Paeds

Question 1

Neonatal Jaundice

Answer 1

• Explain that neonatal jaundice is common
o If < 1 day or > 14 days explain that you will investigate the cause
o 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)
• Breastfeeding can continue as per usual
o 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
• Resources
o NHS Choices Neonatal Jaundice Factsheet
o The Breastfeeding Network (information and support for breastfeeding mothers)
o Bliss (for premature and sick babies)

Question 2

Asthma

Answer 2

• Explain the diagnosis (a condition where the airways are very sensitive and can tighten
suddenly making it difficult to breath)
• Explain the step in the treatment (whether steroids are necessary or not)
• Discuss asthma action plan (carry blue inhaler everywhere, use up to 10 puffs every 30-60
seconds when breathless)
o If no response, call an ambulance
• Explain how to use peak flow meter
• Advise on identifying triggers
• Support: Asthma UK and itchywheezysneezy.co.uk

Question 3

bronchiolitis

Answer 3

• Explain the diagnosis (common chest infection that affects about 1 in 3 children < 1 yr) and
that it usually gets better by itself over 2 weeks
• Advise maintaining good hydration and using paracetamol if child over 3 months old and
distressed
• Safety net about when to go to A&E/ call an ambulance (significant respiratory distress,
apnoea)
• Refer to NHS webpage on bronchiolitis

Question 4

Cow’s Milk Protein Allergy

Answer 4

• Explain the diagnosis (allergic reaction to some of the proteins in milk)
• Explain that it is common (5-15% of infants)
• Treatment is simple: avoid cows’ milk in maternal diet (breastfeeding) or switch to
hypoallergenic formula
o Consider calcium and vitamin D supplementation
o NOTE: it takes 2-3 weeks to fully eliminate cows’ milk from breastmilk
• Many children will grow out of it (review in 6-12 months and consider re-introducing cows’
milk protein using a milk ladder)
• Advise regularly monitoring growth
• Support: British Dietetic Association (BDA) has produced a useful fact sheet

Question 5

Croup (laryngotracheobronchitis)

Answer 5

• Explain diagnosis (common infection of the airways)
• Explain that it gets better over 48 hours and steroids have been given to help that
• 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
• Paracetamol or ibuprofen if distressed
• Advise good fluid intake
• Advise regularly checking on the child at night (cough is worse)

Question 6

Cystic Fibrosis

Answer 6

• Explain the diagnosis (lifelong condition characterised by recurrent respiratory infections
and malabsorption)
• 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:
o Pulmonary – physiotherapy, mucolytics
o Infection – prophylactic antibiotics, monitoring
o Nutrition – enzyme tablets, high-calorie diet, monitor growth
o Psychosocial – provide support for child and carers
• Offer information on genetic counselling if considering having more children

Question 7

Food Allergy

Answer 7

• Explain the concept of allergy (the body’s immune system reacts to substances that are not
harmful to other people (e.g. milk))
• Mainstay of treatment is strict avoidance of the allergens
• Discuss an allergy action plan
• Explain that some children grow out of allergies
• Explain the use of non-sedating antihistamines and adrenaline
• Food allergy to cows’ milk and egg often resolves in early childhood, so gradual
reintroduction may be possible
• Food allergy to nuts and seafood usually persist through to adulthood

Question 8

Pneumonia

Answer 8

• Explain the diagnosis (chest infection)
• Explain whether admission is needed
• Explain treatment (antibiotics)
• Advise paracetamol used if distressed
• Advise adequate fluid intake
• Advise against parental smoking
• Check the child regularly during the day and night
• Seek medical advice if child deteriorates (increased respiratory distress, reduced
responsiveness)

Question 9

Tonsilitis

Answer 9

• Explain that this is tonsillitis
• 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

