Paediatrics Flashcards
1
Q
What counselling should be given to parents with a child with cerebral palsy?
A
- Explain the diagnosis → damage to the brain that would have occurred early in development
- The damage to the brain doesn’t get worse, but the way it manifests will change as the child gets older
- Refer to MDT and especially a paediatrician specialising in developmental disorders
- Long-term management will include physiotherapy, speech and language therapy and special educational needs
- Medications can also be given to help with symptoms
2
Q
What counselling should be given to parents with a child with neonatal jaundice?
A
- Explain that neonatal jaundice is common and usually harmless
- If <1 day, >14 days or >7 days of first presentation of jaundice = explain you will investigate the cause
- If physiological explain why it happens
- Explain treatment - light therapy
- Reassure that the light therapy is not harmful - but eyes will be protected, and blood samples will need to be taken quite regularly
- Encourage frequent breastfeeding (e.g. every 3 hours) and to wake the baby up to feed
- Explain need to stay in after phototherapy has stopped to check rebound hyperbilirubinaemia
- Refer to resources:
- NHS Choices Neonatal Jaundice Factsheet
- The Breastfeeding Network
- Bliss - for premature and sick babies
3
Q
What counselling should be given to parents with a child with gastroesophageal reflux?
A
- Explain diagnosis - immaturity of the gullet leading to food coming back the wrong way
- Reassure that this is common and usually gets better with time
- Breastfeeding: offer assessment ± alginate therapy
- Formula: review feeding history → smaller, more frequent feeds → thickeners ± alginate therapy
- Safety net: keep an eye on the vomitus (if it’s blood-stained or green seek medical attention)
4
Q
What counselling should be given to parents with a child with constipation?
A
- Explain it is simple constipation and that it is very common
- Explain treatment - want to break the cycle of a hard stool being difficult to pass
- Explain that Movicol takes time to work
- Disimpaction = escalating dose for 2 weeks
- Maintenance = can be a long time until bowel habits are re-established
- Advise encouraging the child to sit on the toilet after mealtimes (reflex)
- Advise behavioural intervention (star chart) to aid motivation
5
Q
What counselling should be given to child/parents with a child with Crohn’s disease?
A
- Explain diagnosis → a disease with an unknown cause that causes inflammation of the digestive system leading to malabsorption and bloody diarrhoea
- Explain that it is a life-long condition and there is always a risk of relapse
- Reassure there are many medications to settle down inflammation any time it flares up
- Explain that they will be seen by a gastroenterologist
- Explain complications (malabsorption and bowel cancer)
- Support groups: Crohn’s and Colitis UK
6
Q
What counselling should be given to child/parents with a child with UC?
A
- Explain diagnosis → condition of unknown cause that leads to inflammation of bowel, which leads to symptoms
- Explain it isn’t common but is a well-known disease (1 in 420)
- Explain that there is no cure and it is a condition that tends to come and go in flare-ups every so often - surgery can cure
- Medications can reduce likelihood and treat flare-ups
- Explain the complications (growth issues, bowel cancer)
- Explain that they will be seen by a gastroenterologist
- Support groups: Crohn’s and Colitis UK
7
Q
What counselling should be given to parents with a child with cow milk protein allergy?
A
- Explain the diagnosis - allergic reaction to one of the 5 proteins in the cow’s milk
- Explain that it is common - 3-6% of infants
- Treatment is simple = avoid cows’ milk in maternal diet or switch to hypoallergenic formula
- Many children grow out of it - review in 6-12m and consider re-introducing cows’ milk protein with milk ladder
- Advise regularly monitoring growth
- Support groups → British Dietetic Association (BDA)
8
Q
What counselling should be given to child/parents with a child with croup?
A
- Explain diagnosis -common viral infection of the airways
-
Explain that it gets better over 48 hours and steroids help
- Paracetamol or ibuprofen if distressed
- Advise good fluid intake
- Safety net:
- Advise regularly checking on the child at night - cough is worse
- If it gets worse = come back
- If the child becomes blue or very pale for more than a few seconds, unusually sleepy or unresponsive or serious breathing difficulties call an ambulance
9
Q
What patient education should be given following a hospital admission for an acute asthma attack?
