Paeds Flashcards

Question

Scarlet fever

Answer 1

* Scarlet fever is a contagious throat infection that mostly affects young children, and usually adults do not get scarlet fever. * Complications occur very rarely now but serious complications include infection of other parts of the body e.g. ear infections which occur within days and more seriously, kidney or heart infections which can happen weeks or months after the infection seems to have gone. You should be aware so you can monitor your child over the next few months for any of these complications. * The best antibiotic to treat scarlet fever is penicillin (check penicillin allergy). You will need to make sure your child takes the full 10 days and we advise to keep drinking enough liquids and you can give paracetamol if the fever is distressing for your child. It should start getting better after one week. * Keep your child off school until at least 24 hours after starting antibiotics. * Safety net: If your child becomes very unwell, or if their symptoms do not improve within a week then go to A&E. If your child becomes well again after several weeks, this can be a sign of a complication and you should contact your GP.

Answer 2

* Tonsillitis is an inflammation of the tonsils, usually caused by a viral infection (less often by a bacterial infection). * The thing we worry about most is if the tonsillitis causes problems with the breathing or swallowing. * Mild cases often do not need treatment. However, it is important to drink plenty of water and you can give paracetamol for relieving pain. You can also try saltwater gargling or lozenges for comfort. Antibiotics are not always necessary, especially if the cause is viral. * Safety net: The symptoms should improve after 3 or 4 days, but if they do not improve please contact the GP. If your child develops any breathing or swallowing difficulties, then please seek urgent medical attention.

Answer 3

* Urticaria, or more commonly known as ‘hives’, is a common illness affecting up to 1 in 5 people at some point in their lives. The rash is very itchy and may come and go within hours (typically disappear without treatment within 24 hours). * Allergies to food or medicine may sometimes cause acute urticaria and this is worrying if your child finds it difficult to breath or swallow if the swelling is present in their airways. Most of the time we can’t find a cause for the urticaria. * You can keep a symptom diary to work out what triggers your child’s urticaria and take measures to avoid any triggers where possible. Usually we do not offer medication unless it is having a significant impact on daily living. If your child requires medication, we can prescribe you a tablet (antihistamine) which can relieve the itchiness and review in 6 months with your GP. * Safety net: If you have any concerns, or if your child starts having difficulty breathing or swallowing, then please seek urgent medical attention. You can read more about urticaria on the British Association of Dermatologists website.

Answer 4

* Your child has eczema, have you heard of this before? It is a dry, itchy skin rash and can be common in children. Some children grow out of it, others do not. The exact cause of eczema isn’t known but there is an increased chance of developing it if there is a family history of eczema, allergies and asthma. * Eczema can be really painful and itchy for children which can cause the skin to become thickened. Scratching can cause small cuts which could allow the rash to get infected. * It’s important to use moisturising creams all over the affected areas multiple times a day even when the skin is clear. Keep their fingernails short to avoid scratching. Make sure to apply creams to clean skin and use pump dispensers to ensure the cream isn’t infected. Your child may also need some steroid creams to help get rid of the rash which should be applied at least 15 minutes before moisturisers and should be continued until 48hours after the rash has cleared. Flare-ups and worsening rashes can be given stronger steroid creams, and antihistamine tablets can be given for severe itching. * We will review your child after 3 months. If the eczema is not improving, is getting worse or affecting your child’s school attendance or sleep, please contact us sooner. * Safety net: If the rash starts to blister and are filled with fluid or pus, become very painful and spread to other parts of the body then take your child to A&E immediately as their eczema may be infected.

Answer 5

* Most babies develop a nappy rash at some stage. Usually it is mild and does not bother your baby. * However, it can be more severe and sore in some cases. * There are methods to prevent nappy rash. For example, using high absorbency pads and changing the nappies frequently (at least every 3-4 hours). Try and avoid skin irritants, such as fragrance or alcohol – especially in baby wipes. You can also use an OTC barrier cream, which your pharmacist can advise you on. If your baby is experiencing discomfort from the nappy rash, we can give a mild steroid cream to reduce the inflammation. You can read more about nappy rashes on patient.info website. * Safety net: if you notice your baby feeling particularly unwell/unsettled, or if the infection is getting worse (signs of secondary infection) then please make a GP appointment