Question 10

Viral Episodic Wheeze/Viral-induced Wheeze

Answer 10

• Explain the diagnosis (narrowing of the airways due to a viral chest infection causes
difficulty breathing)
• Inhaled medication helps to open up the airways and make you breathe easier
• Explain that the child will be monitored for 4 hours to see whether they can be symptomfree for 4 hours after the episode
• Discharge with salbutamol and spacer
o 10 puffs through spacer maximum of every 4 hours
o If no response after 10 puffs, seek help
o If symptomatic 48 hours after discharge, seek help

Question 11

Whooping Cough

Answer 11

• Explain the diagnosis (cough that lasts for a reasonably long time)
• Explain that it isn’t seen very often because of the immunisation programme (and discuss
concerns about immunisation with the parent)
• Explain that having it once does not mean you can’t have it again
• Explain that antibiotics can help treat the condition, but the cough often persists for a long
time
• Exclude from school until 48 hours after starting antibiotics

Question 12

Coeliac Disease

Answer 12

• Explain the diagnosis (caused by an inability to digest gluten (present in barley, rye and
wheat)
• Reassure that it is a common condition (1 in 100) and the treatment is fairly straight forward
(gluten-free diet)
• Explain that they will be put in touch with a dietician
• Explain the importance of keeping to a strict gluten-free diet (complications include
malnutrition and cancer)
• Explain that follow-up is usually necessary every 6-12 months
• Advise regular measurements of height and weight on centile charts
• Support: Coeliac UK

Question 13

Constipation

Answer 13

• Explain that this 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
o Disimpaction: escalating dose for 2 weeks
o Maintenance: can be used for a long time until bowel habits are re-established (no
dangers)
• Advise encouraging the child to sit on the toilet after mealtimes (reflex)
• Advise behavioural intervention (star chart) to aid motivation

Question 14

Crohn’s Disease

Answer 14

• Explain the 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 that there are many medications that can be used to settle down the inflammation
any time it flares up (and explain that they will be seen by a gastroenterologist)
• Explain complications (malabsorption and bowel cancer)
• There is no special diet but you may find that certain foods will make it worse
• Support: Crohn’s and Colitis UK

Question 15

Gastro-oesophageal Reflux

Answer 15

• Explain the diagnosis (due to 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)

Question 16

Intussusception

Answer 16

• Explain that it is caused by telescoping of the bowel and typically occurs in young children
• If needing reduction, explain the procedure
• Explain that NG tube aspiration may be required
• Explain the supportive treatment (fluids and antibiotics)
• Explain about the possibility of needing an operation if rectal air insufflation is unsuccessful
(75% success rate)
• 5% risk of recurrence (usually within a couple of days of treatment)

Question 17

Ulcerative Colitis

Answer 17

• Explain the diagnosis (condition with unknown cause that leads to inflammation of the
bowel, which leads to symptoms)
• Explain that 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 flareups every so often
• Reassure that there are medications that can be used to reduce the likelihood of
flare-ups and to treat flare-ups when they happen
• Explain the complications (growth issues, bowel cancer)
• Explain that they will be seen by a gastroenterologist
• Support: Crohn’s and Colitis UK

Question 18

Bacterial Meningitis

Answer 18

• Explain the diagnosis (infection of the tissues surrounding the brain)
• Explain that it is a serious condition, but we have effective antibiotics that can treat the
infection
• It will require hospital admission to administer the antibiotics and monitoring
• There can sometimes be long-term complications, the most common is hearing loss, and
offer formal audiological assessment as follow up
• Follow-up with paediatricians in 4-6 weeks
• Offer ciprofloxacin prophylaxis for contacts
• Support: Meningitis Now

Question 19

Atopic Eczema

Answer 19

• Explain the diagnosis (characterised by dry, itchy skin)
• Explain that it is very common, and many children grow out of it
• Explain the management (and use of steroids if necessary)
o Patients often worry about use of steroids
o Explain that these are topical not systemic
o Only a short course required – it is better to use 1-2 weeks short course to clear up
eczema than to let child suffer for months.
• 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 if possible (keep nails short, use anti-scratch mittens in infants)
• Safety net about signs of infection (oozing, red, fever)
• Information and Support
o Itchywheezysneezy.co.uk - excellent website demonstrating how to apply emollients

