The Normal Child

Question 1

What are the differences between GOR and GORD in a baby?

Answer 1

• reflux is normal in babies
• difference is the complications:
  
  • haematemesis
  • Barret’s oesophagus/oesophagitis
    
    • irritable behaviour (however study at hospital with pH probe showed no link between irritability and behaviour).
  • FTT
  • aspiration
  • cough

Question 2

What is the definition of colic in babies?

Answer 2

• babies who cry and fuss a lot and can’t be settled.
• Clinically: PURPLE acronym
  
  • P = peak at 2mths (6-8weeks)
  • U = unexpected
  • R = resists soothing
  • P = pain-like face
  • L = long lasting - 5 hours +
  • E = worse in the evening

Question 3

What are some complications of PPIs? How do we monitor is its working?

Answer 3

• In babies there is little evidence that PPIs help irritable behaviour.
• Complications:
  
  • increased infections of the GUT, gastro, and pneumonias
• Measure its working using a sleep and cry diary.

Question 4

What is the age a child should be introduced to solid foods? Why is it this age?

Answer 4

• 4 months is the recommended age to start solids
  
  • changed because its been shown to be beneficial if you expose kids early to allergens (nuts, egg, cow’s milk)
  • correlates with teething, interest and swallowing
  • need to be able to sit up unsupported

Question 5

A women presents to her GP concerned that her 6 month old son has an abnormally shaped head, whats the most likely Dx?

1. cephalohaematoma
2. child abuse
3. craniosyntosis
4. positional plagiocephaly
5. congenital hypothyroidism

Answer 5

Positional plagiocephaly

• aka flattened head syndrome
• sleep on their backs favouring a certain side
• cured by reposition therapy

Others:

• Craniosyntosis - at birth
• cephalohaematoma - at birth

Question 6

An 8 year old boy presents with nocturnal enuresis. Dad had the same problem when he was a child. What is the best management?

1. bladder diary
2. desmopressin
3. pad and bell alarm
4. urodynamic studies
5. reassurance

Answer 6

Treatment: e - reassurance

• reassurance:
  
  • not their fault
  • heritable component
  • discuss prevalence
• enuresis - bed wetting beyong age appropriate (approx 5)
• monosymptomatic (no other symptoms):
  
  • alarms - mainstay
  • desmopressin - if polyuric (>3.5L over 24hours in adults)
  • anticholinergic - if decreased bladder capacity
• non-monosymptomatic
  
  • bladder diary
  • urodynamics
  • post-voiding residual volume