PACES paeds

Question 1

Neonatal jaundice counselling

Answer 1

• explain that neonatal jaundice is common
• if <1 or >14 days you will investigate cause
• if physiological explain why happens
• treatment = light therapy
• explain light therapy is not harmful but eyes will be protected and blood samples taken regularly
• encourage frequent breastfeeding (every 3 hours) and wake baby to feed
• need to stay in after phototherapy has stopped to check rebound hyperbilirubinamia
• resources: NHS Choices neonatal factsheet, Breastfeeding network, Bliss (for premature and sick babies)

Question 2

Asthma counselling

Answer 2

• explain is a condition where airways are very sensitive and can tighten suddenly making it difficult to breath
• explain step in treatment (whether steroids are needed)
• discuss asthma action plan (carry blue inhaler everywhere, use up to 10 puffs every 30-60 seconds when breathless)
• if no response = ambulance
• explain how to use peak flow meter
• advise on identifying triggers
• support: Asthma UK and itchywheezysneezy.co.uk
• F/U within 2 days

Question 3

Bronchiolitis counselling

Answer 3

• explain is common chest infection that affects 1 in 3 children <1 year
• usually gets better by itself over 2 weeks
• advise to maintain good hydration and use paracetamol if child >3 months and distressed
• safety net to call ambulance or come to A&E if significant resp distress or apnoea
• refer to NHS webpage on bronchiolitis

Question 4

cows milk protein allergy counselling

Answer 4

• explain that is allergic reaction to some of proteins in milk
• is common (5-15% of infants)
• treatment is simple: mum to avoid cows milk if breastfeeding or hypoallergenic formula in bottle feeding
• consider Ca and Vit D supplement
• takes 2-3 weeks to eliminate cow milk out of breast milk
• many children will grow out of it
• review in 6-12 months, consider reintroducing using steroid ladder
• advise regular growth monitoring
• Support: British Dietetic Association has fact sheet

Question 5

croup counselling

Answer 5

• common infection of the airways
• gets better over 48 hours and steroids given to help that
• if gets worse, come back
• if child becomes blue/very pale for more than a few seconds, more sleepy, breathing difficulties = call ambulance
• paracetamol or ibuprofen if distressed
• advise good fluid intake
• regularly check on child at night as cough is worse then

Question 6

CF counselling

Answer 6

• lifelong condition characterised by recurrent infections and malabsorption
• management requires MDT approach
• referred to specialist CF centre to discuss ongoing management
• outlines of Mx
  Pulmonary = physio, mucolytics
  Infection = prop Abx, monitoring
  Nutrition = high calorie, enzyme tablets, monitor growth
  Psychosocial = support for child and carer
• info on genetic counselling if having more children

Question 7

food allergy counselling

Answer 7

• body’s immune system reacts to substances that are not harmful to other people
• mainstay of treatment is strict avoidance of allergen
• allergy action plan
• some children grow out of allergies
• use of non-sedating antihistamines and adrenaline
• nuts/seafood more likely to persist through adulthood

Question 8

pneumonia counselling

Answer 8

• explain is a chest infection
• explain whether admission needed
• treat with antibiotics
• use paracetamol if distressed
• ensure adequate fluid intake
• advice against parental smoking
• check child regularly during day and night
• seek medical advice if child deteriorates (inc resp distress, reduced responsiveness)

Question 9

tonsillitis counselling

Answer 9

• explain is tonsillitis
• importance of taking abx for 10 days even if symptoms get better in that time
• avoid school until 24 hours after starting Abx and child feeling well
• advice on use of paracetamol, lozenges, saltwater, difflam

Question 10

viral induced wheeze counselling

Answer 10

• narrowing of airways due to viral chest infection causes difficulty breathing
• inhaled medications help open up airways and make you breathe easier
• child monitored for 4 hours to see whether they can be symptom free for 4 hours after episode
• discharge with salbutamol and spacer
• 10 puffs through spacer max of every 4 hours
• if no response after 10, seek help
• if symptomatic 48 hours after discharge seek help

Question 11

whooping cough counselling

Answer 11

• cough that lasts for reasonably long time
• explain that isn’t seen very often because of immunisation programme (discuss concerns about immunisation with parent)
• explain that having it once does not mean you can’t have it again
• explain that antibiotics can help treat condition but cough often persists for long time
• exclude from school until 49 hours after starting antibiotics

Question 12

coeliac disease counselling

Answer 12

• explain caused by inability to digest gluten (present in barley, rye, wheat)
• reassure that is common condition (1 in 100) and treat is straight forward (gluten-free diet)
• we will put you in touch with dietician
• importance of keeping to strict gluten free diet (complications include malnutrition and cancer)
• F/U necessary every 6-12 months
• advise regular measurements of height and weight on centile charts
• support: coeliac

