childhood conditions Flashcards
state various childhood conditions?
check slide 3,4 and 5
what do we consider when dealing with childhood conditions
Aetiology (cause/origin) Differential diagnosis Signs and symptoms Evidence base for OTC medication Practical prescribing and product selection Additional advice
major Gastro-Intestinal System issues kids have?
Reflux
Colic
Constipation/Diarrhoea
what are the causes of reflux
passive transfer of gastric contents into the oesophagus due to transient or chronic relaxation of the lower oesophageal sphincter
Cow’s milk (milk protein) allergy
Rarely – a blockage in stomach or small intestine
Present at less than 6 weeks old with spontaneous resolution at 12-18 months
what are the presenting symptoms of reflux
Recurrent vomiting Difficulty feeding Failure to thrive Abdominal pain Irritability Persistent hiccups or coughing Frequent ear infections Arching back or bringing knees up during feeds
what are the treatment and management for reflux
Reflux in babies is common and Tx not required if baby is happy, healthy and gaining weight appropriately
Thickened feeds e.g. carob seed flour
Sodium alginate e.g. Gaviscon Infant – dose as per recommendation by GP, not recommended for pre-term infants
Proton pump inhibitors e.g. Omeprazole or H2receptor antagonists e.g. ranitidine
what are the advice to give for child reflux
burping baby regularly throughout feeding
giving baby smaller but more frequent feeds
holding baby upright for a period of time after feeding
Explore use of bottles that allow less air to enter
what are the causes of colic
Unknown
Defined as being present when baby cries at least 3h/day & 3d/week for 3w.
what is the presenting symptoms for colic
High-pitched crying with sudden onset and cannot be consoled
the crying begins at the same time each day, often in the afternoon or evening, ‘witching hours’
the baby might draw their legs up when they cry, and their tummy might look swollen
clench their hands
the baby’s face flushes
crying often calms down when the baby is exhausted or when they have passed wind or a stool
when do you refer for colic
Refer if floppy, green vomit, blood in stools, fever - 38°C
what are the treatment and management for colic
Anti-foaming agents, e.g. simethicone, contained in Dentinox® and Infacol®. There is little evidence to show that these drops help in colic.
Gripe water, containing sodium bicarbonate and herbal aromatic oils, evidence for its effectiveness is lacking.
Whey hydrolysate formula milk has been shown to ease symptoms. E.g. Nutramigen®, Pepdite® and Pepti-junior®.
what are the advice to give for child colic
Upright position to allow wind to pass
If breastfeeding avoid chocolate, alcohol, spicy foods, dairy products
If bottle feeding use anti-colic bottle with correct size teat
Baby massage
Take a break – relaxed parents, relaxed baby
what are the causes of child constipation
Changes in diet
‘Toilet phobia’
what are the presenting symptoms of child constipation
Tummy ache
Pain when passing stools
Anxiety associated with potty training
what are the treatments for child constipation
Fibre
Fluids – prune, pear, apple juice
Physical activity
If all else fails – osmotic/bulk forming laxatives
what advice to give for child constipation
Refer if weak, dizzy, pain on defecation, blood in stools
what are the causes of child diarrhoea
Gastroenteritis – viral/bacterial
what advice to give for child diarrhoea
Keep child home from nursery/school for at least 2 days
Maintain hygiene – e.g. washing hands
Do NOT use swimming pool until 2 weeks after the symptoms top
what are the treatments for child diarrhoea
Carry on breast or bottle feeding (small feeds frequently)
Small sips of water between feeds/solid foods
Paracetamol
Oral rehydration solution
Loperamide (children over 12)
when to refer for child diarrhoea
Refer if stops feeding whilst ill, dehydration, blood in stools, diarrhoea for more than 7 days
when to refer for child constipation
Refer if weak, dizzy, pain on defecation, blood in stools
what are the most common respiratory system conditions for kids
Pertussis (Whooping cough)
Croup
Hand, foot and mouth
Asthma
state facts about Pertussis (Whooping Cough)
Caused by Bordetella pertussis
‘Whoop’ only heard in older children – dangerous for babies
when to refer for Pertussis
Refer if any suspected symptoms
what are the symptoms of Pertussis (Whooping Cough)
More common at night
May cause vomiting
Face flushing, bleeding under skin/eyes
Cyanosis (turning blue)
what are the treatment for Pertussis (Whooping Cough)
Antibiotic – erythromycin, only effective if given early
Once Whooping cough is established no tx is effective
Babies likely to require hospital admission, older children tx at home with prophylactic erythromycin on first onset of symptoms
what are the complications from Pertussis (Whooping Cough)
Dehydration (sunken fontanelles) Weight loss Pneumonia Seizures Brain damage from cyanosis (rare) Death (rare)
what are the additional advice for Pertussis (Whooping Cough)
Stay away from nursery from 48 hrs after tx starts or 3 weeks from when cough started
Hand washing
‘Catch it, Bin it, Kill it’
Vaccinations
what are the causes of croup.
