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Management of croup


- If current or previous moderate/severe croup
- Under 6 months old
- Poor feeding.

1. Oxygen
2. Oral dexamethasone (or, if unavailable, prednisolone)
3. If deteriorating further nebulised adrenaline (1:1000)


Management of molluscum contagiosum

- Resolves on its own approx. 18 months
- Avoid towel/clothes sharing
- Stay in school/nursery
- Squeezing spots but this shouldn't be necessary

- Cryotherapy


Management of eczema

Tailored approach based on the severity of their eczema using a 'stepped approach'

Mild eczema:
- Emollient (cream, lotion, bath/shower, ointment)
- Mild topical steroid (~1% hydrocortisone)

Moderate eczema:
- Emollient
- Moderate topical steroid (Betnovate, Eumovate)
- Topical calcineurin inhibitor (tacrolimus)
- Bandages and wet wraps

Severe eczema:
- Emollient
- Potent topical steroid (Betnovate, Beclametasone)
- Topical calcineurin inhibitor
- Bandages and wet wraps
- Phototherapy
- Systemic therapy (oral steroids or non-steroidal immunosuppresants)


Management of acne vulgaris

- Washing no more than twice a day
- Do not pick or scratch
- Fragrance free emollients if dry skin is an issue
- Avoid lots of make-up/buy some derm-friendly stuff

Mild acne:
- Benzoyl peroxide or topical retinoid
- azelaic acid if above doesn't work
- Consider COC, e.g. Yasmin in female patients who want contraception
- Follow-up in 6-8 weeks

Moderate/severe acne:
- As above plus ...
- topical (or oral if difficult to reach areas) antibiotics like tetracyclines
- Refer if risk/current scarring, psychological impact or endocrine pathology suspected


Management of scabies

- Avoid body contact until patient/partners treated
- Machine was clothes/towels/linen on first day of treatment

- Permethrin (2nd-line malathion) applied whole body, twice 7 days apart. Allow to dry then wash about 12-24 hours later.
- All contacts (symptomatic or not) must simultaneously be treated.
- Hydrocortisone for itching


Management of ringworm/tinea

- wash affected skin daily including skin folds
- wash clothes/linen frequently
- Don't share towels
- No need to exclude from school

- topical miconazole/econazole/clotrimazole consult dermatologist before prescribing to under 16s though
- if inflamed --> hydrocortisone


Management of pyloric stenosis


- Plot weight
- Fluid resus with saline bolus
- NG drainage/aspirations
- IV fluids for deficit and maintenance
- Electrolyte/Acid-base monitoring regularly

- Once stable surgery review
- Pyloromyotomy is gold standard


Management of status epilepticus

Call for senior paediatric SpR/Consultant and on call anesthetist

A - ensure patency
B - high flow oxygen mask
C - Assess and gain IV or IO access. Get BM, U+Es, gases

If IV/IO access:
1. Diazepam/Lorazepam/Midazolam and wait 5 minutes
2. repeat step 1
3. Phenytoin 18mg/kg over 20 mins
4. Anaesthetist for RSI

If no IV/IO access:
1. Buccal midazolam/rectal diazepam, wait 10 minutes.
2. If access go to step 2 above otherwise Buccal midazolam/rectal diazepam, wait 10 minutes.
3. If access go to step 3 above, otherwise Paraldehyde PR and try for access again.
4. Anesthetist for RSI


Management after a febrile seizure?


1. Rule out underlying cause, e.g. meningitis, meningococcal disease, encephalitis
2. Admit if:
- 1st febrile seizure or never been seen by a paediatrician for a febrile seizure
- Child is less than 18 months
- Seizure: longer than 15 minutes; focal features; seizure within same febrile illness or 24 hours; incomplete recovery by 24 hours
- Current/Recent antibiotic use
- Parents are anxious that they can't cope


Management of ?viral encephalitis

ABCD + glucose

1. Sepsis work-up:
- Throat/rectal swabs
- Blood culture
- Urine (ideally suprapubic aspirate)
- LP
(also send for PCR analysis)

2. Neuroimaging e.g. MRI
3. Consider EEG
4. Therapy as indicated by causative virus


Management of slipped upper femoral epiphysis

1. Don't walk
2. Painkillers
3. Hip X-ray (widened growth plate, femoral neck anteriorly rotated, femoral epiphysis slipped down and back)
4. Ortho referral for surgical pin fixation


Management of acute infective conjunctivitis (not neonatal)


- Clean secretions with wet cotton wool
- Wash hands regularly, avoid sharing towels/pillows
- Advise condition usually resolves on its own

- Ocular antibiotics usually makes little difference to outcome
- e.g. Chloramphenicol or fusidic acid (the latter in pregnant ladies)


Management of lower UTI


If under 3 months --> admit
If 3months to 3 years --> low threshold for admission, otherwise as below
If more than 3 years...

- Obtain urine specimen for culture before antibiotics
- Encourage and monitor fluid intake

- Fever or pain then give paracetamol
- Oral antibiotics for three days, e.g. trimethoprim, nitrofurantoin, cefalexin, amoxicillin

- Review within 48 hours in person/telephone
- If responding but the organism is sensitive then switch antibiotics and send urine for test of cure analysis after Abx treatment
- If still unwell --> reassess
- If responded consider referral if recurrent UTIs


Management of constitutional delay?

Observe and monitor
If psychosocial adjustment (usually due to short stature) then consider:

- giving boys a weak androgen or testosterone for 3-6/12
- giving girls oestradiol for 3-6/12


Management of ADHD

- Manuals/DVDs/Leaflets for parents on positive parenting techniques
- Maintain a balanced diet and adequate exercise, consider a food-behaviour diary and see if any links. Consider dietitian input.

Pre-school children:
- parent/carer training/education
-drug treatment not recommended

Moderate ADHD:
- Parent/carer training/education
- Offer patient group therapy CBT/social skills, consider individual sessions for older patients
- Drug treatment not recommended

Severe ADHD:
- Drug treatment for severe ADHD
- Methylphenidate (Ritalin) ... or if that fails then atonmoxetine
- Titrate over about 1 month until symptoms improve no further
- Consider modified release
- Provide clear instructions written/pictures on how to take drug.