Paediatrics Flashcards
(88 cards)
1
Q
Down’s syndrome presentation investigations
A
- Look for features of Down’s Syndrome (give examples)
- Karyotyping - Trisomy 21 (confirms diagnosis)
Health complications
• Cardiac echo - ASD, VSD, Tetralogy of Fallot
• Abdo USS - biliary/duodenal atresia
2
Q
Down’s syndrome counselling
A
- What - Extra chromosome 21
- Re-occurence - higher age and genetics, can get genetic testing for both parents
- General care - LD, long-term care, health problems
- Heart disease, hearing problems (otitis media), vision problems (cataracts), hypothyroidism
Management
• MDT (paeds, GP, social worker, specialists (cardio, neuro, gastro etc.)
• Educate parents - support groups
• Early - physio, SALT
• Medium - specialist school, regular review
• Long - help with employment, living independently, fertility
3
Q
Neonatal jaundice investigations
A
Bedside and bloods approach • Obs • Skin examination • Abdominal examination • Urine dip, MC&S
- Blood group
- DAT
- FBC and blood film
- G6PD
- Blood culture
- Bilirubin
- TSH
- LFT
4
Q
Neonatal jaundice (hyperbilirubinaemia) management
A
- Phototherapy or exchange transfusion - refer to treatment threshold graph
- In phototherapy - eyes protected, blood samples taken regularly, can breastfeed and provide skin to skin contact, heated incubator to make baby feel comfortable
• Hydration e.g. encourage frequent breastfeeding
5
Q
Asthma investigations
A
- Obs
- Peak expiratory flow rate
- Resp exam
- Consider spirometry
- Consider skin-prick testing
6
Q
Asthma management
A
10 puffs of salbutamol through a spacer
Long-term:
- SABA
- Low-dose ICS
- Add LTRA
- Stop LTRA, start LABA
- Change ICS and LABA for MART (maintenance and reliever therapy)
- Increase ICS to moderate dose
- Specialist referral, consider high-dose ICS and trial of theophylline
Provide personalised asthma action plan from Asthma UK
Trigger avoidance
Ensure patient has own peak flow meter
Explain how to use inhalers
7
Q
Bronchiolitis investigations
A
- Obs
- Resp exam - coughing, work of breathing, auscultation of lungs
- Nasopharyngeal swab would show RSV (not routine)
8
Q
Bronchiolitis counselling
A
Reassure and discharge
• Common virus causing these symptoms, should resolve in 2 weeks
• Oxygen sats showing they are oxygenating well
• We think its mild and no medication needed, (palivizumab for high-risk preterm)
• Make sure they are feeding well, return if <75%
• Contagious - avoid other infants
9
Q
Cow’s milk protein allergy investigations
A
- Obs
* Examination - skin (signs of anaphylaxis), abdominal, resp
10
Q
Cow’s milk protein allergy management
A
IgE-mediated (minutes after ingestion)
• Allergy testing
• Paeds dietician referral
• Exclude cow’s milk protein from mother’s diet if breastfeeding
• Extensively hydrolysed formula if formula fed
• Elemental (amino acid) formula if that doesn’t work
Non-IgE mediated (2-72 hours after ingestion)
• Same as above but first 2 steps only if severe
Weaned
• Exclude CMP from diet
• Nutritional counselling from paeds dietician
• Regularly monitor growth
• Reintroduce into diet - follow Milk Ladder (Allergy UK)
11
Q
Croup investigations
A
- Obs - A-E approach (RR, O2 sats, HR)
- Avoid examining throat
- Fluid balance assessment
- Resp exam
- Urine dip
• CXR - thumb and steeple sign, not usually done
12
Q
Croup mild, moderate, severe management (according to Westley croup severity score)
A
All
• Oral dexamethasone (single dose for all patients, inhaled bec or IM dex if not possible)
• Analgesics
Mild
• No admission
• Safety net
Moderate
• Oxygen
Severe
• Admit
• Can give steroids while transported if travelling from GP
• Airway support (paeds, nurse, anaesthetists involved)
• O2 high flow via non-rebreathe mask
• Nebulised adrenaline (1 in 1000 1mg/ml), risk of rebound so close monitoring
13
Q
Mild croup counselling
A
- Infection and inflammation of the airways
- Very common, have given some medication and should get better within 48 hours
- Keep caring at home with calpol, plent of fluids, and sitting upright