when does it resolve usually
Parainfluenza virus
Trachaea becomes inflamed and swollen, thick mucus produced
Symptoms resolve within 48-72 hours but cold symptoms may remain
Viral so no tx apart from anti-pyretics/pain relief prn
what are the presenting symptoms of croup.
Difficult/painful breathing, especially on inhalation
Inspiratory stridor
Barking cough
what are the treatment for croup.
no tx apart from anti-pyretics/pain relief prn
AVOID cough medicines that cause drowsiness
what are the complications of croup.
Pneumonia
Middle ear infections
lymphadenitis
when to refer for croup?
Refer if intercostal/subcostal recession, tachypnoea with agitation and pallor
what are the causes of Hand, Foot and Mouth
what is the incubation period
when does it resolve usually
Coxsackie virus
Incubation period 3-6 days
Self-resolution in a week
state facts about Childhood Asthma
when does it peak
what will the gp monitor
how is it treated
at what age is it suspicious for symptoms to show
Peaks at the age of 5 at GPs will not diagnose it until
GP will monitor peak flow PEFR (peak expiratory flow rate) & oxygen saturation
Treated in the same way as adult asthma but ensure patient has a spacer
Salbutamol 100mcg/dose up to 10 puffs prn for severe wheezing
If presenting with symptoms under the age of 2 years, child likely to be asymptomatic by mid childhood
when to refer for asthma?
Refer all suspected cases of asthma
what are the symptoms and causes of asthma
Persistent night time cough
Wheeze, tightness of chest
Hereditary
Triggered by exposure to pets, damp or cold air, laughter and exercise
state facts about ringworm
appearance
causes
OTC treatment choice
Appearance, itchy
Causes – it’s not a worm! Fungal infection
OTC treatment choice– Daktacort (miconazole and hydrocortisone) /clotrimazole
state the Common childhood conditions
Meningococcal disease
MMR
Erythema infectiosum (slapped cheek, fifth disease)
Scarlet fever
state facts about Meningococcal disease
Serious bacterial infection that still causes a number of deaths and permanent disability
Meningococcus organism causes both meningitis (inflammation of meninges in the brain) and septicaemia
It is the septicaemia that can kill rapidly and causes the characteristic purple/blue, non-blanching rash, fever and malaise
Meningitis causes the headaches and light sensitivity
In 1° care pt tx with IM penicillin while contacts are given prophylactic rifampicin
where to refer for Meningococcal disease
Refer to A&E IMMEDIATELY
state the different times to administer the different vaccines for Meningococcal Disease
Vaccine
– Meningitis B (most common) at 8w,16w, 1yr
Meningitis C at 1yr
Meningitis ACWY as a teenager/ university
state facts about measles in kids
presenting symptom
timeline
other associated symptoms
when to refer
Koplik’s spots in mouth – small, irregular, red spots with bluish-white speck in the middle – occurs on buccal mucosa
Measles rash starts at hair line and works downwards. Presents 2-3 days after cold symptoms listed below and lasts 3 days
runny nose, fever, cough and conjunctivitis
always refer
state facts about mumps
when does it resolve
Caused by paramyxovirus
Fever plus swelling of one or both parotid glands (salivary glands) seen behind the angle of the jaw extending behind the earlobe
May be painful to swallow
May be asymptomatic or swelling alone
Will self-resolve over 1 week
No need to refer
state facts about rubella
Cold symptoms
2 days later red-pink, itchy rash, conjunctivitis and swelling of lymph nodes
May be asymptomatic
High risk to foetus especially in early pregnancy so REFER
MMR vaccine given at 1year with a booster dose at 3yr and 4 months (just before school)
Rubella uncommon due to vaccine
state facts about Slapped Cheek/Fifth Disease/ Parvovirus B19
what makes it resistant.
