Paediatric Common Conditions 1 Flashcards

1
Q

What is achondroplasia?

A

Achondroplasia is an autosomal dominant disorder associated with short stature

mutation in the fibroblast growth factor receptor 3 (FGFR-3) gene

This results in abnormal cartilage giving rise to:
short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
‘trident’ hands
lumbar lordosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is acute epiglottitis? Presentation?

A

rare but serious infection caused by Haemophilus influenzae type B

Causes inflammation of the epiglottis

Features:
rapid onset
high temperature, generally unwell
stridor
drooling of saliva
‘tripod’ position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can acute epiglottitis be diagnosed?

A

direct visualisation (only by senior/airway trained staff)

x-rays may be done, particularly if there is concern about a foreign body:
a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’
PA view in croup will show subglottic narrowing, commonly called the ‘steeple sign’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can acute epiglottitis be managed?

A

immediate senior involvement, including those able to provide emergency airway support (e.g. anaesthetics, ENT)

endotracheal intubation may be necessary to protect the airway

if suspected do NOT examine the throat due to the risk of acute airway obstruction

(the diagnosis is made by direct visualisation but this should only be done by senior staff who are able to intubate if necessary)

oxygen, IV antibiotics (ceftriaxone) , dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the main complication to be aware of with epiglottitis?

A

epiglottic abscess, which is a collection of pus around the epiglottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common malignancy affecting children?

A

Acute lymphoblastic leukaemia ( ALL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does ALL present?

A

anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Poor prognostic factors in ALL?

A

age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the key differentials for acute scrotal pain in children?

A

Testicular torsion - Most common around puberty
Irreducible inguinal hernia - Most common in children < 2 years old
Epididymitis - Rare in prepubescent children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Alpha-thalassaemia is due to a deficiency of alpha chains in haemoglobin.

Clinical severity depends on the number of alpha globulin alleles affected:

A

1/ 2 alpha globulin alleles affected = hypochromic and microcytic, Hb level is typically normal

3 alpha globulin alleles affected = hypochromic microcytic anaemia with splenomegaly, Hb H disease

If all 4 alpha globulin alleles are affected (i.e. homozygote) = death in utero (hydrops fetalis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The Apgar score is used to assess the health of a newborn baby. At what times should it be used?

A

at 1, and 5 minutes of age

If the score is low then it is again repeated at 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the APGAR criteria?
What are the normal values?

A

Activity (muscle tone)
Pulse
Grimace (reflex irritability)
Appearance (skin colour)
Respiratory effort

score of 0-3 is very low, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How would you score activity (muscle tone) in the APGAR assessment?

A

active movement = 2
limb flexion = 1
flaccid = 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How would you score pulse in the APGAR assessment?

A

> 100 = 2
< 100 = 1
absent = 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How would you score grimace (reflex irritability) in the APGAR assessment?

A

Cries on stimulation/sneezes, coughs = 2
Grimace = 1
Nil = 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How would you score appearance (skin colour) in the APGAR assessment?

A

pink = 2
body pink, extremities blue = 1
blue all over = 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How would you score respiratory effort in the APGAR assessment?

A

strong, crying = 2
weak, irregular = 1
nil = 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which children with appendicitis are more likely to present atypically?

A

Children who are younger or have a retrocaecal/pelvic appendix

Appendicitis is uncommon in children under 4 years old but in this group often presents with perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is classified as a severe asthma attack in children?

A

SpO2 < 92%

PEF 33-50% best or predicted

Too breathless to talk or feed

Heart rate
>125 (>5 years)
>140 (1-5 years)

Respiratory rate
>30 breaths/min (>5 years)
>40 (1-5 years)

Use of accessory neck muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is classified as a life threatening asthma attack in children?

A

SpO2 <92%

PEF <33% best or predicted

Silent chest

Poor respiratory effort

Agitation

Altered consciousness

Cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Children with severe or life threatening asthma should be transferred immediately to hospital. Which children should you measure PEF in?

A

Children over 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How should children with mild to moderate acute asthma be managed?

A

Bronchodilator therapy:
give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)
give 1 puff every 30-60 seconds up to a maximum of 10 puffs
if symptoms are not controlled repeat and refer to hospital

Steroid therapy:
should be given to all children with an asthma exacerbation
treatment should be given for 3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What dose of prednisolone is given in kids with acute asthma?

A

1-2 mg/kg od (max 40mg)

OR

2 - 5 years = 20 mg od
> 5 years = 30 - 40 mg od

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How should newly diagnosed asthma v newly diagnosed asthma with symptoms >= 3 / week or night-time waking be managed?

