Tutorial 6 - Paediatrics (A)

Question 1

1. How does Newborn jaundice present?
2. What is the 1st line treatment?
3. If jaundice persists what should be done?

Answer 1

1. Yellowing of the skin/eyes
2. Watchful waiting. Reassure Newborn jaundice is common and should resolve in 10-14 days. It normally happens because the primitive liver cannot efficiently clear bilirubin.
3. Refer to paediatrics - phototherapy/further investigations may be conducted.

Question 2

1. What are mongolian spots?
2. Should parents be concerned?

Answer 2

1. Mongolian spots are blue discolorations of the skin - they often look like bruises. They often present on the gluteal region.
2. The rashes are benign. They often fade between the age of 3-5. However, they can persist into adulthood. But nothing to worry about!

Question 3

1. What is erythema toxicum?
2. Should parents be concerned?

Answer 3

1. Erythema toxicum is a benign rash that presents in Newborns. It presents with red papules, macules and pustules. Usually effects the face, back, chest, legs.
2. The rash is benign. They should fade within weeks. Nothing to worry about.

Question 4

1. What are milia?
2. Should parents be concerned?

Answer 4

1. Milia are small right bumps (cysts) on the surface of the skin. They often present on the face.
2. Milia are benign lesions. Normally resolves within a few weeks. Nothing to worry about.

Question 5

What is Newborn dry skin?

Answer 5

• Dryness of a Newborns skin. It is completely normal and should resolve itself in a few weeks.
• If dryness persists bring back to GP to further investigate cause of dryness i.e., eczema.

Question 6

1. What is and causes bay acne?
2. Does it need treating?

Answer 6

1. Like adult acne but on a Newborn. Due to maternal hormones.
2. No treatment is needed/ Should resolve on itself without scarring.

Question 7

1. What is cradle cap?
2. Does it need treating?

Answer 7

1. Scaly/ crusty, yellow/green scales on a baby’s scalp - often due to maternal hormones.
2. Often does not need medical treatment. Often recommended to use a mild shampoo/mineral oil on baby’ scalp. If this does not work - doctor can prescribe an antifungal shampoo or mild hydrocortisone cream to help with scales.

Question 8

1. What is heat rash?
2. How is heat rash treated?

Answer 8

1. Sweat stuck under the skin. Often effects neck, shoulders and chest as well as skin folds - armpit, leg fold, groin.
2. Cool baby down - remove items of clothing. Hydrocortisone cream can help. If rash persists AND/OR bay develops a fever take to paediatrics ASAP.

Question 9

1. Why would a women who is breast feeding present with thrush?
2. What treatment can be provided?

Answer 9

1. Often when breastfeeding - breast can become cracked - allowing for candida infection - thrush.
2. Antifungal cream - apply after breastfeeding. Potentially also recommend oral antifungals for 2-3 days.

Question 10

1. What is a blocked milk duct and how does it present?
2. What causes it?
3. What treatment is provided?

Answer 10

1. Incompletly drained milk duct. hard, tender, warm lump.
2. If baby has a shallow latch or a tongue tie can mean that milk ducts not effectively drained - leading to impaction and blockage. Wearing tight fitted bras can also increase risk of a blocked milk duct.
3. Warm compress, massage, correct baby’s technique - push chin/nose down towards impacted duct. If not treated can lead to mastitis - abscess which often needs surgical draining.

Question 11

1. What is tongue tie?
2. Does it need treating?

Answer 11

1. Tongue tie is where the band of tissue connecting the tongue to the bottom of the mouth is tighter than usual.
2. It often resolves itself (i.e., loosens up). However, if it is hindering baby’s weight gain - refer on to paediatrics team.

Question 12

1. What causes sore nipples during breast feeding?
2. What advice can be given to help with sore nipples?

Answer 12

1. Often because the baby is not properly latched onto the nipple. The nipple should be resting on soft palate and not hard palate of baby.
2. Seek help from midwife regarding optimal latching technique (head facing nipple, skin to skin, rounded cheeks), apply Vaseline, rub breast milk over nipples.

Question 13

1. What causes headlice?
2. How should headlice be treated?

Answer 13

1. Headlice are not due to poor hygiene - they are passed from head-to-head contact.
2. To treat headlice recommend shampoo, condition and wet comb on day 1,5,9 and 13. Access for any nits on day 17. IF STILL present still prescribe dimeticone 4% gel - kills any headlice/eggs. Check everyone in Houshold for nits, and no need to keep child off school.

Question 14

1. How does colic present in Newborns?
2. What advice can be given to parents?

Answer 14

1. Crying 3/7, 3/24. Bringing knees up to tummy/arching back. Windy.
2. Reassure the parents that it should resolve in 6 months. Ask for support from family, friends and CRY-SIS. Things like pacifiers, warm baths, rocking baby can help.

Question 15

What advice would you give mum about weaning?

Answer 15

• Gradually introduce solid foods from 6 months
• At 6 months give baby breast milk (up till 2 years) alongside diet with solid foods.
• Introduce common allergens one at a time - to help find causative allergens early.
• Offer free flow cup filled with water at mealtimes.
• Often you can tell a baby is ready to begin weaning if they can sit up straight, hold their head straight, coordinate their eyes/hand/mouth to pick up food, swallowing without spitting back out.

Question 16

Name some viral causes for skin rashes in children.

