Paediatrics

Question 1

Pyloric stenosis

Answer 1

Usually presents 2-6 weeks

Question 2

Non-IgE Mediated Cow’s Milk Protein Allergy

Answer 2

Significant feeding problems exist day and night
Frequent vomiting
DIarrhoea with blood or mucous
Poor weight gain
Wide-spread eczema

Mx
Consider paediatric referral (To change to extensively hydrolised formula)
Modify mothers diet (not dairy)

Question 3

Lactose overload

Answer 3

Suspect if very frequent breast feeds
- occurs because not getting the creamy milk that tends to occur at the end of feeds
Common when woman has large milk supply but baby doesn’t drain breast
Presents with frothy, watery diarrhoea with perianal excoriation
(Primary lactose intolerance extremely rare)

Mx
Refer to lactation consultant
Optimise fit and hold technique
Block feeding (Offering only one breast for a 2-3 hour period). Down-regulates milk production = more cream
COmmunity resources - Australian Breast feeding association

Question 4

Bronchiolitis

Answer 4

Clinical diagnosis
<12 months
Peak severity day 2-3 (resolution at 7-10 days)
Cough can persist for weeks

Assess for: irritability, lethargy/fatigue, increased RR, chest wall/suprasternal retraction/nasal flaring, low O2 sat, apnoeas, decreased feeding

No routine Ix

Rx
Supportive therapy:
- Minimal handling
- Oxygen therapy if persistent O2 <90%
- Continue oral feeds if tolerated otherwise NGT or IV if required (<50% intake over 12 hours). NGT/IV at 2/3 maintenance due to potential increased ADH release
DO NOT USE: Beta agonists, corticosteroids, adrenaline, neb hypertonic saline, ABx, antivirals. Nasal suction not usually indicated.