Paediatric Flashcards
Viral wheeze
Viral-induced wheeze should be considered in children between the ages of six months and five years with wheezing associated with infection only.
SOB
No crackles
Clues to exclude:
Asthma - previous diagnosis, no infection
Resp infection eg pneumonia or brochiolitis - have crackles and usually inc resp rate, productive cough, fatigue and body ache
Inhaled foreign body - no infection
Management:
Determine the severity of the attack -PEFR and symptoms
ABCDE assessment
POPS score
Consider the need for hospital admission:
Admit all children with life-threatening features or symptoms persisting after initial bronchodilator treatment or significant medical history.
While awaiting admission to hospital:
Give oxygen to all children with oxygen saturation <94%. Need saturation of 94–98%.
Treat with a short-acting beta-2 agonist:
For life-threatening or severe attacks, give nebulized salbutamol.
Monitor peak expiratory flow rate and oxygen saturation to assess response to treatment.
If the child does not require hospital admission:
Use a short-acting beta-2 agonist to relieve acute symptoms.
If the child responds favourably prescribe to use at home as required.
Use either paracetamol or ibuprofen for fever - only as long as the child appears distressed.
Advise to encourage the child to take fluids regularly. For infants that are breastfed, advise continued breastfeeding.
Safety netting:
Seek medical advice if they are unable to cope, or if the child deteriorates, particularly if:
Breathing rate increases or there are any episodes of apnoea or signs of increased effort of breathing.
A baby takes less than 50% of its normal feeds, or there are signs of dehydration such as dry mouth or infrequent passage of urine.
A baby becomes less responsive or difficult to rouse.
There is persistent worsening of fever.
Follow-up:
Within 48 hours of presentation, if not admitted to hospital.
Review symptoms and check peak expiratory flow.
For children with more severe, recurrent attacks of wheezing consider prescribing a low dose inhaled corticosteroid or leukotriene receptor antagonist.
Osgood-Schlatters
Diagnosis:
Clinical (no need for X-ray)
Exclude an alternative cause for knee pain - trauma, systemic symptoms, bone or joint pain elsewhere, night pain etc.
Typically, pain associated with the disease starts in adolescence and is:
Anterior knee pain
Localized to the tibial tuberosity.
Gradual in onset and initially mild and intermittent, but may progress to become severe and continuous.
Unilateral (may be bilateral in up to 30% of people).
Relieved by rest and made worse by kneeling and activity.
Findings:
Tenderness over the tibial tuberosity.
Pain provoked by resisted knee extension.
Swelling or bony enlargement of the tibial tuberosity.
A normal passive range of movement.
The absence of effusion.
RF -very active, tight quads, decent flexibility of hamstrings
Clues to exclude:
Injury - Starts suddenly after trauma to the knee. Any age.
Perthes - 3-19yrs, hip pain, limitation of hip rotation and a subacute limp with referred pain to the groin, thigh, or knee.
SUFE - slipped upper femoral epiphysis- acute onset of pain (hip, thigh, or knee), walk with an antalgic gait out-toeing, shortening of the affected limb. Pain with passive hip movement.
Management:
Self-limiting - 90% resolves within 2yrs
Offering analgesia such as paracetamol and/or NSAID, use of protective knee pads to relieve pain on kneeling, and the intermittent application of ice packs over the tibial tuberosity.
Giving advice about exercise modification and muscle stretching exercises.
Safety netting:
For people whose knee pain does not improve or worsens despite appropriate management - reassess and refer to paediatrician or orthopaedic surgeon.
People whose symptoms persist into adulthood should be referred to an orthopaedic surgeon if symptoms are significantly affecting their functioning.
Threadworms
Parasitic worm
Faecal -oral route or handling contaminated surfaces
Intense Perianal itching, disturbs sleeping
Diagnosis - history and exam
Treatment - treat all household members - mebendazole
Candida - skin folds, mouth or genital area, vaginal discharge, no perianal itching, risk factors - diabetes, HIV, recent Abx use.
Infantile colic
Features:
The infant is less than 5 months of age.
There are recurrent and prolonged periods of infant crying, fussing, or irritability reported by caregivers that occur without obvious cause and cannot be resolved.
Other:
Crying which most often occurs in the late afternoon or evening.
Drawing the knees up to the abdomen or arching the back when crying.
Clenching of the fists.
Unknown cause
Management - self-limiting condition that usually improves by 3–4 months of age, and should resolve by 5–6 months of age.
