General Paeds 2 Flashcards
What is cow’s milk protein intolerance/allergy
Immune mediated allergic response to naturally occurring milk proteins. Classified on aeitiology: IgE mediated, Non IgE mediated or mixed.
Risk factors for cow’s milk protein allergy?
Personal or family history of atopy.
Breast feeding is protective factor.
What are the features of cow’s milk protein allergy?
Regurgitation and vomiting,
Diarrhoea,
Urticaria, atopic eczema,
Colicky symptoms, irritibility,
Wheeze
Chronic cough,
Rarely angioedema, anaphylaxis
What are the investigations for cow’s milk protein allergy?
Often clinical diagnosis by removing cow milk.
Other investigations include skin prick testing, RAST for cow’s milk protein.
What is the management of cow’s milk protein allergy?
Avoid cows milk - if bottle fed then replace formula with hydrolysed formulas (contain cow’s milk but proteins have been broken down so they no longer trigger an immune response)
Most children outgrow allergy by age 3.
Every 6 months infants can be tried on the first step of the milk ladder
Cow’s milk intolerance vs cow’s milk allergy
Intolerance - GI symptoms without allergic features eg, angio-oedema, sneezing or coughing.
Treatment of oral candida in children who are not immunosuppressed
Admission if systemically unwell or widespread infection eg, oesophageal candida (difficulty swallowing).
Exclude risk factors eg, diabetes.
Prescribe oral miconazole for 14 days
Presentation of problematic GORD?
Chronic cough,
Hoarse cry,
Distress crying or unsettled,
Reluctance to feed,
Pneumonia,
Poor weight gain,
What are causes of vomiting in paeds?
Overfeeding,
GORD,
Pyloric stenosis,
Gastritis or gastroenteritis,
Appendicitis,
Infections such as UTIs, tonsillitis or meningitis,
Intestinal obstruction,
Bulimia.
What are red flags for vomiting in paeds
Not keeping down any feed,
Projectile or forceful vomiting,
Bile stained vomit,
Haematemesis or melaena,
Abdnominal distention,
Reduced consciousness, bulging fontanelle,
Respiratory symptoms,
Blood in stool,
Signs of infection,
Rash, angioedema,
Apnoeas
What is the management of GORD?
Small, frequent meals,
Burping regularly,
Not over-feeding,
Keep baby upright after feeding.
Gaviscon mixed with feeds,
Thickened milk or formulas,
PPI.
Rarely may need further investigations with barium meal and endoscopy.
What is Sandifer’s syndrome?
Brief episodes of abnormal movements associated with GORD in infants:
Torticollis (contraction of neck muscles)
Dystonia (muscle contractions causing twisting movements, arching of back or unusual posture).
Resolves as reflux is treated.
Differential diagnosis of diarrhoea in paeds
Infection,
IBD,
Lactose intolerance,
Coeliac disease,
Cystic fibrosis,
Toddler’s diarrhoea,
IBS,
Medications.
What are the different causes of gastroenteritis in paeds?
Viral - rotavirus or norovirus. Adenovirus less common.
E.coli - 0157 produces shiga toxin which can cause HUS.
Campylobacter,
Shigella,
Salmonella,
Bacillus Cereus.
Yersinia enterocolitica.
S. aureus.
Giardiasis
Presentation and treatment of campylobater?
Incubation of 2-5 days. Presents with abdominal cramps, bloody diarrhoea, vomiting and fever.
Often symptom management but if severe or have other risk factors then abx: Azithromycin or ciprofloxacin.