Answer 6

* Scabies is a common and very itchy skin rash caused by a tiny mite. It can affect people of any age, but it is most common in the young and the elderly. It is also easily spread by skin-to-skin contact. * Scabies can cause extreme itching and can disturb sleep. It is also important we treat scabies to prevent further spread. * The treatment of scabies involves using medicated cream applied to the whole body on cool, dry skin. The cream needs at least 8 hours to work and you will need to apply it twice (one-week between applications). All family members and close contacts will need to be treated, even if they are not experiencing any symptoms themselves. Make sure to also wash your bedding, clothes, and towels at high temperatures to kill any remaining mites. * If after two applications (two weeks) the itching does not resolve, please contact your GP for further advice. A recurrence of scabies is unfortunately quite common, so please contact your GP if you experience similar symptoms again. More information can be found on the British Association of Dermatologists website (patient leaflet on scabies).

Answer 7

* Your child has an allergy/intolerance to cow’s milk protein. Have you heard of this before? It can cause skin rashes, vomiting and breathing problems. * It is one of the most common childhood food allergies and most children can grow out of it by the age of 5. This is different to lactose intolerance which is when the body cannot digest a natural sugar found in milk. You can get support from allergy UK or CMPA support. * This can affect their growth and development, or if it is severe can cause serious breathing difficulties when they have an allergic reaction. * To confirm the allergy, we may need to refer your child to a specialist for skin prick allergy testing. Usually, allergy can be confirmed by mum excluding all cow’s milk protein from her diet (if baby is still breastfed) or we can prescribe a trial of cow’s milk protein-free formular feed called extensively hydrolysed or amino acid formula for 2-4 weeks. If the symptoms improve, we’ll ask you to reintroduce cow’s milk protein to see if the symptoms come back. Once we have confirmed the diagnosis, then you should continue to exclude cow’s milk protein from baby +/- mum’s diet until your baby is 9-12 months old and for at least 6 months. We can refer you to a paediatric dietician to support you with this. We will regularly monitor your child’s growth and weight. We can then check if your child has become tolerant to cow’s milk every 6 months. * Safety net: We will give you a prescription for oral antihistamines to keep in case serious symptoms occur such as breathing difficulties or throat swelling. If this happens always go to the nearest A&E.

Answer 8

* Your child has hay fever– have you heard of this before? It is inflammation inside their nose commonly caused by an allergy to dust, pollen animals. This causes their nose to run and feel itchy. * It can cause nasal polyps which are sacs of fluid to grow inside their nose. Sinus or ear infections can also occur. * Try to avoid the trigger by avoiding walking on grass/regularly washing sheets/ avoiding animals. We can prescribe an antihistamine nasal spray or oral tablet. If this doesn’t help then book another appointment and we can discuss using steroid nasal sprays. * If symptoms don’t get better after 2-4 weeks, then please come and see us again. Continue using the intranasal spray or tablet until your child is not exposed to the trigger anymore (after pollen season over).

Answer 9

* Based on your child’s symptoms, we think he might have an inherited condition called CAH. Have you heard of this before? * CAH is a condition where the body is missing a special protein (enzyme) that stimulates the adrenal glands to release the hormone cortisol. This means the body is less able to cope with physiological stress, which can be life-threatening. It also makes the level of male hormone (androgens) increase, which causes male characteristics too early in boys or inappropriately in girls. * Your child will need to be cared for by an MDT. We recommend admission to give fluids and start cortisol and/or aldosterone treatment to replace the missing hormones. Your child will need to take replacement hormone daily for the rest of their lives. * You will be regularly tested for hormone levels and followed up with you GP and specialists in secondary care. You might receive genetic counselling with a specialist.

Answer 10

* Based on your child’s symptoms, we think he might have heart failure. Have you heard of this before? * HF happens when the heart does not pump enough blood out to the body to meet the demand for energy. It can be due to weak heart muscle or due to the valves or a hole somewhere in the heart. This causes fluid to backup into lungs or liver. * Until we know the cause, it is important to give some medications to reduce how hard the heart has to work. We can give diuretics to eliminate extra fluid in the lungs, beta blockers to reduce blood pressure and digoxin to help the heart squeeze better. * We can give high calorie formula to help them get the extra nutrition they need. This might be through a tube from the nose to the stomach. * If HF is due to a structural problem, surgery may be used to fix it. * Your child with have close follow-up with the GP and a cardiologist to monitor the disease over time.

