RTS - Paediatric Health

Question 1

what is oral thrush?

Answer 1

mild fungal infection affecting the mouth and throat - Candida albicans.
White patches in mouth that don’t wipe off,
red sore mouth and discomfort when eating, and drooling

Question 2

oral thrush treatments &directions

Answer 2

antifungals- Miconadazole - daktarin (brand) - oral gel, P med, for babies aged 4 months or above
Apply with a clean finger or cotton wool bud 2-4 times daily
Continue treatment for 7 days after the symptoms clear

Question 3

lifestyle advice for oral thrush

Answer 3

To avoid re infection - sterilise bottles, feeding equipment, sterilise toys they put in mouth

• wash hands thoroughly after changing nappy
• advice to new parents- sometimes it clears up by itself and may not need treatment - it is a MILD infection
• Are they asthmatic? if so check inhaler technique

Question 4

what is pyrexia / fever?

Answer 4

raised body temperature above the normal range of 36.5 - 37.5
Can be due to post immunisation, RTI or UTI infection, chicken pox
- Excess sweating, chills, headache

Question 5

how is body temperature measured?

Answer 5

thermometer under armpit, tongue, ear

Question 6

what are the red flag referral signs for pyrexia?

Answer 6

temperature of >38 if under 3 months, or >39 if 2-6 months
breathlessness
persistent vomiting
rash
seizures
signs of meningitis/sepsis/pneumonia 
treatment failure 
fever >5 days 
crying 
refusal to feed

Question 7

treatment for pyrexia

Answer 7

• drink cool clear fluids, fruit juices, if breastfed continue as normal
• Keep cool 18 degrees and use light blanket and gage the environment they are in
• Antipyretics - para and Ibu
• Monitor temperature regularly
• No cold flannel
• Look out for warning signs

Question 8

what are febrile convulsions?

Answer 8

seizures in young children when they have a fever.
Ranges from 6 months -6 years
Simple febrile - rapid rise int empire lasting <5 mins - If known and <5 mins. - GP
Complex febrile - last >15 mins and recur - 999 (and if its the first time)

Question 9

treatments for pain in children? and referral points

Answer 9

Ibuprofen - only licensed NSAID for children - >3 months OTC. (caution in asthmatic)
Paracetamol - >2 months
Can use combination, do not use aspirin

REFER: if severe, recurring, treatment failed and if they are abnormally drowsy, loss of consciousness, hard to breath

Question 10

What is teething?

Answer 10

new tooth breaking through the gums - 3 months to 3 years (typically 6 months old).
Swollen gums, red cheeks, dribbling, fever, tendency to chew, irritable

Question 11

Treatments for teething

Answer 11

1. analgesics
2. Topical gels e.g Bonjela (the children one NOT adult)
3. Homeopathic that target immune system- not in prescription but an option

Question 12

why can’t the adult version of bonjela gel be used in teething?

Answer 12

The oral choline salicylate it contraindicated in the adults - it contains salicylate which lead to Reyes syndrome in children. (same as aspirin)

Question 13

Lifestyle advice for teething

Answer 13

• teething rings (some can be cooled)
• Raw fruit and veg to Chew IF they have started weaning
• Hardened bread but not sugary rusks
• cool sugar free drinks
• Keep them occupied
• Wipe chin and face often to ensure they don’t get a teething rash

Question 14

what Is infant colic?

Causes

Answer 14

intense periods of crying lasting hours.
Baby may pull up or stiffen legs
Usually starts 2-4 weeks old
CAUSES: maybe problems with digestion, intolerance to lactose, trapped wind

Question 15

treatment for colic

Answer 15

1. gripe water mixtures - of dill, caraway, fennel & ginger
   antacids (e.g sodium carbonate), must be alcohol free
2. colic drops - simeticone (infacol), and Dimeticone (dentinox - disperses trapped wind)
3. Enzyme lactase - colief - breaks down lactose

Question 16

lifestyle advice for colic

Answer 16

• sit baby upright when feeding
• Check the size of the teat on bottle - shouldn’t be too big as air will get in (if bottle fed)
• hold the bottle so the teat is full of milk so avoids sucking air in
• Burp them during and after feed
• Baby massage

Question 17

Referral symptoms for colic?

Answer 17

weak, high pitched continuous cry for several hours
breathing issues
seizures 
vomiting green fluid 
Not feeding 
treatment failure

Question 18

What is nappy rash?

Answer 18

inflammation of the skin in the nappy area - red and raw and white or red pimples which spread out to the folds of the skin
- Sore an itchy when area is wiped and baby unsettled

CAUSES: reaction of skin to urine and faeces mainly. but could be due to - eczema, psoriasis, fungal infections, allergies

Question 19

treatments for nappy rash

Answer 19

1. Barrier creams - Dimethicone & white soft paraffin,
   or - titanium dioxide/peroxide, titanium salicylate, - Brand = metanium ointment
2. Antiseptics - cetirimide
3. Astringents - zinc oxide e.g sudocrem
4. antifungals - clotrimazole cream - canister 1% cream if fungal is suspected or other treatments failed

Question 20

what warning should be given when using barrier creams (white soft paraffin) for nappy rash?

Answer 20

White soft paraffin is flammable

Question 21

lifestyle advice for nappy rash

Answer 21

• change nappy frequently
• clean bum with warm water and cotton wool not wipes
• Dry area thoroughly
• leave nappy off for as long aspossible
• avoid talcum powder
• drink plenty of fluids
• dress them in loose fitting bottoms

Question 22

what is threadworm?