- Comfort child if distressed
- Come back to if symptoms don’t go away
- Call ambulance if drooling, trouble breathing, lethargic
14
Q
Cystic fibrosis investigations
A
- Obs
- Examination
- Sweat test
- Genetic testing (and family) - delta F508 mutation
15
Q
CF counselling
A
- Lifelong condition with recurrent resp infections and malabsorption
- Referred to specialist cystic fibrosis centre
- MDT approach
- Lungs - physio, mucoactive agents (lumacaftor - potentiator, ivacaftor - corrector)
- Infection - prophylaxis (staph aureus), acute infection (pseudomonas aerigunosa)
- Nutrition - enzyme tablets (creon), high-calorie diet, monitor growth
- Psychosocial - support for child and carers
Consider genetic testing if planning on having another child
16
Q
Food allergy investigations
A
- IgE immunoassay
* Skin prick
17
Q
Food allergy management/counselling
A
- Avoid allergens
- Mild - non-sedating antihistamines
- Severe - IM adrenaline and salbutamol if bronchospasm
- Educate on how to manage allergic attack (allergy action plan) and provide epi-pen
- Consider food challenge after 6-12 months of being symptom-free
- Consider in hospital if previous severe reaction
- Nuts and seafood allergies usually persist into adulthood
18
Q
Pneumonia investigations
A
Bedside, bloods, imaging approach
- Obs
- Resp exam
- Urinalysis
- FBC and CRP
- Cultures
• CXR
19
Q
Pneumonia management
A
- Amoxicillin/clarithromycin 5 days
- Co-amoxiclav high severity
- Antipyretics
- Adequate hydration
- Advise against parental smoking
- CHeck child regularly during day and night
- Return if RR increases, dehydration, or worsening fever
Hospital admission if O2 < 92%, grunting, marked chest recession, RR > 60
- Supplemental O2
- PO abx if tolerated, otherwise IV and review to switch back after 48 hours
20
Q
Sore throat (pharyngitis and tonsillitis) investigation
A
- Obs
- Top to toe examination including throat, skin, cervical lymph nodes and ears
- Consider throat swab (rapid antigen test for group A strep)
21
Q
Sore throat management
A
Group A strep confirmed (FeverPAIN 4/5 or Centor 3/4) or very unwell
- Phenoxymethylpenicillin (5-10 days) or clarithromycin
- Avoid amoxicillin in case mono
- Adequate fluid intake
- Antipyretics
- Salt water gargling, difflam
- Return to school 24 hours after taking abx / feeling well
22
Q
Scarlet fever abx
A
Phenoxymethylpenicillin or azithromycin
Notify Health Protection Unit
23
Q
Sinusitis treatment
A
< 10 days
• Antipyretics
• Nasal saline
• IN corticosteroid
> 10 days
• IN corticosteroid 14 days
• Back-up prescription (7 days) - 1. phenoxymethylpenicillin, 2. co-amoxiclav
24
Q
Viral-induced/episodic wheeze management
A
Burst therapy
• 10 puffs of salbutamol using a high-volume spacer
• Puff every 30 seconds
Assess for response, repeat every 10-20 minutes
Discharge after 4 hours with no symptoms
Give salbutamol weaning regime (explain similar management to hospital, at home)
25
Whooping cough investigations
Bedside and bloods approach
• Obs
• Respiratory exam (cardio and abdo for completion)
• PCR of nasopharyngeal aspirate
• Consider IF antibody testing of perinasal swabs
• FBC, CRP, U&E
26
Whooping cough management
* ABx - macrolide e.g. clarithromycin (cough can still persist after ABx)
* Fluids
* Rest
* Calpol
* School exclusion until 48 hours after starting ABx or 21 days after onset of cough if not treated
* Prophylaxis - macrolide to close contacts, particularly if not immunised
* Safety net - come back if seizures, signs of respiratory distress, dehydration or weight loss
27
Coeliac investigations
Bedside, bloods, imaging approach
• Obs
• Abdo exam
• Faecal fat - Sudan Stain
* FBC, glucose, LFTs, U&E
* Vit D, Vit B12, folate, iron
* Calcium
* CRP/ESR
* IgA TTG ab
* EMA ab
• Jejunal/distal duodenal biopsy endoscopically
28
Coeliac counselling
* Inability to digest gluten
* Common but lifelong condition
* MDT - gastro, dietician, endo, speicalist nurse
* Dietician can help modify diet, how to manage in social settings and avoid cross contamination. Also iron supplementation.