A

Newly diagnosed asthma = SABA

More symptomatic = SABA + paediatric low-dose inhaled corticosteroid (ICS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the stepladder of mx for asthma in kids?
SABA SABA + paediatric low-dose inhaled corticosteroid (ICS) SABA + paediatric low-dose ICS + LTRA (e.g. montelukast) SABA + paediatric low-dose ICS + LABA (e.g. Serevent- salmeterol) In contrast to the adult guidance, NICE recommend stopping the LTRA at this point if it hasn't helped SABA + switch ICS/LABA for a maintenance and reliever therapy (MART)
26
What is Maintenance and reliever therapy (MART) ?
a form of combined ICS and LABA treatment in which a single inhaler, containing both ICS and a fast-acting LABA, is used for both daily maintenance therapy and the relief of symptoms as required
27
What is considered as a low dose ICS in kids?
<= 200 micrograms budesonide or equivalent
28
What is the stepladder for asthma mx in children under 5 years?
SABA SABA + an 8-week trial of paediatric MODERATE-dose ICS After 8-weeks stop the ICS and monitor the child's symptoms: if symptoms reoccur within 4 weeks of stopping ICS treatment, restart the ICS at a paediatric low dose as first-line maintenance therapy if symptoms reoccur beyond 4 weeks after stopping ICS treatment, repeat the 8‑week trial of a paediatric moderate dose of ICS SABA + paediatric low-dose ICS + LTRA Referral for specialist assessment
29
What is ADHD?
Attention deficit hyperactivity disorder a condition incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent
30
Give some features that might suggest “hyperactivity” ( ADHD criteria)
Unable to play quietly Talks excessively Does not wait their turn easily Will spontaneously leave their seat when expected to sit Is often 'on the go' Often interruptive or intrusive to others Will answer prematurely, before a question has been finished Will run and climb in situations where it is not appropriate
31
How can ADHD be managed?
ten-week 'watch and wait' period following presentation Secondary care referral if sxs continue Drug therapy should as a last resort and is only available to those aged 5 years + Methylphenidate is first line and should initially be given on a 6 week trial basis Dexamfetamine and Atomoxetine are also available
32
What is Methylphenidate’s mechanism of action? ADRs? How should patients be monitored?
CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor ADRs: abdominal pain, nausea and dyspepsia In children, weight and height should be monitored every 6 months ECG before starting as cardiotoxic
33
What is autism?
a neurodevelopmental condition characterized by qualitative impairment in social interaction and communication as well as repetitive stereotyped behaviour, interests, and activities. three to four times more common in boys than girls typically evident before 2–3 years of age
34
What clinical features may autism present with?
Impaired social communication and interaction: - Children frequently play alone and maybe relatively uninterested in being with other children - may fail to regulate social interaction with nonverbal cues like eye gaze, facial expression, and gestures - Fail to form and maintain appropriate relationships and become socially isolated Repetitive behaviours, interests, and activities: - Stereotyped and repetitive motor mannerisms, inflexible adherence to nonfunctional routines or rituals - particular ways of going about everyday activities ASD is often associated with intellectual impairment or language impairment
35
How can Autism spectrum disorder be managed?
Early educational and behavioural interventions SSRIs: reduce symptoms like repetitive stereotyped behaviour, anxiety, and aggression Antipsychotic drugs: reduce symptoms like aggression, self-injury Methylphenidate: for associated ADHD Family support and counselling
36
What is Benign rolandic epilepsy?
form of childhood epilepsy that typically occurs between the age of 4 and 12 years Features: seizures characteristically occur at night seizures are typically partial (e.g. paraesthesia affecting the face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements) the child is otherwise normal Excellent prognosis; seizures usually stop by adolescence
37
What is biliary atresia?
obliteration or discontinuity within the extrahepatic biliary system, which results in an obstruction in the flow of bile = neonatal cholestasis in first few weeks of life
38
What are the 3 types of biliary atresia?
Type 1: obliteration of the common bile duct Type 2a : obliteration of the common hepatic duct Type 2b: obliteration of the common bile duct, cystic duct, and hepatic duct Type 3: obliteration of the common bile duct, cystic duct, and hepatic duct up to the level of the porta hepatis (90% of cases)
39
Biliary atresia presents in the first few weeks of life with what symptoms and signs ?
Jaundice extending beyond the physiological two weeks Dark urine and pale stools Appetite and growth disturbance, (however, may be normal in some cases) Hepatomegaly with splenomegaly Cardiac murmurs if associated cardiac abnormalities present
40
How should biliary atresia be investigated?
