Paediatrics - Peds PDF

Preview

Summary

Peds...

Description

Paediatrics Most common condition – Asthma, episodic, intermittent. Consider Chest X-ray if first episode > 6yo, try PFTs pre-post bronchodilators. Asthma acute treatment  Relievers (B2-agonists) o Salbutamol, MDI via spacer  Prednisolone o 1mg/kg for 3-5 days – First dose (2mg/kg) Asthma chronic treatment  Education and action plan  Preventers o If frequent episodic asthma (more than 6 weeks) o Aim for lowest dose possible to achieve control  Inhaled corticosteroids.  Symptom controlled or LABA o Use low dose ICS. Spacers  Small spacer if pre-school  Large spacer once school age  Turbuhlaer if >6yo  Autohaler if >8yo  Always check technique. Bronchiolitis  Wheeze < 12 – 24 months  Dx Asthma between 1 – 2 years old.  Winter months  Peaks at day 3 – 5  RSV most common (human metapneumovirus, parainfluenza also possible)  Admit if SaO2 < 94% or if not feeding  IV fluids if no oral  CPAP if severe Constipation  Most common cause of abdo pain in children. Treatment  1-3 years o Dietary, Novalac Constipation formula o Coloxyl drops  1-5 yo. o Paraffin, lactulose and sennakot.  >2yo

o Macrogol Development  Ask for developmental history on all kids seen o Gross motor  Rolling at 3 months  Sitting at 6 months  Crawling at 9 months  Walking at 12 months  Refer if not walking at 18 months  Running at 18 months  Jumping at 2 years. o Fine motor and vision  Reaching at 3 months  Puts to mouth at 6 months  Pincer grip at 9 months  Picks up 100s and 1000s at 12 mo  Copies a line at 3 yo, circle at 3.5yo, cross at 4 and square at 5 yo.  Always check vision. o Language and hearing  Mama/dada at 9 months  First proper word at 12 months  10 words at 18 months (understands 50)  50 words and 2 word sentences by 2 years  Sentences by 3 years  Always check hearing o Personal social skills.  Smiling at 6 weeks  Laughing at 3 months  Stranger anxiety at 9 months  Wave bye-bye at 12 months  “No” and tantrums at 18 months is normal. ADHD  5% in Australia Diagnosis  >5 symptoms of inattentiveness  > 5 symptoms of hyperactivity/impulsiveness  Onset of symptoms < 7 years  At least 2 settings (Home and school minimally)  Interferes with functioning. Treatment  Parenting workshops  Behavioural strategies  Stimulants o Dexamphetamine, methylphenidate.

Mnemonic Medication Allergy Development Family history Immunization – up to date Gestational history – Term baby, meconium after 48 hours (if not, Hirchsprung’s) Social history Eczema  Atopic dermatitis  Dry itchy scaly skin Management  Avoid triggers – soaps, grass , wool Management  Use ointments, better than creams.  Wet dressing wraps.  Steroids o Hydrocortisone 1% to head and neck o ABCDE for body use o Apply 15 minutes after moisturizer. Fever  Find the focus of any fever, treat accordingly o Sore ears, sore throat, runny nose o Cough or respiratory distress o Diarrhoea or vomiting o Rash of meningitis signs o Limp or bone tenderness?  Does the child have meningitis?  If can’t find focus and child looks well o Urinalysis - UTI o CBE – > WCC, septic screen  If can’t find focus and child looks unwell (F)  4-11% of 7-11 yo. (M>F)  8-23% of 11+ yo. (F>M) Diagnosis  History (FAMILY HISOTRY)  Examination (Check fundus, neurological)  Investigations  Neuroimaging o Abnormal clinical symptoms  12 year olds. No known prophylactic treatment. Propanolol probably best. Immunizations  Meningococcal vaccine is now on the schedule, 2, 6, 12 months.  HPV and Prevenar vaccines Rotavirus  50% of Gastroentertitis  6 days in average disease duration.  Multiple infections in first few years of life. Jaundice  Jaundice is not always physiological or just “breast-milk” jaundice at your 6 week check. Causes of jaundice Day 1  Haemolytic disease of the newborn  TORCH infection Day 2 – 5  Physiological jaundice  Sepsis, polycythaemia/sequestered blood Day 5 – 10  Breast milk jaundice  Hypothyroidism  Metabolic disorders  Drugs >10 days  Biliary atresia**. Choledochal cyst  Neonatal hepatitis, sepsis. Kawasaki Disease  IVIg  Aspirin  Most common cause of MI in children Laryngotracheobronchitis (Croup)  Inflammation of the trachea  Stridor and barking cough  6 months to 5 y.o

 

Parainfluenza virus. Differentiate foreign bodies and epiglottitis

Give stat dose of prednisolone or dexamethasone even if mild. Dischrage home if no stridor after 4 hours. Meningitis Nocturnal enuresis  Involuntary passage of urine in a child with a mental age of > 5yo in absence of physical disease.  20% of 5yo.  7% of 7yo.  Strong family history ...