Strategies to improve crying:
Holding the baby through the crying episode, Reducing environmental stimuli, Gentle motion, ‘White noise’, Bathing the infant in a warm bath, Ensuring an optimal winding technique is used during and after feeds.
Encourage parents/carers to look after their own wellbeing by - Asking family and friends for support, Meeting other carers to access peer support, Putting the baby down in a safe place if they feel unable to cope with the crying for a few minutes, to allow ‘time out’.
If the mother is breastfeeding, encourage her to continue wherever possible.
Safety-netting:
Seek specialist advice from a paediatrician or arrange referral if:
Parents/carers feel unable to cope.
There is suspected faltering growth, or symptoms persist beyond 5 months of age.
Clues to exclude:
Infant reflux - suspect if - Distressed behaviour, Hoarseness, chronic cough, A single episode of pneumonia, Unexplained feeding difficulties eg gagging, epigastric pain.
dietary intolerance - eg cow’s milk allergy - IgE-mediated when multiple/severe symptoms - urticaria, angio-oedema, cough, breathlessness after ingestion.
Non-IgE if one or more symptoms such as GORD, abdo discomfort, constipation, diarrhoea, or atopic eczema, treatment-resistant.
pyloric stenosis - suggested by frequent, forceful (projectile) vomiting in infants up to 2 months of age.
Red flags:
A weak, abnormally high-pitched, or continuous cry - potentially serious illness.
Fever
Apnoeic episodes
Cyanosis
Abnormal breathing pattern
Bilious or projectile vomiting
Weight loss or faltering growth
Blood in the stool
GORD
Suspect a diagnosis if they present with visible regurgitation and one or more of the associated symptoms:
Distressed behaviour such as excessive crying, crying while feeding, irritability, back arching.
If there is associated episodic torticollis with neck extension and rotation may indicate Sandifer syndrome.
Hoarseness and/or chronic cough.
A single episode of pneumonia.
Unexplained feeding difficulties, such as refusing to feed, gagging, or choking.
Faltering growth.
Children over 1yr may present with epigastric pain.
Clues to exclude:
Psychological - triggered by stress or emotional factors, unrelated to meals, nausea present anytime, other symptoms not just related to food intake
migraine -
mesenteric adenitis - fever, nausea, diarrhoea, tender RIF, sore throat
Management- thickened milk, omeprazole
Red flags - projectile vomiting, not keeping food down
Newborn baby check
In 24 hours and then repeat at 6-8 weeks.
- Inspect - general state, posture, movements, colour, skin marks, dysmorphic features
2 Head - measure Occipitofrontal diameter, palpate suture lines and fontanelle. Eyes - RB, cataracts. Ears - patent EAM. Cleft-lip palate, suck reflex
3 Chest - palpate clavicles, chest shape + movement, bilateral air entry, auscultate for murmur, heart rate, resp rate, peripheral saturations
4 Abdomen - shape, movement, umbilicus, hernias, femoral pulse, external genitalia, perineum, anus.
5 Hands, limbs, back, hip - hand digits, palmar creases
Limb - position, movements
Palpate spine
Hip dysplasia - ortoleni, barlow - Reflexes - tone, ortos, others eg stepping reflex
Cradle cap
Seborrhoeic dermatitis in babies - skin inflammation which mainly affects scalp and face.
Cause not known.
First 6 months then resolves in few months.
Symptoms - greasy, yellow, scaly patches on scalp.
Management - self-limiting
Daily washing with shampoo and brush to loosen scales.
Rub in oil and leave overnight and wash.
Emollient.
If needed anti-fungal cream.
Erythema toxicum neonatorum
Baby acne is small, inflamed bumps that can appear on a baby’s neck, face, back and chest shortly after birth.
Symptoms- red papules or pustules or vesicles.
May be many spots or very few.
Blanching.
The rash can be temporary and sometimes individual spots can disappear within hours while new ones will appear somewhere else.
Management - gone within 2 weeks. Can recur.
Avoid over washing, cream not necessary,
Common gait issues
Toddler diarrhoea
1-5
Chronic, 3 or more bm, otherwise well
Cause - imbalance of fibre and undigested food in colon
Settles by 5-6yrs of age, higher fat, less fruit juice, balanced fibre
Check for dehydration
Differentials - infection - acute, fever, vomiting, cramps, potential blood/mucus
Dietary intolerance - abdo pain, flatulence, bloating
Coeliac - Abdo distension, NV, slower rate of growth + weight gain
UC - bloody diarrhoea, fatigue, weight loss, anemia (could have skin sores, joint pain)
Crohns -
Nappy rash