Serum bilirubin : Total bilirubin may be normal, whereas conjugated bilirubin is abnormally high LFTs including serum bile acids and aminotransferases : usually raised but cannot differentiate causes of neonatal cholestasis Serum alpha 1-antitrypsin: Deficiency may be a cause of neonatal cholestasis Sweat chloride test: check for CF Ultrasound of the biliary tree and liver: May show distension and tract abnormalities
41
How can biliary atresia be managed? Complications?
Surgical intervention is only definitive tx Medical intervention includes antibiotic coverage and bile acid enhancers following surgery Complications : Unsuccessful anastomosis formation Progressive liver disease Cirrhosis with eventual hepatocellular carcinoma
42
What is Bronchiolitis? Offending pathogen? Presenting features?
acute bronchiolar inflammation Usually RSV (respiratory syncytial virus) other causes: mycoplasma, adenoviruses may be secondary bacterial infection coryzal symptoms (including mild fever) precede: dry cough increasing breathlessness wheezing, fine inspiratory crackles feeding difficulties
43
Give some signs of respiratory distress in a child
Raised respiratory rate Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles Intercostal and subcostal recessions Nasal flaring Head bobbing Tracheal tugging Cyanosis (due to low oxygen saturation) Abnormal airway noises
44
Define wheezing, grunting and stridor
Wheezing is a whistling sound caused by narrowed airways, typically heard during expiration Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup
45
In which patients is bronchiolitis more likely to be severe?
bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis
46
When should 999 be called for a child with bronchiolitis?
child looks seriously unwell to a healthcare professional apnoea- cessation of respiratory effort lasting more than 20 seconds, or shorter accompanied with bradycardia or cyanosis severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute central cyanosis persistent oxygen saturation of less than 92% when breathing air
47
How can bronchiolitis be investigated and managed?
immunofluorescence of nasopharyngeal secretions may show RSV Management is largely supportive: humidified oxygen is given via a head box nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth suction is sometimes used for excessive upper airway secretions
48
What options are available for ventilatory support in children?
High-flow humidified oxygen via tight nasal cannula (“Airvo” or “Optiflow”): delivers air and oxygen continuously with some added pressure (“positive end-expiratory pressure” (PEEP)) to maintain the airway at the end of expiration Continuous positive airway pressure (CPAP): involves using a sealed nasal cannula that can deliver much higher and more controlled pressures Intubation and ventilation
49
What is palivizumab?
a monoclonal antibody that targets the respiratory syncytial virus A monthly injection is given as prevention against bronchiolitis caused by RSV to high risk babies, such as ex-premature and those with congenital heart disease.
50
What is bronchopulmonary dysplasia?
also known as Chronic lung disease of prematurity (CLDP) It occurs in premature babies, typically before 28 weeks gestation, who suffer with respiratory distress syndrome and require oxygen therapy or intubation and ventilation at birth Diagnosis is made based on chest xray changes and when the infant requires oxygen therapy after they reach 36 weeks gestational age.
51
How can bronchopulmonary dysplasia (or CLDP) be prevented?
Giving corticosteroids (e.g. betamethasone) to mothers that show signs of premature labour at less than 36 weeks gestation Once the neonate is born the risk of CLDP can be reduced by: Using CPAP rather than intubation and ventilation when possible Using caffeine to stimulate the respiratory effort Not over-oxygenating with supplementary oxygen
52
How can bronchopulmonary dysplasia (or CLDP) be managed?
formal sleep study to assess their oxygen saturations during sleep Babies may be discharged from the neonatal unit on a low dose of oxygen to continue at home, via nasal cannula. They are followed up to wean the oxygen level over the first year of life. Babies with CLDP require protection against respiratory syncytial virus (RSV) - monthly injections of a monoclonal antibody (palivizumab)
53
Differntiate between Caput succedaneum and Cephalohaematoma
Both are swellings on the head of a newborn, more common following prolonged/ difficult deliveries Managed conservatively Caput succedaneum: soft tissue oedema Present at birth Typically forms over the vertex and crosses suture lines Resolves within days Cephalohaematoma: collection of blood between periosteum and skull Typically develops several hours after birth Most commonly in parietal region, doesn’t cross suture lines May take months to resolve
54
What is cerebral palsy?
disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain Possible manifestations include: abnormal tone in early infancy hand preference below 18 months delayed motor milestones abnormal gait feeding difficulties learning difficulties
55
Describe the gait that may be seen in cerebral palsy
