Paediatrics Flashcards
Immunisations at birth
At birth - BCG if risk factors (see below)
Imms at 2 months
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B
rotavirus - the first dose should not be given after 14 weeks + 6 days and the second dose cannot be given after 23 weeks + 6 days due to a theoretical risk of intussusception
Imms at 3 months
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
PCV
Imms at 4 months
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Men B
Imms 12-13 months
Hib/Men C
MMR
PCV
Men B
2-8 years annual imms
Flu vaccine (annual)
3-4 year imms
‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR
12-13 year imms
HPV vaccination
13-18 year imms
‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY
The ACWY vaccine will also be offered to new students (up to the age of 25 years) at university.
School exclusion - scarlet fever
24 hours after starting abx
School exclusion hand, foot and mouth
No exclusion
Slapped cheek
Parvovirus B19
Croup. Age range
6 months-3 years
Flat feet (pea planus)
Absent medial arch on standing.
Can present at all ages
Typically resolves between the ages of 4-8 years
Orthotics are not recommended
Parental reassurance appropriate
In toeing
Presents usually in first year.
Possible causes:
metatarsus adductus: abnormal heel bisector line. 90% of cases resolve spontaneously, severe/persistent cases may require serial casting
internal tibial torsion: difference the thigh and foot ankle: resolves in the vast majority
femoral anteversion: ‘W’ sign resolves in around 80% by adolescence, surgical intervention in the remaining not usually advised
Out toeing
Presents at all ages
Common in early infancy and usually resolves by the age of 2 years
Usually due to external tibial torsion
Intervention may be appropriate if doesn’t resolve as increases risk of patellofemoral pain
Bow legs. Genu varum
Typical presentation at 1-2 years
Increased intercondylar distance
Usually resolves 4-5 years old
Knock knees (genu valgum)
Typically presents 3-4 years
Increased intermalleolar distance
Typically resolves spontaneously
Rotavirus vaccine
it is an oral, live attenuated vaccine
2 doses are required, the first at 2 months, the second at 3 months
the first dose should not be given after 14 weeks + 6 days and the second dose cannot be given after 23 weeks + 6 days due to a theoretical risk of intussusception
Other points
the vaccine is around 85-90% effective and is predicted to decrease hospitalisation by 70%
offers long-term protection against rotavirus
Constipation red flags
Reported from birth or first few weeks of life
Meconium passage >48 hours
Ribbon stools
Faltering growth
Previously unknown or undiagnosed weakness in legs, locomotor delay
Abdominal distension
Chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
Osgood-Schlatter disease
(tibial apophysitis)
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking
Patellar subluxation
Medial knee pain due to lateral subluxation of the patella
Knee may give way
Patellar tendonitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination
Chickenpox
Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
Measles
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Mumps
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Rubella
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
Erythema infectiousum
Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
Scarlet fever
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Hand foot and mouth disease
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
IM benzylpenicillin for suspected meningococcal septicaemia in the community
Under 1 year - 300mg
1-10 - 600mg
Over 10 years - 1200mg
Speech and hearing 3 months
Quietens to parents voice
Turns towards sound
Squeals
and hearing
