Childrens Health

Question 1

Where can you find the average/expected weight for specific age groups of the paediatric population

Answer 1

BNF for children

Question 2

Define neonate , infant and child

Answer 2

Neonate- An infant less than four weeks old
Infant- from one month up to one year of age
Child- from 1-12 years of age

Question 3

Outline when to refer a child (5)

Answer 3

1) symptoms lasting for long periods
2) recurring or worsening symptoms
3) failure to respond to medicines
4) severe pain
5) presence of danger symptoms

Question 4

List the danger/red flag symptoms in children (9)

Answer 4

1) unexplained loss of appetite
2) unexplained weight loss
3) persistently raised temperature
4) abnormal drowsiness
5) loss of consciousness
6) difficulty breathing
7) cough with vomiting
8) blood in sputum etc
9) persistent night time cough

Question 5

What medicine would you give for dental pain in children (2)

Answer 5

1) non-steroidal anti-inflammatory drugs (NSAID) - ibuprofen only licensed NSID in children
2) benzydamine spray/topical anaesthetics

Question 6

Describe the treatment for headache in a child (2)

Answer 6

1) migraine - refer on initial presentation

2) migraine relief products licensed from age 10

Question 7

Outline the analgesics which can be used to treat children (3)

Answer 7

1) paracetamol
- mild to moderate pain
- overdose dangerous

2) NSAIDs - ibuprofen ( take with or after food) TDS
- particularly useful in pain associated with fever and dental pain.
- cause gastric irritation
- watch asthmatics

Can use a combination in more severe pain
3) aspirin should not be given to children

Question 8

Outline the management of a fever in children (3)

Answer 8

Raised temperature
Management:
1) cold drinks- encourage regular fluids
2) use paracetamol or ibuprofen
3) if child remains unwell alternate with paracetamol (record dose carefully)

Question 9

Outline when to refer a fever in a child (9)

Answer 9

1) children under one year with fever
2) age one to five years 38 degrees and above
3) if temperature raises a over 39 degrees
4) if febrile convulsion (fits) have occurred
5) difficulty breathing
6) any signs of meningitis
7) fever lasting several days along with rash/ conjunctivitis/ other symptoms
8) failure to respond to treatment
9) stiff neck

Question 10

What are febrile convulsions (4)

Answer 10

1) Febrile convulsions are seizures occurring in children aged 6 months to 6 years, associated with fever, without other underlying cause such as CNS infection or electrolyte imbalance.
febrile convulsions 6 months- 6 years
2) sudden rise in temperature rather than a persistently elevated temperature that is thought to cause convulsions
3) antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose
4) refer

Question 11

What are the symptoms of bacterial meningitis in children (8)

Answer 11

1) fever - cold hands and feet
2) refusing food or vomiting
3) fretful, dislike of being handled
4) pale blotchy skin
5) blank starting
6) drowsy
7) stiff neck
8) high pitched cry

Question 12

What are headlice (8)

Answer 12

1) tiny whitish grey-brown insects that live in human hair
2) spread by head to head contact
3) all types of hair can be affected , regardless of length and condition
4) only effect humans and cannot be passed on to animals
5) nits = headlice eggs
6) females lay eggs which hatch after 7-10days
7) female life will then lay eggs after a further 7days
8) clings to hair and feeds on blood from hosts scalp

Question 13

Outline the treatment of head-lice (8)

Answer 13

1) shampoos , lotions , sprays , wet combing
2) all affected persons treated at the same time
3) silicone based e.g dimethicone only kills eggs
4) insecticide e.g malathion, permethrin kill both lice and nits
5) refer younger than 6 months or children with skin conditions
7) only treat if lice have been confirmed and repeat treatment after 7 days
8) alcohol from product might trigger asthma

Question 14

What is teething

Answer 14

1) teething pain may occur as a new tooth starts to break through the gum - will affect most children to some extent

We need to know: WHHAM
Who it’s for - from 3 months - 3 years
Symptoms - swollen red gums , red cheeks , excessive dribbling , fever, nappy rash , disturbed sleep / eating pattern

Question 15

Describe the treatment for teething (5)

Answer 15

1) analgesics - paracetamol or ibuprofen liquid
2) topical gel - local anaesthetic lidocaine usually in combination with an antiseptic e.g. Cetalkonium chloride
3) homeopathic - teething granules
4) oral choline salicylate gels are contraindicated because of the risk of Reye’s syndrome
5) advice: teething ring , chewing on hard food - raw carrots , biscuits

Question 16

What is oral thrush and what are the symptoms (4)

Answer 16

1) mild fungal infection affecting mouth and throat
2) sometimes called a yeast infection
3) cause by Candida albicans
4) symptoms: white patches in mouth is tongue that do not wipe off, sore red mouth or tongue , discomfort during feeding.

