Child Health Management

Question 1

Management of mild acute wheeze

Answer 1

10 puffs MDI salbutamol

Question 2

Mild acute wheeze that is improving

Answer 2

Wean MDI dosing and observe

Goal to get 4 hours between each 10 puffs

Question 3

Management of moderate acute wheeze

Answer 3

10 puffs MDI salbutamol x3 over 1 hour

Oral prednisolone

Question 4

Management of severe/life threatening acute wheeze

Answer 4

Nebulised salbutamol and ipratropium (combi neb) 3 times over 1 hour
Oral prednisolone

Question 5

Severe/life threatening acute wheeze that is not improving with treatment

Answer 5

Continuous nebulised salbutamol
IV hydrocortisone if can't take oral steroid
Consider CXR
IV aminophylline
Discussion with intensive care

Question 6

What is mild croup?

Answer 6

Clinical signs present when upset or active but not at rest

Question 7

Management of mild croup

Answer 7

Single dose of oral dexamethasone

Home with advice sheet

Question 8

What is moderate croup?

Answer 8

Clinical signs present at rest

Question 9

Management of moderate croup

Answer 9

Oral dexamethasone single dose
Observation until symptoms not present at rest
Discharge with advice sheet
If worsening, nebulised adrenaline

Question 10

What is severe croup?

Answer 10

Severe respiratory distress
Cyanosis
Exhaustion

Question 11

Management of severe croup

Answer 11

Nebulised adrenaline
Oral/IV dexamethasone
Facemask oxygen
Senior help/intensive care review

Question 12

When would you admit a baby with bronchiolitis?

Answer 12

If feeding less than half normal volume
If they are dehydrated (e.g. fewer wet nappies)
Will be worse on day 3-4, so if bad on day 1
Are they at greater risk e.g. premature?

Question 13

What would help you decide whether a child with diarrhoea should be admitted?

Answer 13

If they are clinically dehydrated or shocked

Question 14

What fluid would you give to a dehydrated child oral and IV?

Answer 14

Oral - dioralyte with a bit of sugar

IV - 0.9% saline with 5% dextrose

Question 15

What should a diarrhoea with blood be treated as?

Answer 15

Medical emergency (could be haemolytic uraemic syndrome)

Question 16

Management pathway of GORD in babies

Answer 16

Conservative measures e.g. positioning
Thickened feed e.g. gaviscon
PPI or ranitidine
Domperidone (empty stomach faster)

Question 17

What guidance would you use for children who are feverish to determine how best to treat them?

Answer 17

NICE feverish illness in children traffic light guidance

Question 18

When would you do a jaundice screen and what does it consist of?

Answer 18

Baby still jaundiced at 14 days or 21 days if premature
Conjugated/unconjugated bilirubin
Coombs' test (direct antiglobulin test)
TFTs
FBC and blood film
Urine culture and sugars
U&Es, LFTs

Question 19

What would you add to control the asthma of a child which is not controlled by SABA and low dose ICS?

Answer 19

Leukotriene receptor antagonist (montelukast)