* Annual review to monitor height and weight, review symptoms, assessment of diet
* Coeliac UK
29
Constipation investigations
* Abdominal examination - masses, tenderness
| * Could do obs and further examination for completeness but not necessary
30
Constipation management
* Balanced diet with fibre and adequate fluid intake
* Regular toileting
* Behavioural interventions e.g. star chart
* Consider asking health visitor to support
Faecal impaction
1. Osmotic laxative (movicol paediatric plain - polyethelene glucol 3350) for 2 weeks or until impaction resolves
2. Stimulant laxative (senna)
• Can continue at maintenance dose until regular bowel habit established
31
Constipation management for infants not weaned and weaned
Not weaned
• Breast-fed: unsual, consider organic
• Bottle-fed: extra water between feeds, abdo massage, bicycling legs
Weaned
• Extra water, diluted juice
• Lactulose if not effective
32
Crohn's investigations
Bedside, bloods, imaging approach
• Obs
• Abdominal examination (including mouth)
* FBC (anaemia)
* CRP
* Faecal calprotectin
* Vitamin B12 and vitamin D
* AXR - dilated loops, strictures
* Colonoscopy - inflamed, thickened, strictures/fistulae, skip lesions 'cobble-stone'
* Biopsy - inflammation in all layers, increased goblet cells and granulomas
* Small bowel enema/barium study - Kantor's string sign, 'rose thorn' ulcers
33
Crohn's counselling
* Condition with unknown cause
* Digestive system is inflamed and problems absoring nutrients
* Life-long, risk of relapse - important we control it now
* Medication can be used to settle down the inflammation every time it flares up
* Will be seen by gastroenterologist
* No special diet, but may find certain foods will make it worse
* Recommend liquid diet during flare ups
* Complications - osteoporosis, erythema nodosum, bowel cancer
• Support: Crohn's Colitis UK
34
How to induce remission in Crohn's (first 2 options)?
1. Corticosteroids
| 2. Aminosalicylates e.g. mesalazine
35
How to maintain remission in Crohn's?
* Check thiopurine methyltransferase
* Give azathioprine (methotrexate 2nd line)
* Monitor for neutropaenia
* Monitor monthly - check for anaemia, vit deficiency
36
Gastro-oesophageal reflux investigations
* Obs
* Alert, hydration status
* Abdominal exam
37
Gastro-oesophageal reflux management
* Very common, tends to start <8 weeks, becomes less frequent with time
* Due to immature lower oesophageal sphincter
* Advise 3- degree head-up during feeds
* Health visitor can provide support with technique
* Consider trial of smaller and more frequent feeds
38
Gastro-oesophageal reflux DISEASE management (??????????? difference)
* Trial of thickened formula
* Trial of alginate therapy e.g. Gavison, but not same time as thickening agents
* Breastfeeding assessment
* Consider specialist referral and PPI if no resolution or distressed
* May consider enteral tube feeding if faltering growth
39
Gastro-oesophageal reflux
• RFs
• Reasons for admission
RF
• Preterm
• Cerebral palsy
• Oesophageal atresia or diaphragmatic hernia surgery
```
Admission
• Faltering growth
• Not responding to meds
• Not feeding
• Sandifer's syndrome (sudden postures/arching/head throwing after eating)
```
40
Colic investigations
* Obs
* Alert, hydration status
* Abdominal exam
41
Colic counselling
• Common, resolves by 6 months
* Breastfeeding: continue in semi-upright position
* Formula: check bottle teat size
* NHS Choices leaflet, health visitor
* Sooth baby by holding when crying, gentle motion, white noise, warm bath
* Encourage parents to look after themselves - meet other parents, rest, support from family and friends
* Don't recommend infacol and colief
42
Intussusception investigations
Bedside, bloods, imaging approach
• Obs
• Inspection - pallor, behaviour
• Abdominal examination
* Bloods - FBC, U&E, blood gas, glucose, group & save
* USS - target sign
43
Intussusception management
* Secure IV access
* NBM
* Initial resus - 20ml/kg fluid bolus of 0.9% NaCl
* NG tube
* Analgesia
* Reduction by air insufflation under radiological control
* Surgery if peritonitis
44
Ulcerative colitis investigations
Bedside, bloods, imaging approach