Question 17

Outline the treatment for oral thrush (5)

Answer 17

1) miconazole oral gel - anti fungal
2) apply with clean finger or cotton bud
3) continue treatment for 2 days after symptoms have cleared
4) if breast feeding apply to nipples to avoid reinfection
5) advice- avoid reinfection by sterilising feeding equipment and dummies

Question 18

What is infant colic? (4)

Answer 18

1) exact cause unknown
2) problems with digestion
3) intolerance to lactose
4) trapped wind

Question 19

What are the symptoms of infant colic (3)

Answer 19

1) usually starts when the baby is 2-4weeks old
2) intense periods of crying - red faced from crying
3) a bay may pull up or stiffen their legs , as if in pain

Question 20

Outline the treatment for infant colic (6)

Answer 20

1) gripe mixtures
2) colic drops - simeticone disperses trapped wind
3) lactase - breaks down lactose
4) dill, caraway & ginger
5) antacids e.g sodium bicarbonate
6) advice: sit baby upright when feeding
- check the size of the hole in the teat for bottle- fed babies
- hold bottle so that the teat is full of milk, avoid sucking a lot of air
- burp the baby during and after feeding

Question 21

Describe the reasons to refer a baby suffering from infant colic (6)

Answer 21

1) baby is not feeding
2) if baby is vomiting or crying for several hours
3) there is diagnostic doubt ( e.g baby is not thriving)
4) crying is not starting to get better or is getting worse after 4 months of age
5) significant gastro-oesophageal reflux is suspected
6) unable to wean off treatment by the age of 6 months

Question 22

What is constipation and what are the symptoms (3)

Answer 22

1) characterised by infrequent bowel evacuations
2) hard and dry stools
3) difficult to pass

Question 23

What is the treatment for nausea and vomiting

Answer 23

Oral rehydration

Question 24

What is nausea and vomiting and list the common causes (2)

Answer 24

1) vomiting episodes in children with no other symptoms - often caused by primary condition in gastro- intestinal tract
2) common causes :
- gastro- enteritis
- respiratory condition
- problems with feeding
- meningitis
- overexcited/nervous

Question 25

Outline the treatment for constipation (8)

Answer 25

1) stool softeners e.g lactulose
2) bulk forming laxatives e.g. Ispaghula
3) stimulant laxatives e.g. Senna
4) glycerin suppositories
5) continue medication at maintenance dose for several weeks after regular bowel habit is established.
4) advice: increase fluid in the diet
- increase fibre in the diet - fruit and vegetables and bran
- encourage the child to go to the toilet regularly
6) exclude any underlying cause
7) staged approach to management
8) aim to establish a regular pattern

Question 26

Describe when you would refer a child who is suffering from nausea and vomiting (6)

Answer 26

1) systemically unwell with signs of infection or fever
2) frequent vomiting for >24-48 hours
3) frequent regurgitation, failure to thrive, feeding/swallowing difficulties
4) recurrent episodes of unexplained vomiting
5) vomit in blood - stained or looks like “coffee grounds”
6) warning signs- sunken eyes, wrinkly non-elastic skin, dry nappy , drowsiness

Question 27

What is nappy rash and what are the symptoms (5)

Answer 27

1) red rash found in the nappy area
2) glazed appearance if acute
3) red chapped skin in the nappy area
4) bacterial infection - yellow crust
5) fungal infection- skin appears shiny, rash surrounded by areas of red broken skin

Question 28

Outline the treatment for nappy rash (5)

Answer 28

1) barrier creams - dimethicone , white soft paraffin
2) antiseptics
3) astringents
4) antifungals e.g. Clotrimazole
5) advice :
- clean the bottom with warm water and cotton wool
- dry the nappy area thoroughly
- leave nappy off for as long as possible
- avoid using talc
- make sure the baby is drinking plenty of fluids

