Paediatrics - head-lice, oral thrush & threadworm

Question 1

What are the symptoms of head-lice?

Answer 1

• Intense itching of scalp
• Feeling like something is moving
• Physically seeing something moving OR black or brown pieces which are the empty eggs of the nits

Question 2

Does the case need to be confirmed to give treatment?

Answer 2

You must confirm with the patient that they have seen the head-lice due to increased resistance from overuse of chemical insecticides

Question 3

Describe the wet combing method of detection and removal

Answer 3

1) Wash the hair with normal shampoo
2) Apply plenty of conditioner to hair
3) Use fine toothed comb to go through hair sequentially from root to tip, making sure to check back of neck and behind ears
4) Nits and eggshells will appear on the comb after each stroke
5) Do this on day 1,5,9 and 13 to catch any hatched lice
- Check all family members
- 10 mins for short hair
- 20-30mins for thick, long or curly hair

Question 4

What treatment is recommended?

Answer 4

• Continue the wet combing method to check for newly hatched lice and remove them
• Use a physical insecticide like Dimeticone (Hedrin), rather than a chemical insecticide first line because of the growing resistance to chemical insecticides
• Use a chemical insecticide if necessary, e.g. treatment failure or allergy to physical, like Malathion (Derbac)
• Wash bedding and towels regularly
• Do not share bedding, could crawl across pillow to other person’s head
• Let the school know but child can still attend

Question 5

What is oral thrush?

Answer 5

Oral thrush is a fungal infection of the mouth that appears as white patches. These bleed if they are scraped or picked off.

Question 6

What can cause oral thrush?

Answer 6

Have you or your child been on a course of antibiotics recently? Antibiotics kill natural microflora in mouth
Are you breastfeeding? Yes - could pass from mum to baby
Are you brushing the tongue? Poor hygiene
Are you sterilising bottles and dummies regularly?
Does the child take any regular medication? Inhaled corticosteroids (poor inhaler technique)
Does the child suffer from any medical conditions? Might be immunocompromised
How old is the child? Children have underdeveloped immune systems

Question 7

What are the treatment options for oral thrush?

Answer 7

• Miconazole gel
• not for patients on warfarin as there is increased bleeding risk
• Sterilise bottles and dummies regularly
• Inhaler technique and wash mouth out after use

Question 8

When should you refer?

Answer 8

• Treatment failure
• Under 4 months old
• Difficulty or pain swallowing

Question 9

What are the symptoms of threadworms?

Answer 9

• Itching perianal area
• Itching in particular at night
• Irritated/sore skin around perianal area from itching
• Weight loss
• Irritable
• Seeing the white strands (worms)

Question 10

The patient wants to understand how worms are transmitted

Answer 10

Faeco-oral route

Child will scratch perianal area, picking up eggs under their nails
If they touch their mouth the eggs can enter the stomach where the acidity activates them and they hatch and worms travel to intestines
Female worms lay eggs outside the anus at night time
If the child scratches again the cycle re starts

Question 11

What are the treatment options?

Answer 11

• Mebendazole
  inhibits glucose uptake by worms
  treat all family members
  repeat after two weeks
• Keep nails short and clean
• Wash hands regularly, in particular before eating
• Wash bed linen and towels every day if possible
• Do not share towels
• Socks on hands at night to stop scratching
• Disinfect surfaces as much as possible
• Underwear at night
• Shower in morning, paying attention to perianal area
• Lid down before flushing toilet
• Damp dusting and vacuuming

Question 12

Referral

Answer 12

• Pregnant
• Secondary bacterial infection
• Treatment failure
• Any bleeding
• Been abroad