• Obs
• Abdominal examination
* FBC (anaemia)
* CRP
* Faecal calprotectin
* AXR
* Colonoscopy
* Biopsy
45
Ulcerative colitis counselling
* Condition with known cause that leads to inflammation of bowel
* Uncommon but well-known
* No cure and comes and goes in flare-ups
* Medication to reduce likelihood and treat flare-ups
* Complications include growth issues and bowel cancer
* Seen by gastro
* Support: Crohn's and Colitis UK
46
Bacterial meningitis investigations
ABCDE approach, MDT support (acute paediatrician, anaesthetist)
* RR, O2
* HR, ABG
* GCS, AVPU
```
Examine
• Brudzinski's (lift head)
• Kernig's (straighten leg)
• Focal neurology for raised ICP
• Temperature
• Bloods - FBC, blood culture
• LP
```
47
Brief bacterial meningitis counselling
* Infection and inflammation around the brain
* MDT involved
* Admitted - line to give fluid and abx
* Hopefully better in next couple of days but can't say for certain how long they will get better
* Will follow up after clearance of infection in 4-6 weeks
* Possible complications include hearing loss - can offer audiological assessment as follow-uo
* Notify public health who will ask who has been in close contact, and they may need to receive antibiotics (ciprofloxacin) too
48
Traffic light: green signs
Colour
• Normal
```
Activity
• Responds normally
• Smiles
• Awake
• Strong cry / no cry
```
Resp n/a
Circulation + hydration
• Normal skin and eyes
• Moist mucous membranes
49
Traffic light: amber signs
Colour
• Pallor reported
Activity
• Not responding normally
• Not smiling
• Wakes with prolonged stimulation
Resp
• Nasal flaring
• Tachypnoea
• Low O2
```
Circulation + hydration
• Tachycardia
• Long cap refill
• Dry mucous membranes
• Poor feeding
• Reduced urine output
```
* Temp 39+ aged 3-6m
* Fever 5+ days
* Rigors
* Swollen limb
50
Traffic light: red signs
Colour
• Mottled/ashen
Activity
• No response to social cues
• Does not stay awake
• Weak, high-pitched, continuous cry
Resp
• Grunting
• Tachypnoea >60
• Chest indrawing
Circulation + hydration
• Reduced skin turgor
• Temp 38+ aged <3m
• Non-blanching rash
• Bulging fontanelle
etc.
51
Kawasaki investigations
Bedside, bloods, imaging approach
• Obs
• Urine dip + MC+S
* FBC (anaemia, high WCC with left shift)
* ESR, CRP
* Blood cultures, LP
* Echo (coronary artery abnormalities)
* ECG
* CXR (cardiomegaly)
52
Kawasaki management
* IVIG (single dose) + high dose aspirin until 24 hours after fever cessation
* Low dose aspirin
* Drink lots of fluids and continue on meds when discharged
* Follow up with cardiologists for echo as outpatient
* Reduce physical contact for now, stay active and maintain healthy diet
* Stop taking aspirin when all normal
53
Atopic eczema investigations
x
54
Atopic eczema management
Conservative
• Identification and education of triggers
• Cut nails short
(• Consider food allergy diagnosis)
Emollients
• Large amounts and often
• E45, cetraben
```
Topical corticosteroids
• Only areas of active eczema
• Not in <12 months
• Mild - hydrocortisone
• Moderate/severe - betamethasone
```
Topical calcineurin inhibitors
• Second line for moderate/severe
• Not in <2 years
• Tacrolimus
Bandages
• Chronic lichenified skin
Urgent referral (2 weeks) if no response to optimum therapy
55
Infected eczema and eczema herpeticum management
* Swab
* Hygiene e.g. using spatula for emollients
* Flucloxacillin / erythromycin
* Antiseptics e.g. chlorhexidine if recurrent
Eczema herpeticum
• Immediate referral
• Oral aciclovir
• Same-day opth/derm specialist review if around eyes
56
Mild eczema counselling
* Dry, itchy skin
* Common, many children grow out of it
* Steroids may be used, they are not systemic and only short course (1-2 weeks) so don't have as many of the side effects
* Emollients
* Avoid triggers
* Safety net infection
* Itchywheezysneezy.co.uk
57
Minimal change disease investigations
Bedside and bloods approach
• Obs - normal
• Urine dip - frothy, protein
* Blood glucose
* Low albumin
* Hyperlipidaemia (overcompensation)
* Normal FBC
* Consider complement levels - low C3 could be postinfectious glomerulonephritis or SLE
58
Minimal change disease counselling
