Paediatrics 1

Paediatrics 1

• 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

• 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

• 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

• 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

• 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

• 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)

• 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

• Apply barrier cream - after each nappy change, e.g. Zinc and Castor Oil Cream

• Eliminate infection - clotrimazole, e.g. Canesten

• 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

• 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

• 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

• 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