Symptoms in the Pharmacy - Childhood Conditions

Question 1

At what age do children start to teeth?

Answer 1

4-12 months
have full set of teeth around 2-3 yrs

Question 2

How many days before each tooth eruption does pain start/teething?

Answer 2

3-5 days

Question 3

What is the first line for 4-12 months when teething?

Answer 3

direct them to the Cry-sis website for useful info

Question 4

What kind of symptoms?

Answer 4

mild and local; pain in specific place
increased biting
chewing, dribbling, gum-rubbing
sucking
irritability
wakefulness
ear-rubbing
decreased appetite and disturbed sleep
swollen gums and red flushes on cheeks and face

Pulling on ear = more than just a toothache; e.g infection

Question 5

Teething - referral to GP infomation

Answer 5

may cause mild temperature elevation (less than 38C)

if patient suffers severe distress

systemically unwell

change in passage of stools

Question 6

Treatments and dosage for teething

Answer 6

paracetamol 120mg in 5ml SUGAR-FREE oral suspension - 100ml - 1 pack - 2 suggested episode per year

Ibuprofen 100mg in 5ml SUGAR-FREE suspension - 100ml - 1 pack -2”

Question 7

What is the limit for ibuprofen and paracetamol for infants?

Answer 7

not for children 3 months or under/ less than 5kg

(they are not expected to teeth until 4 months)

Question 8

advice for patient how to resolve or manage teething

Answer 8

teething ring ( contain liquid - freezer, cold to numb the gums)

clean, cold , wet flannel

Question 9

things that help teething

Answer 9

sugar-free drinks, cool

gels - containing salicylates

Question 10

Threadworms - describe

Answer 10

thin and small, white thread-like worms about 2-13mm long

females worms lay tiny eggs, around anus

too small to cause itching

treatment can take up to 6 weeks

Question 11

treatment for threadworms

Answer 11

Mebendazole (Vermox) - 30ml via PGD - 1 ep per year

Mebendazole 6 via PGD -

The whole family will most likely have it - there should be a sufficient amount for everyone

Question 12

What if child has threadworms and under 6 months?

Answer 12

cannot give any medication
hygiene measures only

Question 13

advice for patients

Answer 13

hygiene measures should be undertaken for 2 weeks combined with Mebendazole treatment for 6 weeks if used aone

enviromental measures; wash, sleepwear, bed linen, towels

vaccum lamp

clean bathroom

Question 14

warnings threadworms

Answer 14

avoid shaking any material that may be contaminated with eggs, such as clothing or bedsheets

Question 15

strict personal hygiene measure for all treated individuals for 2 weeks if combined with drug treatment or for 6 weeks if used alone:

Answer 15

wear close fitting underpants at night

cotton gloves (mittens) to help prevent stretching at night

bath or shower each morning

Question 16

general personal hygiene measures - advice not treatment

Answer 16

• wash hands first thing in the morning
• discourage nail biting
• keep toothbrushes in closed cupboard and rinse them thoroughly
• don’t eat in bedroom

Question 17

What is Colic?

Answer 17

Infantile colic is a SELF-LIMITING condition which is defined clinically as repeated episodes of excessive and inconsolable crying infant

Question 18

GP referral colic

Answer 18

weak, high pitched, continuous

floppy

vomits

is not feeding

fever

seizure

turns blue

Question 19

Head lice

Answer 19

head lice are small , or white-grey insects

white eggs visible behind neck or ears

Question 20

What is the first line of treatment for Head lice?

Answer 20

Wet comb - from routes, pull down till end of hair

Condition child’s hair thoroughly

split hair into small sections - covered all of head

Question 21

Referral to GP and treatment

Answer 21

Detection comb

2nd line treatment. Dimeticone 4% lotion (Hedrin) - can leave over night (LONG CONTACT HRS). Not suitable for children under 6 months

Question 22

How long to carry out the treatment for? hedrin

Answer 22

Until you can wet comb the hair three times and it’s CLEAR

= end treatment.

Question 23

Nappy rash - common causes?

Answer 23

mild, restricted to the area of nappy

• prolonged contact with urine or faeces
• redness
• candidal fungal infection

Question 24

first line Treatment offered for nappy rash:

Answer 24

1) Zinc and castor oil cream 100g - form barrier/ does not allow urine to penetrate through

Metanium 30g

2) causing discomfort - Hydrocortisone 0.5% cream 15g NOT OINTMENT - (s/e; thinning of the skin)

only given on prescription (or if you have a PDG - contract when you can prescribe specifically the med for certain person and age)

3) Candida infection- Clotrimazole 1% 20g

Question 25

Wales medicines strategy group - nappy rash section

Answer 25

• clean and change the child as soon as possible after wetting or soiling
• use water, fragrance free, alcohol-free wipes
• dry gently after cleaning
• avoid vigorous rubbing
• bath child daily/ no soaps

Question 26

Oral thrush

Answer 26

cause discomfort or be asymptomatic

loss of taste or impleasent taste in mouth

white patches

Question 27

How to confirm oral thrush?

Answer 27

Wipe the tongue

white should come off of tongue and leave a very red tongue

Question 28

oral thrush treatment

Answer 28

first line - miconazole oral gel - 80g (via PGD)
[do not give to interacting medicines = Warfarin, nystatin]
apply gel directly to affected area with clean finger and leave in contact with the mucosa for as long as pos

Nystatin oral suspension - 30ml (via PGD) - for patients taking meds that interact. Usual dos is 1ml x4 a day for adults and children from 4 weeks)

Question 29

what is Erythema?

Answer 29

Redness of skin or mucous membranes

Question 30

how to aintain oral thrush

Answer 30

good dental hygiene
stop smoking
counsel if person is on corticosterioud inhaler
smaller patients - don’t look at back of mouth to reduce the risk of choking

Question 31

test your knowledge:

Answer 31

slide 16/17

Question 32

What is the risk of giving salicylate-containing gel for a 6 year old boy?

Answer 32

Do not give medicines containing choline salicylate to children under 16 years. It’s linked to a rare condition called Reye’s syndrome, which can be fatal

MHRA - does not recommend

Question 33

What is the 1st line treatment for threadworms for a 4 years old child. What else should you do

Answer 33

comb wet hair
wash bed sheets
tie hair up (pon-tail, plates)

Question 34

e.g. question on conselling

Answer 34

Counsel mum on the co-application of both zinc & castor oil as well as hydrocortisone 0.5% cream for nappy rash.
Explain the patient suitability and differences between Miconazole and nystatin for the treatment of oral thrush