OTC - Childhood conditions Flashcards
1) Define colic
2) When does colic normally occur and naturally resolve
3) List common Sx of colic
1) Excessive, high-pitched crying occurring usually in late afternoons/evening > 3 hours a day, 3 days/week for 3 weeks
2) Starts in infancy + resolves by 4-6 months of age
3) Difficult to comfort, red in face, clenched fists, knees drawn up to stomach, excessive gas, trouble passing stool
Referral criteria for colic
- Inconsolable crying (severe underlying condition?) - Failure to put on weight with age - Does not resolve after 4-6 months of age
OTC treatment for colic
1) FIRST LINE TREATMENT is advice and support for parents, and reassurance that infantile colic will resolve. Only consider trying medical treatment if parents feel unable to cope despite advice and reassurance.
2) Simethicone (Infacol) + lactase enzyme (Colief)
How does simethicone work?
Anti-flatulent - Eliminates trapped gas through belching/flatus
How does Colief (Lactase enzyme) work?
Breaks down sugar lactose found in breast and formula milk
Advice for managing colic (general advice to parents)
- Reassure parent not their fault and baby will grow out of it - Massage baby’s tummy in circular motion - Hold baby during curing episode, rock them and give them warm baths, burp after feed, hold upright during feed to avoid swallowing air
Simethicone dose for colic
20mg (0.5ml) administered before each feed and then increased to 40mg (1ml) if necessary. If no improvement after 7 days, refer to GP.
What is cradle cap?
Greasy, yellow scales on scalp
Starts in infancy before <6 months
Self-limiting, clears up after a few weeks/months
As scales flake off, skin underneath may look red
Referral criteria for cradle cap
Severe cradle cap on face/body
Swelling, scratching, bleeding (atopic eczema?)
Infected/inflamed - crusts leak fluid/blood
No improvement after a few weeks treatment
OTC treatment for cradle cap
- Capasal shampoo (salicylic acid + coal tar)
- Nizoral dandruff shampoo (ketoconazole)
General advice for cradle cap
- Common and harmless
- Not contagious
- Do not pick scales - infection
Meningitis:
Non specific + specific Sx
Non-blanching rash (pale, blotchy skin with widespread bruises which does not fade when pressed when press with a glass tumbular)
Non-specific:
- worsening flu like sx
- high fever
- severe muscle ache
- N + V
Specific:
- Stiff neck
- Severe headache
- Cold hands and feet
- Confusion, drowsiness
- Photobia, dislike bright lights
- Seizures
List some common symptoms of meningitis in infants
Floppiness/unresponsive, dislike being handled, refuse feeds, difficuly to work, rapid breathing/grunting, unusual cry, bulging
Referral for meningitis
ALL suspected cases should be referred to hospital
Incubation period for:
- Measles
- Mumps
- Rubella
- Measles 7-14 days
- Mumps 14-21 days
- Rubella 14-21 days
Prodormal phase of MMR (each one has diff. symptoms)
Measles - cold-like Sx, conjunctivitus, Koplik spots (small white spots surrounded by red ring on inner cheek + gums) - picture attached
Mumps - Fever, headache, malaise
Rubella - Lymphadenoapthy (swollen lymph glands, usually at back)
Characterisitcs of MMR (rash looks like? + where does it start?)
Measles - Rash starts behind ears and then spreads to face, trunks and limbs. Rash = confluent, blotchy (pic attached)
Mumps - Swelling of one of both of parotid glands
Rubella - Rash starts on face + spreads to limbs and trunk. Rash = Mascular, non confluent
Which rash is this between measles/rubella
Measles
Which rash is this between measles/rubella?
Rubella
Referral criteria for MMR
All are notifable diseases - refer all to confirm diagnosis
How long to keep children off school for MMR (each one has different times)
Measles - for at least 4 days after rash appears
Mumps - For at least 5 days after swelling appears
Rubella - For at least 6 days after rash appears
Complications of measles
More dangerous childhood illness - otitis media, pneumonia, encephalitis
Complications of adults have mumps
Risk of meningitis and sterility (in men)
Which patient group should avoid contact in those with rubella and why?
