W20 Childhood Conditions Flashcards
What are some childhood conditions?
Teething
Threadworms
Colic
Head lice
Nappy rash
Oral thrush
What is teething?
- Most children start teething around 4-12 months of age
- Generally mild and localised
- Symptoms include pain, increased biting, chewing, dribbling, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, decreased appetite and disturbed sleep.
- Infants may also have red and swollen gums and red flushed cheeks or face
When should you refer a child with teething to the GP?
- A MILD temperature above 38°C (mild is expected)
- Change in passage of stools
- Systemically unwell or in severe distress
What would you use as treatment for teething?
Pharmocological treatment:
Non-pharmacological treatment:
Paracetamol 120mg in 5ml suspension
Ibuprofen 100mg in 5ml suspension
Limit to children > 3 months
- Teething ring- cool in fridge but NEVER tie ring around infant’s neck
- Teething biscuits but NO sugar as can cause tooth decay
- Avoid small objects as they pose as choking risk
- Cool, sugar free drinks to soothe sore gums
- Oral gels containing salicylates can NEVER be used under 16 years old- risk of Reye’s syndrome
What are threadworms?
- Common in children
- Small thin, white thread-like worms (2-12 mm long)
- Cause itching around the anus
What treatment pathways should be used for threadworms?
- Treat if eggs are seen or detected
- Hygiene measures undertaken for 6 weeks
- Mebendazole + hygiene for 2 weeks
- Choose ONLY hygiene methods alone for <6 months and for pregnant/breastfeeding women
What are the hygiene measures for threadworms?
- Discourage nail biting
- Avoid use of shared towels
- Toothbrushes away
- No food in bedroom
What is colic?
A self-limiting condition which is defined clinically as repeated episodes of excessive and inconsolable crying
What are the symptoms of colic?
What is the treatment?
May be due to
Indigestion
Trapped wind
Temporary gut sensitivity
Crying in late afternoon or evening
Advice only :( due to lack of good evidence
What are headlice?
Small whitish or grey-brown insects (nits) that are visible in the hair behind the ears or at the back of the neck.
Symptoms and detection of headline?
What to do if headlice are detected?
Tretments?
Feeling like something is moving, itchy scalp, rash on the back of neck
Combing wet/dry hair using a detection
- if headlice detected, try wet combing but if ineffective, purchase Hedrin
- Detection comb and Dimeticone 4% lotion (Hedrin)
What is Nappy Rash?
Causes?
Mild rash restricted to the nappy area.
- Prolonged contact with urine/faeces
- Candidal fungal infection presenting as redness involving skin creases
What are the treatments for nappy rash?
- Zinc and castor oil cream
- Metanium
If discomfort: - Hydrocortisone 0.5% cream
-Only Babies > 1 month
-Maximum of 7 days use, apply od - Clotrimazole 1% cream
- Advise parents to not use a barrier preparation until after candidal infection settled
- Apply 2-3 times a day for at least 2 weeks
When to refer nappy rash?
Symptoms not resolved after 7 days
Person has difficulty or pain in swallowing
What is Oral thrush?
Symptoms?
Oral thrush can cause discomfort or be asymptomatic.
- Generalised erythema (skin reaction), loss of taste or unpleasant taste in the mouth that can be wiped off leaving behind red patches.
Treatments for Oral thrush? (2)
Duration?
Cautions?
Advise topical miconazole therapy for initial course of 7 days
(further 7 days after symptoms resolve using miconazole oral gel/nystatin)
-All doses to be given after food
- Advise person not to eat/drink until 30 mins after using gel or liquid
Miconazole Oral gel 80g and Nyastatin oral suspension (100,000u/ml)
When are they used?
What patients cannot take miconazole?
Miconazole
- First-line treatment
- Do not issue to warfarin pts- consider nyastatin
Nyastatin
- For pt who take meds that interact with miconazole
- 1ml Four times a day
- >4 weeks of age
What is the 1st line treatment for teething 3 months old patient who is dribbling, biting and seems in pain?
Paracetamol 120mg/5ml oral sugar free suspension
What is the 1st line treatment for teething 4 months old patient who is seems in pain, distress and seems systemically unwell. His temperature is 38.1°C?
Referral to a GP
What is the risk of giving salicylate-containing gel for a 6 year old boy?
Shouldn’t be given to <16 due to risk of Reye’s syndrome
What is the 1st line treatment for threadworms for a 4 years old child. What else should you do?
Hygiene measures alone for 6 weeks or for 2 weeks combined with Mebendazole 100mg/5ml suspension OR
What is 1st line treatment of colic for a 3 week old baby?
- Advice only
- Reassure that baby is fine and this is a phase
- Holding baby through crying episode
- Burp baby after feeds
- gentle motion & white noise & warm bath
Discuss the various treatment options for headlice. Consult the BNF to see the different efficacies of the different formulations.
- Wet combing is best and first-line
- Hedrin lotion (Dimeticone 4%)
Counsel mum on the co-application of both zinc & castor oil as well as hydrocortisone 0.5% cream for nappy rash.
Zinc & Castor oil
- Apply thinly at each nappy change
Hydrocortisone 0.5% cream
- >1month of age
- Apply od for a max of 7 days
- Apply topical hydrocortisone first before barrier preparation
Explain the patient suitability and differences between miconazole and nystatin for the treatment of oral thrush.
Patient suitability:
Miconazole-
-Not for patients that take warfarin
Nystatin-
If patients take medicines that interfere with miconazole
Head lice consultation:
- Identifiy to parent that child has head lice but this will need confirmation with wet combing on wet or dry hair
- If detected, will need to treat. If not, treatment is needed
- wet combing, offer detecting comb
- Offer Hedrin if not accepted
Will also need to comb all household members and close contacts to see if they have head lice
Will need to notify school but no need to keep child off school
Wet combing method
Wash hair with ordinary shampoo and then apply conditioner
Use a wide toothed comb to untangle hair
Hedrin lotion
2nd line treatment
Ok to use in pregnancy and breastfeeding
Use for all in the family
Rub into dry hair and scalp, allow to dry naturally. Shampoo after minimum of 8 hours (usually leave on overnight)
Repeat after 7 days
Detection combing should be done on Day 9 or 10 or 17 to check that treatment has worked
Oral thrush: How to use nyastatin?
2nd line treatment if Daktarin interacts with patients other medications
1ml FOUR times a day
Continue for 2 days after patches clear
Prevent recurrence by
- Checking inhaler technique
- Rinsing mouth after using steroid inhaler
- Using a spacer device
Mrs Q consults regarding her 3-year-old daughter, who has been complaining of an “itchy bottom” for a couple of days. Mrs Q says that she has noticed something that looks like small cotton threads in her daughter’s stools when she goes to the toilet.
No-one else in the family is symptomatic. In the household there are Mrs and Mr Q, their 3-year-old daughter and an 8-month-old son. No-one takes other medication or suffers with any other illness.
- What is the most likely diagnosis? How can this be confirmed?
- Which pharmacological treatment would you recommend?
- What additional measures need to be taken?
Threadworms
Visible in stools or around the anus.
Treatment- Hygiene measures and Mebendazole
OTC (Ovex) contraindicated <2 years
Dose 100mg stat and Hygiene measures
For all family members
