Paediatrics Flashcards
What are the age ranges for... Neonates Infants Children Adolescents
Neonates - 0-1 month
Infant - 1 month - 2 years
Children - 2 years - 12 years
Adolescents - 12 years to 18 years
What age range can the following cough and cold products NOT be used in?
- Chlorphenamine (amines)
- Dextromethorphan and pholcodeine
- Guaifenesin and ipecacuanha
- Phenylephrine, pseudoephedrine, ephedrine
Under 6 years
Describe irritant napkin dermatitis…
- Nappy rash
- Red raw rash
- Contact from dirty nappies on skin, damp, humid, friction
- NOT in flexures
- NO satellite lesions
- NO other sites effected
Describe Candidal infected napkin dermatitis
- Nappy rash with candidal infection
- Bright red and well demarcated
- IN flexures (creases of skin)
- SATELLITE lesions (small red/white lesions away from main rash)
- OTHER sites infected
Describe Seborrhoeic dermatitis (nappy area)
- Mistaken for irritant nappy rash
- Shiny or greasy red nature
- IN flexures of skin
- NO satellite lesions
- OTHER sites infected
Describe psoriasis (nappy area)
- Thick, brittle skin, can be scaly
- IN flexures of skin
- NO satellite lesions
- OTHER sites infected
What are the referral symptoms of suspected napkin dermatitis or differential diagnoses?
- Severe rash (over most of nappy area)
- Signs of bacterial infection (broken skin, crusting, weep)
- Treatment failure after 7 days treatment
- Psoriasis
How do you treat napkin dermatitis?
- Avoid coarse towelling (quality nappies)
- Change frequently
- Allow skin to breathe
- Avoid perfumed washes/wipes
- Use barrier prep after every change
- ZINC (SUDOCREM)
- TITANIUM (METANIUM)
- DIMETHICONE (CONOTRANE) protect against water
How do you treat napkin dermatitis with candidal infection?
- Use clotrimazole cream 2-3 times a day
- Do not use the barrier cream when using the clotrimazole cream
- The oily cream may cause infection to spread otherwise
How do you diagnose eczema?
- Dry, itchy skin
- Babies may present with it on cheeks
- Flex of elbow and behind knees
How do you treat eczema?
- Different age ranges
- Under 10 years - emollient cream
- Over 10 years - Hydrocortisone cream
- Over 12 years - Clobatasone
LIFESTYLE:
- Mittens at night to reduce scratching
- Wet wrap to relieve itching and soothe
When would you refer eczema?
- If suspicion that skin is infected
- Weeping, crusting
- IMPETIGO = crusted yellow lesions
What virus causes the chicken pox virus?
- Varicella Zoster Virus
- Herpes virus
What are the symptoms of chicken pox?
- Fever, headache, sore throat
- Rash a few days later
- Fluid filled vesicles
What are the referral symptoms of chicken pox?
- Secondary infection due to scratching
- Signs of chest infection
- Severely ill
- Pregnancy
- New born
What is the treatment for chicken pox?
- Antipyretics - paracetamol
- Antihistamines - piriton, sedating?
- Calamine lotion - cooling, helps itch AQ CREAM LESS DRYING THAN LOTION
- Mitts at night
- Keep cool
What are some signs and symptoms of measles?
- Fever
- Cough and cold
- Sore throat
- Reddish eyes
- Photophobia
- Kopliks spots (in mouth, like glued sugar)
- RASH STARTING AT HAIR LINE AND PROGRESSES
REFER
What virus is measles caused by?
What are some complications?
- Paramyxo virus
- Otitis media
- Pneumonia
- Encephalitis
What are the symptoms of head lice?
What must be done before treatment commences?
REFERRAL?
- Itching, irritation of scalp, crawling sensation
- Must identify live louse for treatment on patients head (could just be empty eggs)
- Small black dots, crawling
- Refer if crusting, bleeding, weeping, itching elsewhere
- Scalp condition
- ASTHMA, ECZEMA (alcohol based)
What are the three treatment options for head lice?
WET COMBING:
- Bug buster comb
- Every 4 days for at least 2 weeks
PHYSICAL INSECTICIDE: - Dimeticone: (HEDRIN) lotion leave 8 hrs 6 months + - Isopropyl myristate, cyclomethicone: (FULL MARKS) leave for 5 mins 2 years
CHEMICAL INSECTICIDE:
- Malathion liquid (DERBAC) not as effective (immune)
How do you use head lice treatments?
Lifestyle advice?
- Leave product on for specified time
- Sometimes requires combing though with metal comb
- Wash out with normal shampoo
- ADVISE to carry out twice, 7 days apart
- Separate hair into sections for ease
- Tie hair up to avoid contact
- REASSURE NOT A CLEANLINESS ISSUE!
What are the symptoms associated with threadworm?
What are referral criteria?
- Night time perianal scratching, local tingling to acute pain
- Sleep disturbances due to itching
- Secondary infection due to itching
- Worms in stools
- Recent foreign travel (other worms)
- Under 2 yrs (no treatment)
- Pregnant (no treatment)
- If treatment failure occurs after 2 doses
What treatment is available for threadworm?
Lifestyle?
- Mebendazole (Ovex) Suspension
- Mebendazole (Ovex) Tablets
- Stat dose, repeat after 2 weeks if reinfestation
- Family members can be treated with oral solution
- Hygiene measures - hand washing
- Do not share towels
- Wash bed sheets regularly
- Advise children not to scratch (faecal oral route)
- Short fingernails
- Underwear at night to prevent transmission to sheets
What is the normal temperature of a child?
- What is classed as a fever?
- Where should temperature be taken?
- 37 +/- 1
- Fever over 38
Suggest under arm
(mouth and rectal not suggested by guidelines)
When should you refer a child with a fever?
- Fever in under 3 months
- Child 3-6 months with fever above 39
- Fever and no other symptoms
- Febrile convulsions
- Purpuric rash CHECK MENINGITIS
- Stiff neck
- Long than 5 days
- Unresponsive
- Dehydration
What is the treatment for temperature?
- Antipyretics:
- Paracetamol > 3months
- Ibuprofen > 3months
What may be reasons for vomiting in infants?
- Refer when?
- Posseting (regurgitation when fed)
Advise that this is normal (unless excessive)
REFER - Gastro-oesophageal reflux
Crying, colic, weight loss
REFER - Projectile vomiting
REFER - if lasts longer than 24hrs or bile present
What can be recommended for children/infants with diarrhoea?
- LIFESTYLE
- What could be the cause
- Refer?
- ORT
- Dioralyte
- Infants make up with boiled and cooled water
- Give sips throughout the day
- Wash hands, don’t share towels
- Sterilise bottles
- Extra fluids
- No swim for 2 weeks
- See if change in feed
- Vomiting
- Sunken soft spot on head
REFER:
- Over 24hrs 1 year
- Over 48hrs 3 years