Pregnany women - foetal damage
Two types of nappy rash and qualities of both
1) Irritant nappy rashs - Erythamous rash on buttocks
2) Fungal nappy rash - Satellite rash (small, red papules on outer edge of rash). Rash concentrated in skin folds
Which organism commonly causes fungal nappy rash?
Candida albicans
Referral criteria for nappy rash
- Broken skin, severe nappy rash
- Yellow crust, weeping (antibiotics)
- Other body areas affected (atopic eczema?)
- OTC failure > 1 week
OTC treatment for nappy rash
- Barrier preparation (forms protective layer) -> sudocrem, drapolene etc
- Antifungal topic -> clotrimazole / miconazole (apply for 7 days after clearing to prevent reoccurence)
Referral for oral thrush (infants and children)
- All except babies (less common in children)
- Recurrent infection
- OTC failure > 1 week
OTC treatment for oral thrush (children)
> 4 months - Miconazole. Apply QDS after meals
- Continue for at least 1 week after sx disappear
- Don’t apply to back of throat -> choking
Most common organism that causes oral thrush
Candida albicans
Symptoms of slapped cheek syndrome
- Initial cold-like symptoms (most contagious period)
- Bright red rash on cheeks
- Light pink, lace-like itchy rash on trunk and limbs
- Sore throat, fever
Referral for slapped cheek syndrome (think of patient groups, not children)
High risk groups
- Pregnant women - increased risk of miscarriage
- Blood disorders (sickle cell anaemia and thalassamia) - risk of severe anaemia
Common presentation of whooping cough
The first signs of whooping cough are like a cold.
- coughing bouts that last for a few minutes and are worse at night
- will make a “whoop” sound – a gasp for breath between coughs (young babies and some adults may not “whoop”)
- may bring up a thick mucus, which can make you sick (vomit)
- may become very red in the face (more common in adults)
Referral for whooping cough
All cases (antibiotic <3 weeks)
A+E if significant breathing difficulties (cyanosis, rapid/shallow breathing, breathlessness, choking)
How long to stay off from school for whooping cough
Stay away from school 5 days after starting antibiotics (or 3 weeks after coughing started, whichever sooner)
How long to stay off school for if chickenpox
5 days after spots appeared
Referral criteria for chickenpox
- Adults
- Pregnant
- Weakened immune system
- < 4 weeks old
- Shingles for possible antivirals (esp if over >50, preg, immunocompromised, severe rash/pain, eyes, non-truncal involvement)
What OTC product should you avoid in people with chickenpox and why
Ibuprofen - serious skin reaction
When to refer a temperature in children?
Temperature:
< 3 months = >38
3-6 months = > 39
Duration:
> 24 hours = 3-6 months
>72 hours = > 6 months
How to measure temperature in children <5
Under armpit
Symptoms of impetigo and two types of impetigo
Goldren crust lesions
1) Non bullus impetigo - starts as small red sores around nose + mouth, quickly develops into bilsters and burst, itchy but otherwise Asx
2) Bullus impetigo - common in neonates, starts as fluid-filled blisters on trunk or arms, quickly spreads before bursting, painful/itchy, fever and swollen LN common
Referral for impetigo
All require antibiotics - topic fusidic cream for mild cases in small areas
Oral flucloxacillin if severe/widespread
Scarlet fever presentation
- Pink-red itchy ‘sandpaper’ rash (develops 12-48 hours after initial sx). first appears on chest and stomach, before spreading to other areas
- Sx before rash - sore throat, H, high temp, flushed cheeks, swollen tongue
- Other sx - red and swollen tongue (strawberry tongue), swollen LN, malaise, reduced appetite
Referral criteria for scarlet fever
ALL - requires antibiotic treatment - amoxicllin 10 days
How long to keep children off school for scarlet fever
>24 hours after starting antibiotic