* Kidneys aren't working as they should and protein is leaking into the urine
* Could be related to a problem with the immune system - don't know for sure
* Something we can treat - steroid tablets every day for 6 weeks, then every other day for a further 6 weeks
* Low-salt diet and restrict fluid intake
* Come straight back if this reoccurs
* 1/3 have one episode, 1/3 have infrequent relapses, 1/3 have frequent relapses
* Usually stops before adulthood
59
Septic arthritis investigations
Bedside, bloods, imaging approach
• General inspection for lymphadenopathy, rashes, bruising
• Closer knee examination (temperature, swelling, movement)
• Obs (HR, temp)
(if in GP, now refer to A&E)
* FBC (WCC, neutrophil left shift)
* ESR
* Blood cultures
* Joint aspirate and culture
* USS
* CTI/MRI
60
Septic arthritis treatment
* Flucloxacillin or clindamycin
* IV 2 weeks, oral 2 weeks
MRSA - vanc
Gonococcal - cefotaxime
61
Blood differences in septic arthritis from transient synovitis
High ESR
High temp
Very high WCC
(non-weight bearing too)
62
Cerebral palsy investigations
* Height and weight
* Tone and reflexes
* Hand dominance
• Consider MRI/CT/cranial USS to assess cause but not timing of injury (GA or sedation may be needed for procedure)
63
Cerebral palsy ddx
* Muscular dystrophy
* Chromosomal e.g. Fragile X
* Foetal alcohol syndrome
* Inherited metabolic disorders e.g. maple syrup urine
64
Cerebral palsy management
Refer to paediatrician specialising in developmental disorders
MDT approach
• Assessment of LD, swallowing, visual, hearing, bone mineral density
• Physiotherapy - encourage movement, prevent loss of motion
• SaLT - improve language abilities
• OT - identify difficult tasks and make them more accessible
```
Medication
• Stiffness - baclofen, diazepam
• Sleep - melatonin
• Constipation - laxatives
• Epilepsy - anticonvulsants
• Drooling - anticholinergics or botulinum toxin A
• Low BMD - calcium and vit D intake
```
65
Epilepsy investigations
* Obs
* Examination (alert, resp, hydration, skin)
* FBC
* Metabolic panel
* Blood glucose
* Septic screen and CRP - infective cause?
* EEG
* ECG - exclude cardiac causes
66
Epilepsy management (first fit)
```
Advice
• Recognise seizure
• Record future episode
• Avoid dangerous activity until diagnosis confirmed
• Make school aware
• Want to promote independence
```
Epilepsy specialist nurse
• Education and advice
Antiepileptic drug therapy
• Not all children
• Depends on type
• Rescue therapy (buccal midazolam) if prolonged seizures
• Discountinued after 2 years free of seizures
67
Febrile seizure investigations
* Obs
* Examination via NICE traffic light system
* Resp, skin, ENT, abdo, neuro
* Urine dipstick
* FBC, CRP - signs of infection
* Blood cultures, lactate, glucose - signs of infection
* Metabolic panel
* U&E - electrolyte imbalance
68
Febrile seizure (6 months - 6 years) management
If first febrile sizure, <18 months, diagnostic uncertainty, abx to mask:
• Arrange immediate hospital assessment by paediatrician
• Refer to first fit clinic
• Period of observation
At home
• Not same as epilepsy (although risk slightly higher)
• Cushion head and remove dangerous objects
• Check airway and recovery position after
• Call ambulance if > 5mins
• Reducing fever does not prevent recurrence but may help with symptoms
• Carry on with routine imms
69
Diabetic ketoacidosis investigations
* Obs
* Examination - sunken eyes, skin turgor, alert
* Urine dipstick - glucose and ketones
At this point, call for help e.g. acute paediatric reg on-call, anaesthetist and other MDT
Start ABCDE approach with a focus of circulation
• Measure body weight and monitor blood gases
• IV 0.9% saline and IV insulin (1-2 hours after fluids)
• Give with 40mmol/L KCl unless renal failure
• Once glucose <14, switch to IV 0.9% saline + 5% dextrose
Only consider stopping if child is alert, ketosis is resolving, and can take oral fluids
70
What to do if if blood ketone level is not falling in DKA treatment?
Think about increasing insulin dosage and seek senior help
71
What should you consider in DKA if child is vomiting and has reduced level of consciousness?
