Common problems in paediatric out-patients Flashcards
Describe the referral pathway from primary to secondary care
What info is needed in any referral letter regarding a child ?
- General health including growth- weight, height (and OFC) with centiles and development
- Age
- Vaccinations
- Relevant social information eg child on CP register (child protection issues?) or concerns re previous OP attendances
- Parental concern - what are they worried about?
- Impact on school
What are the top 10 reasons for referral to general paediatric out-patient clinics ?
- Concern about growth
- UTI
- Constipation
- Abdominal pain
- Headaches
- Funny turns
- Heart murmur
- Food allergy/intolerances
- Minor abnormalities in infants –eg head shape
- Is it asthma?
What do you need to consider as the cause of obesity in the very obese child who also has short stature ?
Endocrine cause
UTI’s are very common in kids what are some of the specific signs/symptoms of UTI’s?
- Pain or a burning sensation when peeing
- Needing to pee frequently
- Deliberately holding in their pee
- Change in their normal toilet habits e.g. wetting themselves or wetting the bed
- Pain in their tummy (abdomen), side or lower back
- Unpleasant-smelling pee
- Blood in their pee
- Cloudy pee
What are some of the causes which make some kids more vulnerable to UTI’s than others ?
Constipation – can sometimes cause part of the large intestine to swell, putting pressure on the bladder and prevent it emptying normally
Dysfunctional elimination syndrome – a relatively common childhood condition where a child “holds on” to their pee, even though they have the urge to pee
Vesicoureteral reflux – an uncommon condition where urine leaks back up from the bladder into the ureters and kidneys; this occurs as a result of a problem with the valves in the ureters where they enter the bladder
When a child presents with a UTI what features potentially also seen would concern you (red flags)?
- Frequent infections
- Non-E.Coli pathogens
- Family history of renal disease
- Poor growth/general health
- Poor urinary flow in infant – e.g. posterior urethral valves (narrowing of the urethra)
- Voiding problems/constipation
- Spinal abnormality
- Raised blood pressure
- Renal tract abnormalities on antenatal scan
- Abdominal mass
Define constipation
Pain, difficulty or delay in defaecation
Define what is meant when someone soils themselves (soiling)
Escape of stool into the underclothing - often a sign of constipation
What is encopresis ?
Usually caused by constipation caused by various physiological, psychological, or neurological disorders etc
Leads to faecal impaction – when a large, solid stool becomes stuck in their rectum (back passage) and begins to stretch and weaken the surrounding muscle walls. Watery stools then leak out from around this blockage.
At first, you may just notice streaks in your child’s underwear and assume they aren’t wiping properly, but it usually gets worse and can lead to entire bowel movements in their underwear.
What is the management of constipation in kids ?
First line - Dietary modification (particularly increased intake of fluids and dietary fibre)
Plus - osmotic laxative (lactulose)
Give some examples of underlying disease which can cause constipation in kids ?
- Hirschsprung’s
- Metabolic (thyroid)
- Coeliac
- Anorectal abnormalities
- Neuromuscular
What is the characteristic sign of hirsprungs disease ?
Failure to pass meconium (dark, tar-like poo that healthy babies pass soon after being born) within 48hrs
What are some of the concerning features in kids with abdo pain ?
- Involuntary weight loss.
- Deceleration of linear growth.
- Gastrointestinal blood loss.
- Significant vomiting.
- Chronic severe diarrhoea.
- Unexplained fever.
- Persistent right upper or right lower quadrant pain.
- Family history of inflammatory bowel disease.
What are some of the signs/symptoms to be concerned about in kids with headaches ?(redflags)
- Headache on waking
- Worse with coughing or bending
- Associated vomiting- especially in the morning
- Visual disturbance
- Gait disturbance
- Cranial nerve palsy