Question 13

Chron’s counselling

Answer 13

• explain disease with unknown cause that causes inflammation of digestive system leading to malabsorption and bloody diarrhoea
• life-long condition, always risk of relapse
• many medications can be used to settle down inflammation any time it flares up
• seen by gastroenterologist
• complications = malabsorption and bowel cancer
• no special diet but find certain foods will make it worse
• support: Chron’s and Colitis UK

Question 14

GORD counselling

Answer 14

• explain due to immaturity of gullet leading to food coming back back the wrong way
• is common and gets better with time
• breastfeeding: offer assessment –> alignate therapy
• formula: review feeding history –> smaller, more frequent feeds –> thickeners –> alignate therapy
• safety net: keep eye on vomit (if blood stained or green seek medical help)

Question 15

intussusception counselling

Answer 15

• caused by telescoping of bowel and typically occurs in young children
• if needed reduction, explain
• NG tube aspiration may be needed
• supportive treatment (fluids and antibiotics)
• explain possibility of needing operation if rectal air insufflation is unsuccessful (75% success)
• 5% risk of recurrence (usually within couple days of treatment)

Question 16

UC counselling

Answer 16

• condition with unknwon cause that leads to inflammation of bowel, leads to symptoms
• isn’t common but is well known
• there is no cure but is it a condition that tends to come and go in flare ups every so often
• medications that can be used to reduce likelihood of flare ups and treat flare ups when they happen
• complications = growth issues, bowel cancer
• seen by a gastroenterologist
• Support: Chron’s and Colitis UK

Question 17

meningitis counselling

Answer 17

• explain is infection of tissues surrounding brain
• serious condition but we have effective antibiotics that can treat infection
• require hospital admission to administer Abx and monitoring
• sometimes be long term complications, most common hearing loss and offer formal audiological assessment as F/U
• F/U with paediatrician in 4-6 weeks
• offer ciprofloxacin prophylaxis for contatcs
• support: meningitis Now

Question 18

atopic eczema counselling

Answer 18

• characterised by dry, itchy, skin
• very common, many children grow out of it
• management (use of topical steroids that are topical and short course needed)
• encourage frequent liberant use of emollients and soap substitiute
• association with other atopic conditions
• advise avoidance of triggers
• safety net about signs of infection (oozing, red, fever)
• information and support: itchywheezysneezy.co.uk, explain how to apply emollients

Question 19

ADHD counselling

Answer 19

• explain is a condition that affects people’s behaviour. People with ADHD can seem restless, may have trouble concentrating and may act on impulse.
• characterised by difficulties in social interaction, language impairment and ritualistic behavioural tendencies
• management: psychological interventions to reduce ritualistic behaviours, speech and language therapy, educational assessment and plan
• carer’s needs will be attended to and link them to support websites e.g. National Autistic society

Question 20

cerebral palsy counselling

Answer 20

• damage to brain that would have occured in early developemnt
• damage to brain doesn’t get worse but way it manifests will change as child gets older
• refer to paediatrician specialising in this
• long term mangaement: physio, SALT, special educational needs
• medications can be given to help with symptoms

Question 21

epilepsy counselling

Answer 21

• tendency to have unprovoked seizures
• aim to promote independence and confidence
• school should be made aware
• situations where having seizure could lead to injury/death should be avoided (e.g. unsupervised swimming, deep bath)
• driving only allowed 1 year free of seizures

Question 22

DKA counselling

Answer 22

• DKA is a complication of diabetes where blood sugars get very high
• DKA can result in drowsiness, abdominal pain, nausea
• important to treat as can lead to severe dehydration
• we will give fluids and insulin to get glucose back into healthy range
• discuss factors that led to this episode
• advice on how to manage intercurrent illness (e.g. viral infections lead to increased insulin demand)
• arrange to see diabetes specialist to discuss treatment
• support: Diabetes UK

Question 23

T1DM counselling

Answer 23

• condition where body is unable to control sugar levels in the blood
• resonably common and well understood
• management is quite intensive and involved regular self-monitoring of glucose levels and insulin injections
• importance of good blood glucose control
• explain how to identigy DKA (drowsiness, abdo pain, nausea)
• need to be seen in diabetes clinic to dicuss ongoing management
• encourage healthy, balanced diet and regular exercise

Question 24

anaphylaxis counselling

Answer 24

• severe allergic reaction
• priority right now is to treat this reaction and make sure child is stable
• will be referred to allergy clinic where further tests may be required to establish exact allergens
• future management of allergy will be discussed (e.g. carry an EpiPen)

check airway, lie patient flat, raise legs, administer adrenaline into thigh or arm, call ambulance

Question 25

sepsis counselling

Answer 25

- child has infection that may have crossed into the blood | - important to monitor closely, identify source of infection and treat with Abx

Question 26

NAI counselling

Answer 26

- we have to talk about what to do next from a medical and non-medical standpoint - whenever we have a case where we don't know how an injury occurred, we have to involve some other people - this includes social services and child safeguarding team (maybe the police) - this is routine requirement for all children in these situations - our aim is to keep your child safe - sometimes when children have similar injuries, they do not happen by accident and they are caused by someone else

Question 27

questions to ask in constipation

Answer 27

any change in diet | any recent change in lifestyle

Question 28

treatment of contipation

Answer 28

- escalating dose of movicol - if unsuccessful after 2 weeks = stimulate laxative - maintenance treatment for several months until bowel patterns are re-established

Question 29

how does movicol work?

