Common Childhood Conditions

Question 1

Questions involved in paediatric history

Answer 1

-Pregnancy history:
=Normal conception/ IVF
=Progression (infections/ bleeding/ gestational diabetes)
=Term vs preterm birth history
=Type of delivery
=Birth weight
-Immunisation
-Feeding
-Developmental, growth
-Drug (allergies)

Question 2

Acute assessment of child

Answer 2

-Well/ unwell (general appearance, work of breathing, circulation to skin)
-Appearance (activity, alertness and eye contact)
-Breathing
-Colour
-Rash (type and location)
-Red flags or worrying features
-History

Question 3

Presentation of respiratory distress in children

Answer 3

-Nasal flaring
-Tracheal tug
-Subcostal and intercostal recession

Question 4

NICE guideline on feverish illness

Answer 4

-Temperature
-RR >60
-CRT prolonged >2 secs
-HR

DEPENDS ON AGE

Question 5

Presentation of hand foot and mouth disease

Answer 5

-Fever (mild)
-Malaise
-Anorexia
-Abdominal pain
-Sore mouth (spots)

Question 6

What is hand foot and mouth disease?

Answer 6

-Coxsackie A & B, HSV
-Contagious
=Avoid pregnant women and other children while rash present
=Stay at home while unwell

Question 7

Presentation of infected chickenpox (bacterial)

Answer 7

-Vesicles
-Redness, unwell, new temp
-Collections

=Independent of presence of eczema
=Incubation 14-21 days
=Infectious 1-2 days before and 5-6 days after rash (strep or staph)

Question 8

Presentation of eczema herpeticum (viral)

Answer 8

-Eczema
-Punched out lesions with ‘cold sores’
-Red skin (+/- bacterial component)

Question 9

Describe Croup (viral laryngo-trachea-bronchitis)

Answer 9

-Harsh barking cough (tracheal oedema and collapse), hoarse voice (inflammation of vocal cords), inspiratory stridor
-Inflammation of upper respiratory tract (predominantly larynx and trachea but may affect the bronchi) as a result of viral infection
-Multiple viral causes (most common parainfluenza)
-6 months to 6 years peak incidence second year of life
-Worse at night appears less severe in daytime

Question 10

Describe viral induced wheeze

Answer 10

-Wheeze associated with viral URTI, similar presentation to asthma but child is usually well between episodes
-Continue for some weeks after viral infection has resolved
-Beta agonist via large volume spacer, amoxicillin if bacterial infection

=Persistent wheeze without crackles
=Recurrent episodic wheeze
=Personal/ family history atopy
=Older infants (6 months to 5 years)

Question 11

Describe bronchiolitis

Answer 11

-Coryza to cough, SOB, hyperinflation, crackles, wheeze, poor feeding
-Apnoea
-Afebrile/ low-grade fever
-Unusual to lokm “toxic”
-RSV 70%
-Winter months
-1 in 3 infants
-3 and 6 months, under age of 2

Question 12

Diagnosis of bronchiolitis

Answer 12

-Coryzal prodrome lasting 1 to 3 days, followed by:
=persistent cough and
=either tachypnoea or chest recession (or both) and
=either wheeze or crackles on chest auscultation (or both)

=Fever, apnoea, and poor feeding common

*High fever over 39 and/ or persistently focal crackles= Pneumonia!

Question 13

Indications for intensive care for bronchiolitis

Answer 13

-Signs of exhaustion, for example listlessness or decreased respiratory effort/ worsening work of breathing (RR 70, grunting, nasal flaring, marked chest recessions, central cyanosis)
-Recurrent apnoea or central cyanosis
-Failure to maintain adequate oxygen saturation despite oxygen supplementation (<92%)

-Clinical dehydration
-Difficulty breastfeeding (50-75% usual volume)

Question 14

Management of bronchiolitis

Answer 14

-Chest physiotherapy assessment for relevant comorbidities (difficulty clearing secretions)
-Oxygen supplementation
-CPAP for impending respiratory failure
-Upper airway suctioning in respiratory distress or feeding difficulties
-Nasogastric tube if not feeding

Question 15

Asthma severity in children

Answer 15

-Mild: <92%, normal
-Moderate: >92%, 1-5 years 140 HR/ 125 HR over 5, 1-5 yrs 40 RR/ 30 RR above, 50% PEF
-Severe: +140 HR, +40 RR, 33-50% PEF
-Life threatening: PEF <33%, Exhaustion, unable to talk, silent chest, cyanosis, poor respiratory effort, hypotension

Question 16

Safety netting for discharge asthma

Answer 16

-When β2-agonists are needed no more frequently than 10 puffs every four hours
-Oxygen saturation should be greater than 94%, and if available, PEF or FEV1 should be greater than 75% of best or predicted

Question 17

Describe whooping cough

Answer 17

-Highly infectious Bordetella pertussis
-Sharp inhalation of breath during bouts of paroxysmal cough

Three phases:
-Catarrhal: 1-2 weeks, nasal discharge, conjunctivitis, malaise, sore throat, low-grade fever, dry unproductive cough
-Paroxysmal: 1-6 weeks, whoop cough more common at night, thick mucous pugs or watery secretions, cyanosis
-Convalescent: 3 months, gradual improvement

Question 18

Diagnosis of whopping cough

Answer 18

-Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
=Paroxysmal cough.
=Inspiratory whoop.
=Post-tussive vomiting.
=Undiagnosed apnoeic attacks in young infants.

Question 19

Management of whooping cough

Answer 19

-Clarithromycin/ azithromycin/ co-trimoxazole
-Erythromycin for pregnant women

Question 20

Describe GORD in children

Answer 20

-Usually begins before the infant is 8 weeks old and is caused by inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity
-Nearly all symptomatic reflux resolves by 12 months of age, probably due to maturation of the lower oesophageal sphincter, upright posture, and more solids in the diet.
-Manage with alginate therapy, feed thickeners, PPI

Question 21

Presentation of GORD

Answer 21

-Distressed behaviour shown, for example, by excessive crying, crying while feeding, and adopting unusual neck postures.
-Hoarseness and/or chronic cough.
-A single episode of pneumonia.
-Unexplained feeding difficulties, for example, refusing to feed, gagging, or choking.
-Faltering growth.

Question 22

Describe measles

Answer 22

-Fever, usually of 39ºC or more without antipyretics
-Maculopapular rash
-Koplik’s spots
-Cough
-Coryzal symptoms
-Conjunctivitis.

-Oral fluid testing kit (IgM/G/ viral RNA)