Answer 16

1. Slapped cheek syndrome - caused by parvovirus B19. Often presents with a fever, headache, sore throat - with a unilateral/bilateral cheek rash. Self limiting.
2. Roseola - caused by human herpes virus 6 (HHV6). High temperature and flu like symptoms. Followed by a rash from tummy/chest spreading to neck, arms and face. Self limiting.
3. Varicella - Also known as chickenpox. Caused by varicella zoster virus. Presents with rash –> fluid filled blisters –> scabs. Self-limiting. Prevalence reduced since chickenpox vaccine came out in 1995. Self limiting.
4. Hand, foot and mouth - viral infection. Presents with blister lesions on tongue, gums and inside of cheeks. Rashes on palms and soles of foot. Fever. Self-limiting.
5. Measles - Viral infection. Initially presents with flu like symptoms, then white spots on inside of cheeks/lips, then a rash which begins on face/behind ears before progressing to rest of body. MMR vaccine available. Self limiting.

Question 17

Name bacterial causes for skin rashes in chidren.

Answer 17

1. Scarlet fever - caused by strep A. Initially flu like symptoms (headache, sore throat etc), the later on develop rash on tummy/chest and a strawberry tongue. 10-day amoxicillin antibiotics therapy.
2. Cellulitis - Due to bacterial infection. Often post skin trauma. Presents with red, tender, painful skin and fever/chills. Oral/IV antibiotic prescribed depending on severity.
3. Impetigo - Caused by group A strep. Presents with red sores/blisters which then burst and leave a golden-brown crusting. Treat with oral antibiotics.

Question 18

Name other (not bacterial/viral) causes for rashes in children.

Answer 18

1. Eczema - Inflammatory skin condition. Often due to genetics and people with atopy. Can be worsened by allergens, stress, diet. Rashes found on flexor surfaces. Combination of emollients and topical steroids used to treat.
2. Scabies - Caused by human itch mite. They burrow into the skin and lay eggs. Presents with a raised itch rash. Should be treated with insecticide gel to stop from spreading.
3. Urticaria - Often caused due to allergens i.e., food allergens. Raised itchy patches on skin. Oral antihistamines can help.

Question 19

1. What is hay fever and how does it present in children?
2. How is hay fever managed?
3. How can you differentiate this from general allergic rhinitis and infection?

Answer 19

1. Seasonal allergic rhinitis specifically due to grass and pollen. Sneezing, itchy/red eyes, runny/blocked nose.
2. Avoid triggers. Oral antihistamines. Nasal antihistamines/steroids.
3. Allergic rhinitis - all year round due to all allergens. Infection - fever, yellow/green mucus.

Question 20

1. What is Osgood Schlatter disease?
2. How does it present?
3. What are its risk factors?
4. How is it diagnosed?
5. How is it managed?

Question 21

What are your differentials for osgood schlatters?

Answer 21

1. Injury
2. Perthes
3. SUFE

Question 22

1. What is toddlers’ diarrhoea and what advice should be given to mum?
2. How does it present?

Answer 22

1. Persistent diarrhoea in kids of the age of 1-5 yrs. Encourage to increase fat, decrease fibre and stay clear of too many juices. Reassure will resolve by age 5/6.
2. 3x loose stools a day. The stool is pale, smelly and may contain vegetables/food left overs and abdominal cramps. Otherwise the baby is well and growth is not hindered.

Question 23

What are your differentials for toddlers diarrhoea?

Answer 23

1. Dietary intolerance - i.e., lactose intolerance. Investigate with food diary and diet of elimination.
2. IBD - Often presents in people aged 20-30 yrs. Blood and mucus in stool. Weight loss. Family history.
3. Coeliacs - Bloating, diarrhoea, weight loss, stomach cramps. Serum test for antibodies positive. Potentially biopsy.
4. Infection - Acute, travel history, diet changes, stool culture showing infection.

Question 24

1. What are threadworms and how are they spread?
2. How would it present?
3. How is it diagnosed?
4. How Is it treated?

Answer 24

1. Parasitic worm which infest there gut. faecal oral route transmission. I.e. baby itches bum - handles toy - eats afterwards.
2. Perianal itching - worse at night causing waking, itchiness around vagina in girls, can be visible in perianal area/stools.
3. Clinical history, tape test if still unsure.
4. oral antihelminthic i.e., mebendazole. But if under 6 yrs or pregnant/breastfeeding advice strict hygiene for 6 weeks instead.

Question 25

What are your differentials for threadworm?

Answer 25

- Candida infection.

Question 26

1. What is GOR & GORD? 2. How does it present? 3. How is it treated? 4. When should you refer?

Answer 26

1. GOR - reflux of gastric contents up oesophagus with no symptoms. GORD - reflux with symptoms. 2. Chest pain, heartburn (more prominent when lying down or after meals), acidic taste. 3. Reassure normal and often kids grow out of it. If particularly irritating can recommend gaviscon or PPI such as omeprazole. 4. If any sign of haemotemesis, malaena or dysphagia refer to paediatrics ASAP.

Question 27

What are your differentials for GORD?

Answer 27

1. Mesenteric adenitis - Swelling of lymph nodes in abdomen. Often caused bu virus. Can cause abdominal pain, fever, nausea, diarrhoea. 2. Abdominal migraine - Presents with abdominal pain, cramps,diarrhea,vomitting.

Question 28

What is infantile colic?

Answer 28

- Inconsolable crying (3/7, 3/24). - bringing knees up to tummy/arching back. - Windy/loud tummy.

Question 29

What are your differentials for infantile colic?

Answer 29

1. Infant reflux - Inconsolable crying, bringing up breast milk again, not gaining weight. 2. Dietary intolerance - i.e., lactose intolerance. Bloated, diarrhoea, vomiting, crying. 3. Pyloric muscle does not allow food from tummy to SI. Vomiting, constipation, dehydration, weight loss.

Question 30

What is the viral wheeze?

Answer 30

- Wheeze (sound heard on expiration). Due to viral infection.

Question 31

What are the differentials for viral wheeze?

Answer 31

1. Asthma 2. Respiratory infection 3. Inhaled foreign body