NG tube - risk of aspiration
72
Signs and treatment of 2x DKA complications
Cerebral oedema
• Headache, drop in HR, increased BP
• Mannitol or hypertonic sodium chloride
Hypokalaemia
• ST depression, prominent U waves, flattened P waves
• Stop insulin temporarily, central venous catheter for IV potassium solutions (discuss with paeds crit care specialist)
73
T1DM management
* Insulin: basal-bolus, insulin pump, 1/2/3 injections per day
* Diet and lifestyle
* Blood glucose and HbA1c monitoring: 5 capillary glucose tests a day (fastin 4-7, after meals 5-9)
* Blood ketone monitoring
* Psych/social support
74
Anaphylaxis management
Medical emergency
• ABCDE approach
• Airway
• Breathing
• If unresponsive and not breathing normally, start CPR
• Otherwise examine chest for obstruction, check circulation
• Sit up if airway difficulty, legs up if blood pressure problem/feeling faint, recovery if unconscious but breathing
* IM adrenaline 1:1000
* Repeat at 5 min intervals until adequate response
* High flow O2
* IV fluids
* IV chloramphenamine + IV hydrocortisone
75
Sepsis investigations + management
* Behaviour
* Examination - resp, cardio, skin, dehydration, fontanelle
* Obs
Transfer to acute hospital setting (if meningitis, IM benzylpenicillin first) + involve senior clinicians + start sepsis 6
1. Give high flow O2
2. IV/IO access (take gas, glucose, cultures)
3. IV/IO abx
4. Consider fluid resus and monitor urine output
5. Involve senior clinicians
6. Consider inotropic support
76
Sepsis abx
< 72 hours: IV benzylpenicillin + gentamycin
< 3 months: IV amoxicillin + cefotaxime
> 3 months: IV cefotaxime
In meningococcal: ciprofloxacin for close contacts
77
NAI investigations
Bedside, bloods, imaging approach
* Obs
* Examination inc. physical signs of neglect e.g. dirty clothes
• FBC, bone profile (rule out leukaemia, ITP)
* Fundoscopy - retinal haemorrhages
* Skeletal survey
* CT head if injuries found
78
NAI management
* Make sure child is in a safe space
* Contact child safeguarding team and consult seniors e.g. on-call paediatric consultant
* Consider contacting the police (Child Abuse Investigation Team)
* Document everything well, as I would in any other scenario, as I could be expected to provide written reports for further investigations
79
NAI counselling
* We have to talk about what to do next
* Whenever we have a case where we don’t know why an injury has occurred, we have to involve some other people
* This includes social services and the child safeguarding team (and maybe the police)
* This is a routine requirement for all children in these situations, and our aim is to keep your child safe
* May be necessary to move child to a place of safety while ongoing investigations are conducted
80
```
Conditions exluded from school for following times:
• 24 hours after abx started
• 48 hours after abx started
• 48 hous after symptoms settled
• 4 days from rash onset
• Lesions crusted
• Treated
• Recovered
```
24 hours after abx started
• Scarlet fever
48 hours after abx started
• Whooping cough
48 hous after symptoms settled
• D&V
4 days from rash onset
• Measles
• Rubella
Lesions crusted
• Chickenpox
• Impetigo
Treated
• Scabies
Recovered
• Influenza
81
Exclusion from school for mumps
For 5 days from onset of swollen glands
82
When are most children dry by day only and day + night?
Day only: 4 years
| Day + night: 5 years
83
Enuresis investigations
* Obs
* Abdominal examination - constipation a cause (detrusor muscle instability)?
* Urinalysis
84
Enuresis management
```
< 5 years (night)
• Normal
• Ensure easy access to toilet at night e.g. potty near bed
• Encourage bladder emptying before bed
• Consider positive reward system
```
> 5 years (night)
• Watch-and-see / star chart if < 2 per week
• Long-term: 1. enuresis alarm, 2. desmopressin, 3. refer to secondary care/enuresis clinic/community paediatrician
(day)
• Refer to secondary care
(secondary - dry for 6 months before)
• Consider management of underlying causes e.g. UTI or constipation
85
Obesity investigations
Heigh and weight for BMI
| Weight / square of height
86
Obesity counselling
* Be a good role model - children learn by example
* Encourage physical activity every day
* Keep to child-sized portions
* Eat healthily
* Less screen time and more sleep
87
Necrotising entercolitis investigations + management
Acute - ABCDE approach + sepsis 6
Abdominal exam
Abdominal X-ray - dilated bowel loops, intramural gas, bowel wall oedema
```
Senior help - on-call paeds reg
Stop feeding - TPN
Triple abx as per local policy
Fluids and resp support
Analgesia
```
88
Necrotising entercolitis counselling
* Serious condition we know affects newborn babies, especially when born early or have low birthweight
* Severe inflammation of the gut and can make babies unwell
* Need to admit to NICU, give fluids and abx, feed through tube, and monitor closely
* Will likely need surgery as the inflammation can cause some of the bowel to die, which needs to be removed