what is the incubation period?
what leads to life long immunity?
single-strand DNA virus with no lipid coat, which makes it very resistant to the normal means of killing viruses, such as disinfectants and freezing
Incubation period is 4-20 days before the rash develops. It is infective from 10 days pre-rash until the onset of the rash. Once the rash appears, it is no longer infectious
One attack confers lifelong immunity
state other facts about Slapped Cheek/Fifth Disease/ Parvovirus B19
treatment?
differential diagnosis?
when to refer?
Presents with cold/flu like symptoms followed by sickness/diarrhoea
Treatment is symptomatic
Differential diagnosis: Measles, Rubella, Scarlet fever
Refer immunocompromised/pregnant women
state symptoms of Scarlet Fever?
when to refer?
Red/pink blotchy rash usually starts on trunk
Feels like sandpaper
Blanching rash
strawberry tongue differentiates it from slapped cheeks
Mild infection treated with oral antibiotics at home to prevent complications
Severe infection/mild infection in immunocompromised requires admission
Refer all suspected cases
what is the treatment of scarlet fever
10 day course penicillin V
10 day course amoxicillin if compliance with QDS penicillin on empty stomach is an issue
Azithromycin if allergic to penicillin
how to do Ear Examinations?
Only a limited examination is possible within the confines of community pharmacy
Use of a pen torch
ADULT: gently but firmly hold the helix and pull it up and back
CHILD: gently but firmly hold the lobule and pull it down and back
state facts about ear wax impaction?
Ear wax needs to be removed – MISCONCEPTION!
Ear wax protects the tympanic membrane, it is acidic so protects from infections.
Ears are self cleaning – the skin of the tympanic membrane migrates outwards away from the ear drum on shedding, and along the ear canal. Ear canal sheds wax from the ear.
Attempts to remove wax/clean ears can cause it to become trapped as migration is inhibited leading to impaction or worse – lacerate ear canal.
Symptoms – fullness, slight hearing loss, mild discomfort.
how do you know about Ear Wax Impaction?
Foreign body in the EAM
Dizziness/tinnitus
OTC medication failure
Pain originating in middle ear
what are Ear Wax Impaction - Treatments?
Very little evidence to suggest currently marketed products are better than warm water
Products available :
BNF suggests olive oil/almond oil/ sodium bicarbonate (BD/TDS up to 3 days)
Cerumol – cerumunolytic, 5d BD/TDS, plug with moistened cotton wool
Otex/Exterol – peroxide-based, 5d OD/BD, keep head tilted, do not plug 3-4days
Waxsol – docusate, fill the ear with the drops for max 2 consecutive nights
explain Otitis Externa
Inflammation of the EAM
Causes – prolonged exposure to moist, humid environments and water (swimming), skin infections
Symptoms – irritation of Otitis externa, discharge that is NOT mucopurulent, pain
Differential diagnosis – perichondritis, auricular haematoma (cauliflower ear) from trauma, otalgia (ear ache)
