W20 Childhood Conditions

Question 1

What are some childhood conditions?

Answer 1

Teething
Threadworms
Colic
Head lice
Nappy rash
Oral thrush

Question 2

What is teething?

Answer 2

• 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

Question 3

When should you refer a child with teething to the GP?

Answer 3

• A MILD temperature above 38°C (mild is expected)
• Change in passage of stools
• Systemically unwell or in severe distress

Question 4

What would you use as treatment for teething?
Pharmocological treatment:
Non-pharmacological treatment:

Answer 4

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

Question 5

What are threadworms?

Answer 5

• Common in children
• Small thin, white thread-like worms (2-12 mm long)
• Cause itching around the anus

Question 6

What treatment pathways should be used for threadworms?

Answer 6

• 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

Question 7

What are the hygiene measures for threadworms?

Answer 7

• Discourage nail biting
• Avoid use of shared towels
• Toothbrushes away
• No food in bedroom

Question 8

What is colic?

Answer 8

A self-limiting condition which is defined clinically as repeated episodes of excessive and inconsolable crying

Question 9

What are the symptoms of colic?
What is the treatment?

Answer 9

May be due to
Indigestion
Trapped wind
Temporary gut sensitivity
Crying in late afternoon or evening

Advice only :( due to lack of good evidence

Question 10

What are headlice?

Answer 10

Small whitish or grey-brown insects (nits) that are visible in the hair behind the ears or at the back of the neck.

Question 11

Symptoms and detection of headline?
What to do if headlice are detected?
Tretments?

Answer 11

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)

Question 12

What is Nappy Rash?
Causes?

Answer 12

Mild rash restricted to the nappy area.
- Prolonged contact with urine/faeces
- Candidal fungal infection presenting as redness involving skin creases

Question 13

What are the treatments for nappy rash?

Answer 13

• 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

Question 14

When to refer nappy rash?

Answer 14

Symptoms not resolved after 7 days
Person has difficulty or pain in swallowing

Question 15

What is Oral thrush?
Symptoms?

Answer 15

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.

Question 16

Treatments for Oral thrush? (2)

Duration?
Cautions?

Answer 16

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

Question 17

Miconazole Oral gel 80g and Nyastatin oral suspension (100,000u/ml)

When are they used?
What patients cannot take miconazole?

Answer 17

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

Question 18

What is the 1st line treatment for teething 3 months old patient who is dribbling, biting and seems in pain?

Answer 18

Paracetamol 120mg/5ml oral sugar free suspension

Question 19

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?

Answer 19

Referral to a GP

Question 20

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

Answer 20

Shouldn’t be given to <16 due to risk of Reye’s syndrome

Question 21

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

Answer 21

Hygiene measures alone for 6 weeks or for 2 weeks combined with Mebendazole 100mg/5ml suspension OR

Question 22

What is 1st line treatment of colic for a 3 week old baby?

Answer 22

• 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

Question 23

Discuss the various treatment options for headlice. Consult the BNF to see the different efficacies of the different formulations.

Answer 23

• Wet combing is best and first-line
• Hedrin lotion (Dimeticone 4%)

Question 24

Counsel mum on the co-application of both zinc & castor oil as well as hydrocortisone 0.5% cream for nappy rash.

Answer 24

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

Question 25

Explain the patient suitability and differences between miconazole and nystatin for the treatment of oral thrush.

Answer 25

Patient suitability:

Miconazole-
-Not for patients that take warfarin
Nystatin-
If patients take medicines that interfere with miconazole

Question 26

Head lice consultation:

Answer 26

• 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

Question 27

Wet combing method

Answer 27

Wash hair with ordinary shampoo and then apply conditioner
Use a wide toothed comb to untangle hair

Question 28

Hedrin lotion

Answer 28

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

Question 29

Oral thrush: How to use nyastatin?

Answer 29

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

Question 30

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?

Answer 30

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