childhood conditions

Question 1

state various childhood conditions?

Answer 1

check slide 3,4 and 5

Question 2

what do we consider when dealing with childhood conditions

Answer 2

Aetiology (cause/origin)
Differential diagnosis
Signs and symptoms
Evidence base for OTC medication
Practical prescribing and product selection
Additional advice

Question 3

major Gastro-Intestinal System issues kids have?

Answer 3

Reflux
Colic
Constipation/Diarrhoea

Question 4

what are the causes of reflux

Answer 4

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

Question 5

what are the presenting symptoms of reflux

Answer 5

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

Question 6

what are the treatment and management for reflux

Answer 6

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

Question 7

what are the advice to give for child reflux

Answer 7

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

Question 8

what are the causes of colic

Answer 8

Unknown

Defined as being present when baby cries at least 3h/day & 3d/week for 3w.

Question 9

what is the presenting symptoms for colic

Answer 9

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

Question 10

when do you refer for colic

Answer 10

Refer if floppy, green vomit, blood in stools, fever - 38°C

Question 11

what are the treatment and management for colic

Answer 11

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®.

Question 12

what are the advice to give for child colic

Answer 12

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

Question 13

what are the causes of child constipation

Answer 13

Changes in diet

‘Toilet phobia’

Question 14

what are the presenting symptoms of child constipation

Answer 14

Tummy ache
Pain when passing stools
Anxiety associated with potty training

Question 15

what are the treatments for child constipation

Answer 15

Fibre
Fluids – prune, pear, apple juice
Physical activity
If all else fails – osmotic/bulk forming laxatives

Question 16

what advice to give for child constipation

Answer 16

Refer if weak, dizzy, pain on defecation, blood in stools

Question 17

what are the causes of child diarrhoea

Answer 17

Gastroenteritis – viral/bacterial

Question 18

what advice to give for child diarrhoea

Answer 18

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

Question 19

what are the treatments for child diarrhoea

Answer 19

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)

Question 20

when to refer for child diarrhoea

Answer 20

Refer if stops feeding whilst ill, dehydration, blood in stools, diarrhoea for more than 7 days

Question 21

when to refer for child constipation

Answer 21

Refer if weak, dizzy, pain on defecation, blood in stools

Question 22

what are the most common respiratory system conditions for kids

Answer 22

Pertussis (Whooping cough)
Croup
Hand, foot and mouth
Asthma

Question 23

state facts about Pertussis (Whooping Cough)

Answer 23

Caused by Bordetella pertussis

‘Whoop’ only heard in older children – dangerous for babies

Question 24

when to refer for Pertussis

Answer 24

Refer if any suspected symptoms

Question 25

what are the symptoms of Pertussis (Whooping Cough)

Answer 25

More common at night May cause vomiting Face flushing, bleeding under skin/eyes Cyanosis (turning blue)

Question 26

what are the treatment for Pertussis (Whooping Cough)

Answer 26

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

Question 27

what are the complications from Pertussis (Whooping Cough)

Answer 27

``` Dehydration (sunken fontanelles) Weight loss Pneumonia Seizures Brain damage from cyanosis (rare) Death (rare) ```

Question 28

what are the additional advice for Pertussis (Whooping Cough)

Answer 28

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

Question 29

what are the causes of croup. when does it resolve usually

Answer 29

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

Question 30

what are the presenting symptoms of croup.

Answer 30

Difficult/painful breathing, especially on inhalation Inspiratory stridor Barking cough

Question 31

what are the treatment for croup.

Answer 31

no tx apart from anti-pyretics/pain relief prn | AVOID cough medicines that cause drowsiness

Question 32

what are the complications of croup.

Answer 32

Pneumonia Middle ear infections lymphadenitis

Question 33

when to refer for croup?

Answer 33

Refer if intercostal/subcostal recession, tachypnoea with agitation and pallor

Question 34

what are the causes of Hand, Foot and Mouth what is the incubation period when does it resolve usually

Answer 34

Coxsackie virus Incubation period 3-6 days Self-resolution in a week

Question 35

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

Answer 35

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

Question 36

when to refer for asthma?

Answer 36

Refer all suspected cases of asthma

Question 37

what are the symptoms and causes of asthma

Answer 37

Persistent night time cough Wheeze, tightness of chest Hereditary Triggered by exposure to pets, damp or cold air, laughter and exercise

Question 38

state facts about ringworm appearance causes OTC treatment choice

Answer 38

Appearance, itchy Causes – it’s not a worm! Fungal infection OTC treatment choice– Daktacort (miconazole and hydrocortisone) /clotrimazole

Question 39

state the Common childhood conditions

Answer 39

Meningococcal disease MMR Erythema infectiosum (slapped cheek, fifth disease) Scarlet fever

Question 40

state facts about Meningococcal disease

Answer 40

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

Question 41

where to refer for Meningococcal disease

Answer 41

Refer to A&E IMMEDIATELY

Question 42

state the different times to administer the different vaccines for Meningococcal Disease

Answer 42

Vaccine – Meningitis B (most common) at 8w,16w, 1yr Meningitis C at 1yr Meningitis ACWY as a teenager/ university

Question 43

state facts about measles in kids presenting symptom timeline other associated symptoms when to refer

Answer 43

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

Question 44

state facts about mumps when does it resolve

Answer 44

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

Question 45

state facts about rubella

Answer 45

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

Question 46

state facts about Slapped Cheek/Fifth Disease/ Parvovirus B19 what makes it resistant. what is the incubation period? what leads to life long immunity?

Answer 46

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

Question 47

state other facts about Slapped Cheek/Fifth Disease/ Parvovirus B19 treatment? differential diagnosis? when to refer?

Answer 47

Presents with cold/flu like symptoms followed by sickness/diarrhoea Treatment is symptomatic Differential diagnosis: Measles, Rubella, Scarlet fever Refer immunocompromised/pregnant women

Question 48

state symptoms of Scarlet Fever? when to refer?

Answer 48

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

Question 49

what is the treatment of scarlet fever

Answer 49

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

Question 50

how to do Ear Examinations?

Answer 50

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

Question 51

state facts about ear wax impaction?

Answer 51

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.

Question 52

how do you know about Ear Wax Impaction?

Answer 52

Foreign body in the EAM Dizziness/tinnitus OTC medication failure Pain originating in middle ear

Question 53

what are Ear Wax Impaction - Treatments?

Answer 53

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

Question 54

explain Otitis Externa

Answer 54

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)