GORD presentation
- regurgitation, chronic hiccups
- refusal to feed and failure to thrive
- haematemesis
- older children: laryngitis
- adolescents: heartburn and acid brash
GORD diagnosis
- endoscopy and oesophageal pH
- diagnosis is usually clinical
GORD management
- avoid over-feeding, sit upright longer after feeds, nursing in prone position
- antacids
- proton pump inhibitors
- most cases resolve by 6-9 months
pyloric stenosis presentation
- projectile vomiting after feeding (within minutes, milky and doesn’t contain bile)
- baby not keen to feed, few stool movements
- visible peristalsis, olive shaped mass in right upper quadrant
pyloric stenosis diagnosis
- diagnosis is usually clinical
- ultrasound
pyloric stenosis management
pyloromyotomy
what is intussusception
- typically around 6 months
- bowel telescope in on itself causing obstruction (most commonly in terminal ileum)
intussusception presentation
- intermittent vomiting (milky/yellow)
- redcurrant stool
- child puts leg up in pain and then it goes limp
- sausage shaped abdominal mass
intussusception management
- air enema reduction
- surgery if air up anus fails
malrotation volvulus cause
caused by absent attachments of the small bowel mesentery, which creates instability and allows organs to wrap around each other and form a volvulus that quickly becomes ischaemic
malrotation volvulus presentation
- green (fairy liquid) bilious vomit
- assume malrotation until proven otherwise
malrotation volvulus diagnosis
- if malrotation is suspected, commence management
- abdominal x-ray
- upper GI contrast series and ultrasound
malrotation volvulus management
surgical emergency
toddler’s diarrhoea cause
thought to be due to bowels not working completely effectively
toddler’s diarrhoea presentation
- watery diarrhoea 4-10 times a day, with visible lumps of feed
- child otherwise well
- no deviation in growth
toddler’s diarrhoea management
- reassurance
- restrict amount of high sugar drinks
cow’s milk intolerance presentation
chronic diarrhoea
cow’s milk intolerance diagnosis
trial of milk free diet
cow’s milk intolerance management
continue milk free diet with challenge tests every 6 months until tolerance resolved
constipation red flags
- failure to pass meconium within 48 hours
- abnormal appearance of anus
- constipation from birth
- faltering growth
functional constipation management
- less than 3 defecations per week
- large stools that may block toilet
- large, hard stools and rabbit droppings
- 1 weekly episode of overflow incontinence
- red flags include obesity, low fibre intake and low fluid intake
functional constipation management
stool softeners (Movicol, lactulose)
Hirschsprung’s cause
ganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses
Hirschsprung’s pathophysiology
- parasympathetic neuroblasts fail to migrate from the neural crest to the distal colon, leading to developmental failure of the parasympathetic Auerbach and Meissner plexuses
- leads to uncoordinated peristalsis and then functional obstruction
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immunisations12
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growth9
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nutrition and breast feeding17
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development and developmental milestones74
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respiratory43
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ENT12
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cardiovascular27
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gastrointestinal31
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UTI8
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measles, mumps and rubella16
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dermatology35
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neurology19
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non-accidental injury24
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child and adolescent psychiatry15
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other conditions16
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neonatal assessment6
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preterm babies and associated complications18
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neonatal medical problems5
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congenital abnormalities7
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bowel obstruction in the neonate12