Answer 22

happens in children >2 years.
White threadlike worms in the stool, itchy bottom
easily spread

Question 23

treatments for threadworm

Answer 23

MEBENDAZOLE - Ovex brand.
Tablet or suspension - from 2 years OTC.
- Single dose, repeat after 2 weeks if infection persists
- treat the WHOLE family (except preg/BF)
Must also use strict hygiene measures.

Question 24

lifestyle advice for threadworm

Answer 24

Keep nails short and clean

• Careful washing & scrubbing of hands and nails after toilet and before eating
• wash bed linen daily
• Shower first thing in morning
• Wear underwear or mittens to stop scratching
• dust damp surfaces, vacuum daily
• discourage nail biting, finger sucking

Question 25

referral points for threadworm

Answer 25

``` <2 years signs of secondary bacterial infection doubts about diagnosis fever, bedwetting, discharge vomiting, dioarrhoea, weight loss recent travel abroad ```

Question 26

What is constipation? Symptoms causes

Answer 26

difficulty or strain passing stools, pass less often than normal and stools are hard, large and pellet like Also have tummy ache, poor appetite, irritability, restlessness, nausea Causes: (a) idiopathic - common and can be due to anything, diet, stool holding, emotions, random (b) underlying disease - uncommon, e.g could be due to hypothyroidism, CF, side effects of medication

Question 27

treatments for constipation children

Answer 27

1. lactulose - osmotic laxative, stool softeners - 1 year (MACROGOLS) 2. Ispaghula husk - bulk forming laxative >6 years old 3. Senna syrup >12 years, Macrogols (POM) 4. Glycerin suppositories - Lubricant and irritant, osmotic laxative - 1g <12 years - 2 g >12 years continue treatment at the maintenance dose for several weeks after regular habit is established

Question 28

lifestyle advice for constipation

Answer 28

increase fluid and fibre intake (fruit, veg, bran) Change milk if there is a possible intolerant to cows milk protein encourage to go toilet regularly

Question 29

referral for constipation

Answer 29

``` severe abdominal pain rectal bleeding or blood stain stool vomiting severe pain on defacation persistence despite treatments ```

Question 30

Nausea and vomiting, and treatments

Answer 30

Vomiting episodes caused by e.g gastroenteritis, respiratory condition, feeding, meningitis, emotion Treatment - oral rehydration - boiled and cooled drinking water, and correct volume dilution regular sipping if don't use - throw away after an hour, but if keep in fridge - throw after 24 hours

Question 31

referral for vomiting

Answer 31

``` signs of infection & ever frequently >24=48 hours Feeding and swallowing difficulties Unexplained vomiting frequently It is blood stained or looks like coffee grounds ``` WARNING signs - sunken eyes, wrinkly non elastic skin, dry nappy, drowsiness

Question 32

what are head lice?

Answer 32

insects that live in human hair (white/grey brown), spread via head to head contact and all types of hair. Clings on hair and feeds on blood (schools may have outbreaks)

Question 33

Head lice treatment cannot be used when a child has what medical condition?

Answer 33

Eczema (using E45) - ingredient that makes it flare up and there is alcohol (same with asthma)

Question 34

treatments for head lice

Answer 34

(a) INSECTICIDES 1. Dimeticone (silicone based) - shampoo sprays etc, suffocate lice by blocking resp system- Hedrin, once, nydra 2. Isopropyl myristate and cyclomethicon - dissolve and disperse waxy coating = dehydration - full marks solution 3. Octane-1,2 diol - dissolve waxy coating - dehydrate then - Hedrin Protect & go (b) use a lice comb

Question 35

3 types of insecticides for head lice

Answer 35

1. dimeticone 2. isopropyl myristate and cyclomethicon 3. Octane-1,2 diol

Question 36

what is wet combing? (headlice)

Answer 36

Use a fine tooth comb and comb them out - break their legs so they fall out. Also detection- can comb them out - Use conditioner - Stops the cycle of laying eggs and hatching

Question 37

referral for head lice

Answer 37

severe skin or scalp conditions children <6 months suspected scalp infection

Question 38

wat is bacterial meningitis?

Answer 38

Symptoms such as stiff neck, photophobia, fontanelle, unresponsive NON blanching rash (tumbler test)

Question 39

what are the general points for children medicine administration?

Answer 39

- shouldn't be mixed with large amount of food - Not to mixed or administered in a milk bottle - Children under 5 should have liquid prep - Sugar free provided where posoible

Question 40

how does a parent administer eye drops/ointment to child?

Answer 40

wrap in blanket / lay down - place drop into inner corner of eye. Better with eye open but still drains if eye is closed if keep head still

Question 41

how does a parent administer ear drops to child?

Answer 41

wrap tightly in blanket, | pull ear lobe backwards to open up ear canal, avoid touching ear with dropper

Question 42

how does a parent administer nasal drops to child?

Answer 42

lay across lap with head hanging down. wrap small in blanket) To remove mucus from nose, tickle with cotton wool warm drops are better tolerated and no more than 2-3 drops

Question 43

how are suppositories administered

Answer 43

lay children with knees pulled up lubricate supp & insert 2-4 cm into rectum hold buttocks together for 5 mins

Question 44

administering liquids - how is a spoon used?

Answer 44

Ensure child no more than 45 degree angle to reduce risk of choking. Shakebottle Pour onto the spoon according to dosage and give water to wash down Don't use household spoon - 5ml med spoon

Question 45

how is a syringe used?

Answer 45

Insert syringe into the bottle adapter, turn bottle upside down and pull plunger until the medicine reaches the volume required Turn and move, insert into mouth into the side slowly

Question 46

what other counselling points must be remembered in administration?

Answer 46

Length of supply expiry date for them to always wash hands