Paediatrics 1

Paediatrics 1

Paediatrics 1

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Fever

  • Protective response normally to bacterial or viral infection
  • Generally a temperature above 38 degrees is considered a fever
  • Various thermometers available - armpit, ear, infrared, rectal. Forehead strips not recommended
  • Causes included:
    • Respiratory tract infections
    • Flu
    • Ear infections
    • Urinary tract infections
    • Common ailments such as chicken pox and whooping cough
    • Vaccinations
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Fever Management

  • Fluid
    • Prevent dehydration - happens more rapidly in children
  • Appropriately dressed for surroundings
  • Antipyretics - paracetamol and ibuprofen
    • Not used together, if still distressed before next dose is due then try the other
    • Paracetamol >2 months
    • Ibuprofen >3 months
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Meningitis Signs in Babies

  • Tense or bulging soft spot on head
  • High temperature
  • Very sleepy/staring expression/too sleepy to wake up
  • Breathing fast/difficulty breathing
  • Extreme shivering
  • 'Pin *****' rash/marks or purple bruises anywhere on the body
  • Sometimes diarrhoea
  • Vomiting/refusing to feed
  • Irritable when picked up, with a high-pitched or moaning cry
  • Blotchy skin, getting paler or turning blue
  • A stiff body with jerky movements, or floppy and lifeless
  • Cold hands and feet
  • Refer to A&E or call ambulance immediately
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Chicken Pox

  • Highly contagious, common illness that mainly affects children
  • Caused by varicella zoster virus
  • Itchy, spotty rash
  • Symptoms appear 1-3 weeks after becoming infected
  • Main symptoms
    • Early symptoms - fatigue, high temperature, nausea, headache, aching muscles, loss of appetite in older children/adults
    • Spots - red raised spots develop on the face or chest before spreading to other parts of the body
    • Blisters - over the next few hours, very itchy fluid blisters develop on top of spots
    • Scabs and crusts - a few days after the blisters dry out and scab over. Then crusts fall off over the next two weeks
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Chicken Pox: Rash Stages

  • Spots: 1-3 weeks after infection
  • Blisters: after a few hours of spot appearance
  • Scabs and crusts: after a few days
  • Infection is spread in fluid found in blisters and also in the droplets of the coughs and sneezes of infected individuals
  • An individual is infectious from 1-2 days before spots appear until all blisters dry out and crust over
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Chicken Pox: Management

  • Management options include painkillers, antipyretics and antipruritics
  • Painkillers and antipyretics
    • Paracetamol
    • Not ibuprofen - due to increased risk of secondary bacterial infection
  • Lotions and creams
    • Calamine (antipruritic)
    • Cooling gels
  • Antihistamines
    • Chlorphenamine (Piriton)
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Nappy Rash: Preventative Measures

  • Change wet/dirty nappies as soon as possible
  • Clean whole nappy area gently, wiping from front to back, using water or fragrance free and alcohol free baby wipes
  • Bath baby daily - not more than twice a day as it may cause skin to dry out
  • Dry baby gently after washing
  • Leave nappy off for as long and as often as possible to let fresh air get to the skin
  • Do not use soap, bubble bath or lotions
  • Do not use talcum powder as it can irritate babies' skin
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Nappy Rash: Treatment

  • Apply barrier cream - after each nappy change, e.g. Zinc and Castor Oil Cream
  • Eliminate infection - clotrimazole, e.g. Canesten
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Colic: Symptoms

  • Difficult to comfort
  • Excessive crying
  • Grimacing/frowning
  • High-pitched, piercing sound
  • Red face
  • Clenched fists
  • Knees drawn up to chest
  • Excessive gas
  • Worse in afternoon/evening but can happen any time
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Colic: Advice

  • Holding baby during crying episodes
  • Sitting or holding upright during feeding
  • Use fast-flow teat if breastfeeding - holes in bottles that are too small may cause baby to swalloe air as they feed
  • Burping baby after feeds
  • Don't drink too much tea, coffee, or other caffeine drinks if breastfeeding
  • Avoid overstimulation of baby by continually picking them up and putting them down
  • Babies like movement, e.g. gentle rocking over the shoulder
  • Background noise, e.g. white noise may be soothing
  • Gentle stomach or back rubs or a warm bath may help
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Colic: Key Points

  • Cause is poorly understood but is multifactorial: spasmodic contraction of smooth muscle in GI tract - linked to lactose intolerance?
  • Question parents about:
    • Cry quality: high-pitched, fist clenching, drawing legs up
    • History of crying: will have been present for some time
    • Aggravating factors: hunger, thirst, too hot/cold, trapped wind
  • Conditions to eliminate:
    • Acute infection - fever, no history of excessive crying
    • Intolerance to cow's milk protein - not as common as people think
    • GORD - regurgitation >5x per day, failure to gain weight, refusal to feed
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Colic: Management

  • Advice to parents
    • Not their fault
    • Baby will eventually get better
    • Look after your wellbeing
  • Preventative measures
    • Check feeding technique: underfeeding results in excessive sucking and air intake leading to colic-like symptoms
    • Check teat size: when bottle is turned upside down milk should drop slowly
  • Treatment
    • Lactase enzymes - Colief
    • Simeticone - Infacol
    • None have good evidence but parents usually want to try
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