Paediatrics 2

Paediatrics 2

Paediatrics 2

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Headlice

  • Presence of live lice is prognostic
    • Empty egg shells (nits) does not constitute evidence of current infection
  • Itching
    • Not always present
  • Rule out:
    • Dandruff, psoriasis, seborrhoeic dermatitis 
  • Myths:
    • Not only associated with dirty hair
    • Do not only infect children
    • Children should not be kept off school
    • Can not jump or fly
    • Only affect people and can not be caught from animals
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Checking for Headlice

  • Dry/wet combing
  • Straighten and untangle dry hair using normal comb, or wash hair with normal shampoo and apply hair conditioner
  • Switch to a detection comb
  • Starting from the back of the head, comb from the scalp to the end of the hair
  • After each stroke examine the comb for live lice
  • Continue to comb all hair in sections until the whole head has been combed
  • Rinse out conditioner if wet combing
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Headlice: Treatment

  • Over 6 months
    • Permethrin
    • Malathion
    • Dimeticone
  • Over 2 years
    • Isopropyl myristate
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Oral Thrush

  • Oropharyngeal candidiasis - opportunistic muscosal infection
  • 5% of newborns suffer from this condition
  • Typically patients present with patches that are irregular and vary in size that are difficult to remove
  • Usually causes some pain
  • Often effects tongue and cheeks
  • It is unusual in otherwise healthy adults - a healthy adult with no risk factors requires referral
  • Adult risk factors:
    • Diabetes
    • Dry mouth/ill-fitting dentures
    • Immunocompromised
    • Recent antibiotics/inhaled corticosteroids
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Oral Thrush: Causes and Treatment

  • Potential causes:
    • immature immune system
    • recent antibiotic use
    • steroid inhaler use
    • recent courses of antibiotics used by mother
  • Treatment
    • Treatment over 4 months is with Daktarin (miconazole)
    • 4-24 months 1.25ml four times daily after meals
    • 2 years+ 2.5ml four times daily
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Threadworms

  • More common in school and pre-school children but still can infect adults
  • Transmitted most commonly by the faecal-oral route - eggs get lodged under finger nails
  • Eggs are very hardy and can easily be transferred to clothing, bed linen etc. resulting in dust-borne infection
  • Clinical features:
    • Night-time perianal itching caused by mucus produced by females when laying eggs
    • Can range from local 'tickling' sensation to acute pain
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Conditions to Eliminate and When to Refer

  • Conditions to eliminate:
    • Other worm infections: round and tape worm infections usually contracted by adults visiting poor and developing countries
    • Contact irritant dermatitis: no recent history of infection, no visible signs of worms in faeces
  • Referral:
    • Medication failure
    • Secondary infection from scratching
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Threadworms: Management

  • Hygiene measures (lifespan of threadworm approx. 6 weeks)
    • Keep nails short and clean
    • Careful hanf washing and nail scrubbing before meals and after each visit to the toilet
    • Wash bed linen regularly - ideally every day
    • Don't share towels
    • Underwear underneath night clothes
    • Shower daily immediately on rising
    • Damp dusting and daily vacuuming
  • Treatment:
    • Mebendazole for >2 years - whole family should be treated. Repeated dose after 14 days if re-infection is suspected. 
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