hemiplegic or diplegic gait this gait is caused by increased muscle tone and spasticity in the legs the leg will be extended with plantar flexion of the feet and toes, meaning they have to swing the leg around in a large semicircle when moving their leg from behind them
56
What may you see on examination of a patient with cerebral palsy?
signs of an upper motor neurone lesion good muscle bulk, increased tone, brisk reflexes and slightly reduced power look for athetoid movements that indicate extrapyramidal (basal ganglia) involvement
57
What can cause cerebral palsy?
antenatal (80%): e.g. cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV) intrapartum (10%): birth asphyxia/trauma postnatal (10%): intraventricular haemorrhage, meningitis, head-trauma
58
What are the different classifications of cerebral palsy?
spastic (70%) hemiplegia, diplegia or quadriplegia increased tone resulting from damage to upper motor neurons dyskinetic damage to the basal ganglia and the substantia nigra athetoid movements and oro-motor problems ataxic caused by damage to the cerebellum with typical cerebellar signs mixed
59
Give some complications / associated conditions for cerebral palsy
Learning disability Epilepsy Kyphoscoliosis Muscle contractures Hearing and visual impairment Gastro-oesophageal reflux
60
What tx can be considered for cerebral palsy?
physiotherapy to strengthen muscles OT SLT Dietetic support (some children require PEG tubes) treatments for spasticity include oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery and selective dorsal rhizotomy anticonvulsants, analgesia as required.
61
Chickenpox is caused by primary infection with varicella zoster virus. How does it present?
fever initially itchy rash starting on head/trunk before spreading - macular then papular then vesicular systemic upset is usually mild infectivity = 4 days before rash, until 5 days after the rash first appeared
62
How can chickenpox be managed?
keep cool, trim nails calamine lotion school exclusion: until lesions have crusted over (usually about 5 days after the onset of the rash) immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG) If chickenpox develops then IV aciclovir should be considered
63
Complications of chickenpox?
Secondary bacterial infection of the lesions - NSAIDs may increase risk, group A strep may cause necrotising fasciitis pneumonia encephalitis (cerebellar involvement may be seen) disseminated haemorrhagic chickenpox
64
Spot diagnosis : Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions
Patau syndrome (trisomy 13)
65
Spot diagnosis: Micrognathia Low-set ears Rocker bottom feet Overlapping of fingers
Edward's syndrome (trisomy 18)
66
Spot diagnosis : Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
Fragile X
67
Spot diagnosis : Webbed neck Pectus excavatum Short stature Pulmonary stenosis
Noonan syndrome
68
Spot diagnosis: Micrognathia Posterior displacement of the tongue (may result in upper airway obstruction) Cleft palate
Pierre-Robin syndrome
69
Spot diagnosis: Hypotonia Hypogonadism Obesity
Prader-Willi syndrome
70
Spot diagnosis : Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis
William’s syndrome
71
Spot diagnosis : Characteristic cry (hence the name) due to larynx and neurological problems Feeding difficulties and poor weight gain Learning difficulties Microcephaly and micrognathism Hypertelorism
Cri du chat syndrome (chromosome 5p deletion syndrome)
72
How do cleft lip and cleft palate form?
polygenic inheritance maternal antiepileptic use increases risk cleft lip results from failure of the fronto-nasal and maxillary processes to fuse cleft palate results from failure of the palatine processes and the nasal septum to fuse
73
How can feeding and speech be improved in children with cleft lip / palate? What problems can cleft palate cause?
feeding: orthodontic devices may be helpful speech: with speech therapy 75% of children develop normal speech increased risk of otitis media for cleft palate babies
74
How are cleft lip and palate managed?
cleft lip is repaired earlier than cleft palate, with practices varying from repair in the first week of life to three months cleft palates are typically repaired between 6-12 months of age
75
Coeliac disease is caused by sensitivity to gluten, with repeated exposure leading to villous atrophy which in turn causes malabsorption. Children normally present before the age of 3 years. What features may the present with?
Features may coincide with the introduction of cereals (i.e. gluten) failure to thrive diarrhoea abdominal distension older children may present with anaemia many cases are not diagnosed to adulthood
76
What other conditions are associated with coealic disease?
Down's syndrome autoimmune thyroid disease IDDM
77
What is dermatitis herpetiformis?
an itchy, blistering skin rash, typically on the abdomen, caused by coeliac disease
78
How is coeliac diagnosed?
jejunal biopsy showing subtotal villous atrophy and crypt hyperplasia First line blood tests: Total IgA levels (to exclude IgA deficiency) Anti-tissue transglutaminase antibodies (anti-TTG) (anti-endomysial and anti-gliadin antibodies are also useful)
79
Complications of coeliac disease?
Nutritional deficiencies Anaemia Osteoporosis Hyposplenism Ulcerative jejunitis Enteropathy-associated T-cell lymphoma (EATL) Non-Hodgkin lymphoma Small bowel adenocarcinoma