Question 20

Attention Deficit Hyperactivity Disorder (ADHD)

Answer 20

• Explain the diagnosis
• Explain that the manifestation will change as the child gets older (e.g. hyperactivity tends to
become less of a problem, and inattention becomes more pronounced as the tasks they face
become more complex)
• Some may grow out of it
• Explain the management
• Watch and wait for 10 weeks
• Group parent training programme - will teach various parenting techniques to deal with ADHD
and meet other parents in similar situations
• If medication needed:
• Explain that it is a 6-week trial
• Side-effects: loss of appetite, mood changes, palpitations, tics
• If medication is continued, requires 6 monthly height and 3 monthly weight monitoring

Question 21

Autism Spectrum Disorders (ASD)

Answer 21

• Explain that autism is a spectrum, so it is difficult to predict the extent of the impact on the
child’s life
• Explain that it is characterised by difficulties in social interaction, language impairment and
ritualistic behavioural tendencies
• Explain that management involves:
o Psychological interventions to reduce ritualistic behaviours
o Speech and language therapy (with a focus on social skills)
o Educational assessment and plan
• Explain that the carer’s needs will also be attended to and link them to support websites:
o National Autistic Society

Question 22

Cerebral Palsy

Answer 22

• 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 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

Question 23

Epilepsy

Answer 23

• It is a tendency to have unprovoked seizures
• Aim to promote independence and confidence
• The school should be made aware of the condition
• Situations where having a seizure could lead to injury or death should be avoided (e.g. deep
baths, swimming unsupervised)
• Driving is only allowed after 1 year free of seizures

Question 24

Diabetic Ketoacidosis (DKA)

Answer 24

• Explain DKA (complication of diabetes where the blood sugars get very high)
• Explain the features of DKA (drowsiness, abdominal pain, nausea)
• Explain that DKA is important because it can lead to severe dehydration
• Explain the steps in the acute management of DKA (giving fluids and insulin to get the blood
glucose back to a healthy range)
• Discuss factors that led to this episode
• Advice on how to manage intercurrent illness (e.g. viral infections leading to increased
insulin demand)
• Arrange to see diabetes specialist to discuss treatment
• Support: Diabetes UK

Question 25

Diabetes Mellitus (Type 1)

Answer 25

• Explain diagnosis (a condition where the body is unable to control the sugar levels in the
blood)
• Explain that it is reasonably common, and it is well understood
• Explain that the management is quite intensive and involves regular self-monitoring of
glucose levels (using skin prick) and taking insulin injections
• Stress the importance of good blood glucose control
• Explain how to identify DKA
o Damage to kidneys and blood vessels
o Explain that they will be seen in a diabetes clinic to discuss ongoing management
• Encourage healthy, balanced diet and regular exercise

Question 26

Anaphylaxis

Answer 26

• Explain that this is a severe allergic reaction
• Explain that the priority right now is to treat this reaction and make sure the child is stable
• Explain that they will be referred to an allergy clinic where further tests may be required to
establish the exact allergens
• Explain that future management of allergy will be discussed (e.g. carrying an EpiPen)
o Check the airway
o Lie patient flat
o Raise legs
o Administer adrenaline into the thigh or arm (repeat after 5 mins if no response)
o Call an ambulance

Question 27

Sepsis

Answer 27

• Explain that the child has an infection that may have crossed into the blood
• It is important to monitor closely, identify the source of the infection and treat with antibiotics

Question 28

NAI

Answer 28

• We have to talk about what to do next from a medical and non-medical standpoint
• Whenever we have a case where we don’t know why an injury has occurred, we have to
involve some other people
• This includes social services and the child safeguarding team (and maybe the police)
• This is a routine requirement for all children in these situations, and our aim is to keep your
child safe
• Sometimes when children have similar injuries, they do not happen by accident and they
are caused by someone else

Question 29

Headache

Answer 29

Meningitis 
Tension headache 
Migraine 
Space occupying lesion
Sinusitis