URTI in a child

Question 1

3 yo child with fever of 39C and coryza for 12 hours. no significant past MHx, immunization are up to date.

Impression/DDx/Goals/

1)How do you determine the nature of the illness? 2) how do you determine the severity of the illness, what is safety netting and how would you safety net?

Answer 1

Impression
URTI, either bacterial or viral however viral is more likely

Ddx:
Life threatening 
- sepsis, pneumonia, meningitis, epiglottitis, bacterial tracheitis, Quincey 
Other infective
- AOM
- Tonsillitis 
- Pertussis

Non-infective
- Asthma

Goals:

• Ensure child is stable
• Rule out RF and life-threatening
• Assess severity of illness and where child should be managed
• Treat accordingly
• Safety net with appropriate review/follow up

Question 2

Paediatric URTI - History

Answer 2

Natural history:

• history of symptoms, time-course
• Risk factors: sick contacts, previous illnesses,
• Assess severity: drinking, eating, wet nappies, behaviour (flat vs not)

Paediatric history:

• Immunisations
• Milestones
• Details of pregnancy

Question 3

Paediatric URTI - Exam

Answer 3

Exam

• end-of-the-bedogram
• Obs: RR, HR, BP, SP02, temp
• Tympanic membrane
• Pharyngeal visualisation
• Resp (wheeze, creps, stridor, WOB)
• Fluid status - assessing for dehydration

Question 4

Paediatric URTI - Investigations

Answer 4

Investigations:
Depends on the extent of the illness

• Only required if hx/exam indicates severe disease
• Otherwise watch and wait, most likely is viral urti that only requires symptomatic treatment

Question 5

Paediatric URTI - Management

Answer 5

Non-pharm:
Supportive:
- Fluids
- Analgesia
- Rest
- Sinus rinse

Pharm
- Broad spectrum antibiotic script (only for use if non-resolving illness after 2-3 days sx)

Amoxicillin is 1st line for AOM and pneumonia (etg) UNLESS tonsillitis (phenoxymethypenicillin). Amoxil can cause rash in setting of EBV

Harms of ABx- diarrhoea, rash or more serious hypersensitivity reactions, bacterial resistance
Only decrease symptoms by 1 day in tonsilitis and AOM

Safety netting; present to hospital if:

• Increased WOB
• Not tolerating fluids/no wet nappies
• Stridor
• Flat
• Vomiting, dehydration, rigours
• If fever/ symptoms not improving within 3-7 days - or a reasonable time period