80
What is Congenital diaphragmatic hernia (CDH)?
the herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm can result in pulmonary hypoplasia and hypertension which causes respiratory distress shortly after birth
81
Give some acyanotic congenital heart diseases
ventricular septal defects (VSD) atrial septal defect (ASD) patent ductus arteriosus (PDA) coarctation of the aorta aortic valve stenosis
82
Give some cyanotic congenital heart diseases
tetralogy of Fallot transposition of the great arteries (TGA) tricuspid atresia
83
What is the most common congenital infection in the UK?
Cytomegalovirus
84
What are the characteristic features of congenital rubella?
Sensorineural deafness Congenital cataracts Congenital heart disease (e.g. patent ductus arteriosus) Glaucoma
85
What are the characteristic features of congenital toxoplasmosis?
Cerebral calcification Chorioretinitis Hydrocephalus
86
What are the characteristic features of congenital CMV?
Low birth weight Purpuric skin lesions Sensorineural deafness Microcephaly
87
What are the causes of constipation in children?
Idiopathic - most common dehydration low-fibre diet medications: e.g. Opiates anal fissure over-enthusiastic potty training hypothyroidism Hirschsprung's disease hypercalcaemia learning disabilities
88
What red flags might suggest an underlying condition as opposed to idiopathic constipation?
Reported from birth or first few weeks of life Passage of meconium > 48 hours ‘Ribbon' stools Abdominal distension Faltering growth is an amber flag Previously unknown or undiagnosed weakness in legs, locomotor delay Signs of maltreatment
89
Prior to starting treatment for constipation, the child needs to be assessed for faecal impaction. Factors which suggest faecal impaction include:
symptoms of severe constipation overflow soiling faecal mass palpable in the abdomen (digital rectal examination should only be carried out by a specialist)
90
How can children with constipation be managed?
If faecal impaction is present polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) using an escalating dose regimen as the first-line treatment Can add a stimulant laxative after 2 weeks if needed consider regular toileting and non-punitive behavioural interventions consider asking the Health Visitor or Paediatric Continence Advisor to help support the parents
91
How can constipation in an infant be managed?
Infants not yet weaned (usually < 6 months) bottle-fed infants: give extra water in between feeds. Try gentle abdominal massage and bicycling the infant's legs breast-fed infants: constipation is unusual and organic causes should be considered Infants who have or are being weaned offer extra water, diluted fruit juice and fruits if not effective consider adding lactulose
92
Give some features of Cow's milk protein intolerance/allergy (CMPI/CMPA)
regurgitation and vomiting diarrhoea urticaria, atopic eczema 'colic' symptoms: irritability, crying wheeze, chronic cough rarely angioedema and anaphylaxis
93
How can cows milk allergy be investigated and managed?
Diagnosis is often clinical (e.g. improvement with cow's milk protein elimination) Ix: skin prick/patch testing total IgE and specific IgE (RAST) for cow's milk protein Mx: Management if formula-fed = extensive hydrolysed formula (eHF) milk is the first-line replacement formula Management if breastfed = continue breastfeeding eliminate cow's milk protein from maternal diet. Consider prescribing calcium supplements for breastfeeding mothers
94
What is the prognosis for children with non-IgE mediated intolerance to cows milk?
Most children with non-IgE-mediated cow's milk protein allergy will be milk tolerant by 3 years of age
95
What is Croup?
also known as laryngotracheitis URTI characterised by stridor which is caused by a combination of laryngeal oedema and secretions Usually caused by parainfluenza virus typically affects children aged 6 months to 2 years
96
Presenting features of croup?
stridor barking cough (worse at night) fever coryzal symptoms
97
When should children be admitted with croup?
Moderate / severe < 6 months of age known upper airway abnormalities (e.g. Laryngomalacia, Down's syndrome) uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
98
How can croup be managed?
single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity high-flow oxygen nebulised adrenaline
99
Central cyanosis in the neonatal period can be recognised clinically when the concentration of reduced haemoglobin in the blood exceeds 5g/dl. How can you distinguish between cardiac and non-cardiac causes?
The nitrogen washout test The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease
100
Initial management of suspected cyanotic congenital heart disease?
supportive care prostaglandin E1 e.g. alprostadil used to maintain a patent ductus arteriosus in ductal-dependent congenital heart defect this can act as a holding measure until a definite diagnosis is made and surgical correction performed
101
What is Acrocyanosis?
often seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities (hands and feet) occurs immediately after birth in healthy infants. It is a common finding and may persist for 24 to 48 hours.