme tiredness
- anaemia
management of inflammatory bowel disease
- diagnosed and treatment initiated by hospital
- aim to initiate remission
- maintenance therapy
- flare-ups (may require inpatient stay with similar treatment as initiation)
community pharmacy responsibilities for treating and managing inflammatory bowel disorders
- ensuring supplies of medication
- supporting patients and their families
- OTC advice
- patient counselling on medications
- adherence
- looking out for adverse drug reactions
- addressing concerns
- signposting
- appropriate referral
what is CAHMS?
children and adolescent mental health service
what mental disorders have pathways and guidance provided by NICE on them?
- anti-social behaviour and conduct disorder in children and young people
- attention deficit hyperactivity disorder
- depression and anxiety
- psychosis and schizophrenia
- eating disorders
what age is the development of an eating disorder most likely?
13-17
what age and gender of people are mental health problems most prevalent in?
17-19 year olds girls
high risk groups of having ADHD
- children who were premature
- epilepsy
- family history
- mood disorder
- neurodevelopmental disorders
symptoms of ADHD
hyperactivity
impulsiveness
inability to focus on a task
who can make an ADHD diagnosis and what are these based on?
- only by a specialist psychiatrist or paediatrician
- based on lots of different factors
how can the education system be used as a management for ADHD?
- educate patients and family on how this will impact their life
- at school, socially and adult life
non-pharmacological advice for ADHD
- ADHD-focused group parent-training programme
- CBT (cognitive behavioural therapy)
pharmacological treatments for ADHD
- medication
- commonly use controlled drugs
risk factors for depression
- ‘single recent undesirable life event’ (recent trauma)
- family history
- previous diagnosis of depression or mood disorder
- looked after children (in care) or those known to local safeguarding teams
symptoms of depression
- irritable or grumpy / on edge
- no longer interested in things they used to enjoy
- tired / exhausted / sleeping more than usual
- trouble sleeping
- loss of confidence
- problem behaviour (particularly in older children)
describe management of depression in young people, including pharmacological and non-pharmacological methods
- managed by CAHMS
- non-pharmacological: CBT, healthy lifestyle, family support
- pharmacological: first line therapy is SSRI
what role do pharmacists have to play regarding eating disorders in young people?
- recognising symptoms and signposting
- diagnosis only done by a specialist
- managed in community where possible
describe bulimia and binge eating including symptoms and what must happen after diagnosis
- not always associated with weight loss, harder to identify ‘as an outsider’
- change in behaviour related to shame
- require specialist support after diagnosis
describe, generally, what age group is affected by ARFID as opposed to other eating disorders
much younger age group
signs of ARFID
- picky eating
- lack of interest
- only eat certain foods
- associated weight loss
risk factors for ARFID
- OCD
- ASD (autistic spectrum disorder)
- anxiety
- ADHD
management of ARFID
- vitamin / mineral correction
- CBT
- speech and language therapy (SLT)
highest risk age group of anorexia nervosa
13-17, males and females
signs of anorexia nervosa
- low or very low BMI
- rapid weight loss
- social withdrawal
- dieting / restrictive eating
- physical signs of malnutrition
- laxative misuse
specialist and hospital management of anorexia nervosa
- specialist care (work towards gaining and maintaining healthy weight)
- inpatient admission if a nasogastric tube is needed for calorie intake or electrolyte monitoring
non-pharmacological management of anorexia nervosa
main emphasis on family therapy or individual CBT
pharmacological management of anorexia nervosa
- vitamin / mineral support to prevent re-feeding
- bone protection (eg. calcium and vitamin D supplement)
what should not be a pharmacological management strategy for anorexia nervosa in under 18s?
medications such as antidepressants are not routinely offered to under 18s and should NEVER be used on their own
