Common Problems in Paediatric Outpatients Flashcards
What should be considered when a child is being allocated to a clinic?
Age of child (0-14), where they live, principal issues, degree of urgency, presence of red flags
What details should be included in a referral letter?
General health = growth/height/weight, all with centiles and development
Relevant social information (i.e on CP register)
Parental concern and impact on schooling
What is the role of secondary care in the management of paediatric outpatients?
Help make diagnosis/confirm GP diagnosis
Advice on ongoing management
Useful when there is concern in missing serious disease
Reassurance
What are the top ten reasons for paediatric outpatient referral?
Concerns about growth, UTI, constipation, abdominal pain, headaches, funny turns, heart murmurs, food allergy/intolerance, minor abnormalities, asthma
Why might a child display short stature?
Familial implication (i.e small parents) or constitutional delay
What should be considered in an obese child who also has short stature?
Endocrine causes
What is the most common pathogen implicated in UTIs in children?
E.coli
What determines whether a UTI should get further investigation?
The age of the child, nature of infection, family history of UTI/renal disease, other concerns about general health
Do all children with UTIs need to be seen in secondary care?
No = some can be managed at home
What are some more complicated renal problems that may present with a UTI?
Vesicouretric reflux, renal scarring, renal tract abnormalities
What are some concerning features of a child with a UTI?
Younger age, frequent infections, non-E.coli pathogens, family history of renal disease, poor growth/general health, poor urinary flow in infant, voiding problems/constipation, spinal abnormalities, raised BP, abdominal mass, renal tract abnormalities on antenatal scan
What is constipation defined as?
Pain, difficulty or delay in defaecation
What is the definition of soiling?
Escape of stool into underclothing = affects 2% of school age children
What is encopresis?
Passage of normal stool in abnormal places
How is constipation treated?
Laxatives, attention to food and drink, toileting behaviour advice
When should an underlying disease be considered in constipation?
Onset from early infancy or refractory to treatment
What is a red flag for constipation in paediatrics?
Delay in passage of meconium more than 24hrs after birth
What aspect of a child’s life can abdominal pain interfere with?
Very disruptive to school attendance
What should particular attention be paid to when taking a history in a child with abdominal pain?
The growth of the child
What are important diagnoses not to miss that present with abdominal pain?
Coeliac disease, IBD, malrotation, intermittent volvulus
What is a red flag in a child with abdominal pain?
Vomiting bile
What are some concerning features in a child with abdominal pain?
Involuntary weight loss, deceleration of linear growth, GI blood loss, significant vomiting, chronic severe diarrhoea, family history of IBD, recurrent oral ulceration, perianal disease
What are some specific sites of abdominal pain that may indicate a certain diagnosis?
Epigastric = if chronic, may indicate heartburn
Acute RIF pain = appendicitis
How are headaches usually diagnosed?
By history and examination alone
What are some red flags in a child with headaches?
Headache on walking, worse when coughing/bending, associated vomiting (especially in morning), visual disturbance, gait disturbance, cranial nerve palsy
What is vital in diagnosing funny turns?
Clear history from a first hand witness
What does the aetiology of a funny turn depend on?
The age of the child
What are some causes of funny turns in children?
Seizures, breath-holding, reflex anoxic seizures, benign neonatal sleep myoclonus, night terrors, faints, gratification disorder, cardiac, ALTE, toxins
What are red flags for children with cardiac syncope?
Syncope in child with known congenital heart disease
Syncope during exercise/when supine
Syncope preceded by palpitations
Heart murmur or other CV abnormalities on examination
What are some features of the family history that would raise a red flag in children with cardiac syncope?
Family history of sudden death, prolonged QT syndrome or hypertrophic cardiomyopathy
What are some red flag symptoms in children with heart murmurs?
Breathlessness, pallor, sweaty, poor feeding, dysmorphism, cyanosed
Are most paediatric murmurs benign or malignant?
Most are benign murmurs that may resolve over time
What are some features that would indicate an innocent heart murmur?
Systolic, low intensity, second left interspace, medial to the apex, beneath clavicle (may be continuous venous hum that disappears when supine)
What are some red flag features of heart murmurs?
Any diastolic murmur, loud >= grade 3, harsh, associated thrill, radiates widely, symptomatic
What are some features of food allergies?
Type 1 IgE mediated response, acute allergic reaction, may cause anaphylaxis
What are some features of food intolerances?
Delayed reaction, more varied symptomatology, mechanism unclear
What are some minor abnormalities that may occur in infants?
Head shape or size, skin lesions, feeding concerns, crying excessively
What are some concerning features in children with minor abnormalities?
Abnormal growth (weight and OFC), concerns about development
How do symptoms of minor abnormalities present in infants?
Non-specific = low index of suspicion
How is asthma usually diagnosed in children?
Tests are less helpful = diagnosis often based on probability
What are some features that increase the probability of a child having asthma?
Personal history or atopic disease, family history of atopic disease/asthma, widespread wheeze on auscultation, more than one of cough/wheeze/difficulty breathing/chest tightness
In what scenarios would a child having symptoms indicate a diagnosis of asthma?
Frequent and recurrent onsets, worse at night or early morning, occur or are worse during exercise or with other triggers, occur apart from colds