A
- Before discharge, the following should be reviewed with the child and family
- When drugs should be used - regularly or PRN / frequency and dosage / relief vs prevention
- How to use the drug / inhaler technique
- What to do if asthma worsens - personalised asthma management action plan
- Inform the parents and child about features of poorly controlled asthma
- Cough, wheeze, breathlessness, difficulty walking/talking/sleeping, decreasing relief from bronchodilators
- Measurement of peak flow at home will allow earlier recognition of deteriorating asthma
10
Q
What counselling should be given to parents with a child with eczema?
A
- Explain the diagnosis - characterised by dry, itchy skin
- Explain it is very common and many children grow out of it
- Explain the management (and use of steroids if necessary)
- Encourage frequent, liberal use of emollients - and as a soap substitute)
- Explain the association with other atopic conditions
- Advise avoidance of triggers - e.g. types of clothes, detergents, soaps, animals
- Avoid scratching
- Safety net about signs of infection or eczema herpeticum
-
Information and Support
- Itchywheezysneezy.co.uk – excellent website demonstrating how to apply emollients
- British Association of Dermatologists (BAD) – has an information leaflet on atopic eczema
- National Eczema Society – has fact sheets
11
Q
What counselling should be given to parents with a child with tonsillitis?
A
- Explain that this is tonsillitis → Centor score the child
- Explain that importance of taking antibiotics correctly for 10 days even if symptoms get better in that time
- Avoid school until 24 hours after starting antibiotics and the child is feeling well
- Advise on the use of paracetamol, lozenges, saltwater gargling and Difflam for symptomatic treatment
12
Q
What counselling should be given to child/parents with a child with pneumonia?
A
- Explain the diagnosis - chest infection
- Explain whether admission is needed
- Explain treatment - antibiotics
-
Advise:
- Paracetamol used if distressed
- Adequate fluid intake
- Against parental smoking
- Check the child regularly during the day and night
-
Safety net
- ↑ RR
- Apnoea
- Cyanosis
- ↑ WOB
- Dehydration
- Fever does not settle 48h+ of AbX
- ↑ Drowsy
13
Q
What counselling should be given to parents with a child with cystic fibrosis?
A
- Explain the diagnosis - thick secretions
- Explain it is lifelong
- Explain that that management requires an MDT approach
- Explain that they will be referred to a specialist cystic fibrosis centre to discuss the ongoing management
- Offer to outline the aspects of management
- Pulmonary – physiotherapy, mucolytics
- Infection – prophylactic antibiotics, monitoring
- Nutrition – enzyme tablets, high-calorie diet, monitor growth
- Psychosocial – provide support for child and carers
- Offer information on genetic counselling if considering having more children
- Support groups - Cystic Fibrosis Trust
14
Q
What counselling should be given to parents with a child with primary bed-wetting without daytime symptoms?
A
- Bedwetting not the child/parent’s fault - take a neutral attitude to bedwetting so not to embarrass
- Reason is excess volume that does not wake the child to go to the toilet
- Reassure that pretty much all children become dry with time as their bladder capacity increases and they learn to wake at the sensation of a full bladder
- Child should go to the toilet regularly and before bed
- Avoid caffeine before bed
- Easy access to toilet
- Waterproof mattress or bed pads
- Lifting or waking during the night does not promote long-term dryness
- Positive reward systems - rewards for going to the toilet before bed
- Drink the recommended amount of fluid during the day
- Support groups
15
Q
What counselling should be given to parents with a child with whooping cough?
A
- Explain the diagnosis - cough that lasts for a reasonably long time
- Explain it’s uncommon because of the immunisation - discuss concerns about immunisation with the parent
- Explain you can have it again
- Explain the treatment = antibiotics but cough often persists for a long time
- Exclude from school until 48 hours after starting antibiotics