Answer 29

soften stools by drawing more water into it medication takes time to act persevere with dosing instructions for up to 2 weeks

Question 30

what to check in children with a fever

Answer 30

ears and throat

Question 31

<6 months, UTI further investigations

Answer 31

- Renal USS - MCUG - DMSA

Question 32

what is a posterior urtheral valve?

Answer 32

obstructing membrane in posterior male urethra | causes BOO in male newborns

Question 33

asthma additional management

Answer 33

personalised asthma action plan (asthma UK) advise about trigger avoidance peak flow how to use inhalers recommend: Asthma UK, itchywheezysneezy.co.uk safety net: of reliever inhaler not working and attempted several puffs, come to A&E

Question 34

important investigations in DKA

Answer 34

ABCDE | capillary blood glucose and capillary ketones

Question 35

what to ask if any bowel problem>

Answer 35

meconium passage

Question 36

ask about in neonatal history

Answer 36

if newborn: apgar scores | heel prick test

Question 37

aspects of CF management

Answer 37

respiratory infection nutritional psychological

Question 38

RFs for bronchiolotis

Answer 38

- preterm infant with bronchopulmonary dyplasia - underlying lung diseasse e.g. CF - congenital cyanotic HD

Question 39

UC counselling

Answer 39

- condition where your bowel becomes inflamed without obvious cause/trigger - when becomes inflamed = these symptoms - goal right now is to give some medication to reduce inflammation and achieve normal bowel function

Question 40

Mx of febrile convulsion

Answer 40

1. hospital paeds assessment if first seizure or less than 18 months 2. traffic light method to assess seriousness 3. refer to be seen at first fit clinic 4. if no focus, admit for period of observation

Question 41

facts to remember about febrile seizures

Answer 41

- common - occur early when temp is rising - short, simple = no long term consequence - NOT same as epilepsy

Question 42

Investigation and management of OS disease

Answer 42

- assess gait - swelling/tenderness/pain on passive movement Mx: pain relief, intermittent ice pack, protective knee pads, stop activity, stretching leaflet with stretches on

Question 43

when is exchange tranfusion indicated in SCD?

Answer 43

acute chest syndrome stroke priapism (consultant to decide)

Question 44

TOP surgical

Answer 44

<14 week: vacuum aspiration >14 week: dilation and evacuation surgical abortion = NSAIDs, prophylactic Abx

Question 45

TOP assess

Answer 45

- 2 doctors to agree - Abortion Law - Gillick competence

Question 46

specific questions to ask in ASD

Answer 46

- how is his speech - how does he react if something falls out of his routine - ask about all 4 domains of development (gross motor, vision and fine motor, speech, behavioural/social/emotional) - ask about school/nursery opinion

Question 47

investigations in ADS

Answer 47

See the child and speak to the nursery about their thoughts • Physical examination to exclude physical causes (e.g. Down syndrome) and to establish baseline physical state • Refer to specialist (CAMHS, developmental paediatrician) • Autism Assessment: 3DI assessment, ADI (autism diagnostic interview) ADOS (autism diagnostic observation schedule), social communication questionnaire, children’s communication checklist • Learning Difficulties Assessment: WISC or WPSSI (global intelligence assessment for pre-school assessment) - Conner’s Rating Scale is used for 6-18 years olds

Question 48

management in ADS

Answer 48

MDT Approach: paediatrician, GP, psychologist, psychiatrist, speech and language therapist, occupational therapist, educational and social services • Education: apply for an education, health and care plan (EHCP) – legal document describing the special educational needs and support of a patient • Carer’s Needs: assess the carer’s needs and discuss the need for respite care • Behavioural Modification Approaches: can help ritualistic behaviours • Speech and Language Therapist

Question 49

co-morbidities of ASD

Answer 49

Learning difficulties ADHD Seizures Affective disorders (anxiety, sleep disturbance)

Question 50

Aspergers syndrome

Answer 50

Refers to children with the social impairment of ASD with near normal speech development and intelligence

Question 51

questions to ask in child headache

Answer 51

- affect on school - any vision problems - wake you up at night - sudden onset - impaired consciousness - aura - fever - neurological deficit/ change in personality - precipitating factors/ worse on standing

Question 52

important to mention in management of headache

Answer 52

headache diary (frequency, duration, severity, associated symptoms, possible precipitants, links to menstruation)