Question 29

What are threadworms and what are the symptoms? (2)

Answer 29

1) enteribius vermicularis - different from tape worm

2) white threadlike worms in stool

Question 30

Outline the treatment for threadworms (4)

Answer 30

1) mebendazole (ovex) from 2 years OTC
2) repeat after two weeks If infection persists- treat whole family
3) single dose
4) advice: hygiene measures
- keep nails short and clean
- careful washing and scrubbing of hand and nails before eating and after the toilet
- wash bed linen frequently , ideally every day
- wear underwear under nightwear to prevent scratching
- bathe or shower first thing in the morning
- eggs remain viable for up to 2 weeks
- damp dust surfaces and vacuum daily
- wear underwear to prevent eggs from falling onto sheets
- adult life cycle = 6 weeks therefore continue with these measures for at least 6 weeks after treatment

Question 31

When would you refer children suffering from threadworms (2)

Answer 31

1) fever , bed wetting, vaginal discharge

2) vomiting , diarrhoea , unexplained weight loss

Question 32

What is hayfever and what are the symptoms? (4)

Answer 32

1) pollen = allergen
2) lining of nose and eyes
3) pollen count and pollution
4) symptoms:
- sneezing, cough , itchy eyes/ nose and throat , watery and red eyes, runny or blocked nose
- normally for older children

Question 33

Outline the treatment for hayfever (5)

Answer 33

1) nasal sprays
2) antihistamines
3) eye drops
4) oral antihistamines - chlorphenamine liquid from 1 year , loratadine 2 years , cetrizine liquid 6 years
5) topical antihistamines e.g azelastine , corticosteroid nasal sprays 18+ only ,sodium cromoglycate mast cell stabiliser , eye drops adults and children

Question 34

Outline when you would refer a child suffering from Hayfever (6)

Answer 34

1) failed treatment
2) shortness of breath
3) wheezing
4) pain in the head, ear or sinuses
5) conjunctivitis with a purulent discharge
6) consider referring very young children e.g.

Question 35

Explain how you would administer medication to a child (5)

Answer 35

1) a medicine should not be mixed with large quantities of food
2) should not be mixed or administered in a baby’s bottle.
3) children under 5 generally need liquid formulations
4) sugar free medicines should be provided where possible
5) can disguise flavour

Question 36

Explain the advice you would give to parents about administering eye drops and eye ointment to children (2)

Answer 36

1) Eye drops:
- can wrap child/ baby in a blanket , older children can lie on bed
- in small children and babies, place the drop into the inner corner of the eye. This is easier when the eye is open, but the liquid will still drain on to the eye even with a closed eye if you can hold child’s head still for a few seconds

2) Eye ointment
- as above
- can successfully apply while a baby is sleeping

Question 37

Describe the information you would give to a parent about administering ear drops to children (3)

Answer 37

1) can wrap child/ baby tightly in a blanket
2) pull ear lobe backwards to open up ear canal
3) avoid touching ear with dropper

Question 38

Outline the information given to parents about administering nasal drops to children (4)

Answer 38

1) lay child across lap with head hanging down
2) wrap small babies/ young children in a blanket
3) to remove mucus from a baby’s nose tickle with cotton wool.
4) warm drops better tolerated. No more than 2-3 drops

Question 39

Describe the advice given to parents about administering suppositories to children (3)

Answer 39

1) lie child on side with knees pulled up
2) lubricate suppository and insert 2-4 cm into rectum
3) hold buttocks together for 5 minutes

Question 40

Outline the information you would give to parents about administering oral liquid to children (6)

Answer 40

1) ensure child is sitting or standing at not more than 45 degree angle to reduce the risk of choking
2) give medicine along side of mouth on inside of cheek
3) lift child’s chin
4) can mix unpleasant tasting medicines with more palatable foodstuffs
5) if mixed with something make sure child consumes whole amount
6) chilled medicine is often more acceptable

Question 41

Outline the advice given to parents about administering tablets to children (5)

Answer 41

1) place tablet or capsule on back of tongue
2) give them a drink from an adults cup/glass so tablet is swallowed along with the drink
3) sometimes can be mixed with food
4) crushing not recommended unless leaflet states that it is a safe practice
5) do not tilt head back