Answer 11

* Based on your child’s symptoms, we think he might have cyanotic heart disease. Have you heard of this before? * Cyanotic heart disease happens when a person has low blood oxygen level because of a heart defect. There are many different types of defect involving the valves or the vessels. * Until we know the cause, it is important to give some medications to reduce how hard the heart has to work. We can give pain killers to calm your child and some oxygen to help increase the blood levels. We will give beta blockers to reduce blood pressure and sometimes medication to help the heart squeeze better. Your child might need antibiotics to protect the heart against infection. * We can give high calorie formula to help them get the extra nutrition they need. This might be through a tube from the nose to the stomach. * If the cyanosis is due to a structural problem, surgery may be used to fix it. * Your child with have close follow-up with the GP and a cardiologist to monitor the disease over time.

Answer 12

* Tetralogy of Fallot is one of the most common forms of congenital heart disease (1 in 3,600 live births). It can sometimes be associated with other genetic conditions, like Down’s syndrome. The heart defects make it difficult to pump oxygenated blood around your child’s body, leading to some of the symptoms you have experienced. * Due to problems with how the heart pumps blood, we are concerned about the strain on your child’s heart. If left untreated, this can be life-threatening. * We ideally would like to perform an operation within the first year of life to correct some of the heart defects seen in people with Tetralogy of Fallot. * You can join support groups online via the website, TOFS.org.uk for more information. * Safety net: If your child experiences a ‘tet spell’ (episodic shortness of breath, deep and rapid breathing, looking distressed) then you must call 999 as this is a medical emergency.

Answer 13

* Jaundice causes yellowing of the skin and eyes. Have you heard of this before? It is caused by the build-up of a substance called bilirubin. When levels of bilirubin are too high, this causes jaundice. * This is common in new-born babies and is usually harmless. It usually develops 2-3 days after birth and can be caused by breastmilk. Usually, this will go away by the time your baby is 2 weeks old. * (If jaundice started < 48hrs old or prolonged > 2 weeks), sometimes the yellowing of their skin is a sign of an underlying condition. We will run some blood tests to find out what is causing this in your baby. * If bilirubin levels get too high, we will admit your baby to the specialist baby unit to give them some light therapy which helps decrease the levels of bilirubin. This is to prevent damage to the brain. Sometimes, we may need to exchange your baby’s blood with a blood transfusion to help lower really high levels of bilirubin. * We will be monitoring your baby’s bilirubin levels with blood tests to decide when to stop light therapy. Depending on the cause of the jaundice, your baby may need antibiotics (congenital infection)/surgery (biliary atresia)/medication (congenital hypothyroidism). * Safety net: If you notice that your baby’s skin/eyes is yellow or poo is pale/urine is dark, reluctant to feed at 2 weeks old or within 48-72 hours of life, then contact your midwife and come back to the hospital.

Answer 14

* Down syndrome is a genetic chromosome problem which results in the typical features of this condition. It cannot be cured but treatment and support can help someone with Down syndrome to lead an active life. * People with Down syndrome will have some degree of learning disability and are at higher risk of having other medical problems involving the heart, brain, bowels and thyroid. * The focus of treatment is to maximise independence and the multidisciplinary learning disability support team will help you with that. Your child’s care will involve early interventional therapies in childhood and co-ordinating care with you and in the future, your child’s school. Are you planning on having future children? We can offer you genetic counselling with a specialist to discuss the likelihood of your future children having Down syndrome if you would like. * This may be a lot of information to take in and it is important for you to know that we will support you as parents too. You can access support groups such as Down Syndrome Association or the National Down Syndrome Society.

Answer 15

* Based on your child’s symptoms, we think he might have GORD. Have you heard of this before? * GORD is when some of the food and drink and stomach acid travels back up the food pipe instead of passing into the intestines. This can irritate the lining of the food pipe and make it sore. It’s very common in infants as the muscle ring in the food pipe hasn’t matured yet. It should improve with age. * We recommend feeding your baby while upright and holding them upright for 30mins after each feed. We can also take some other measures to help: * Breastfed: we can try some baby Gaviscon for 2w to improve the reflux. You should stop the Gaviscon every 2w to see if symptoms have improved. If that doesn’t work, we can consider other medication. * Formula-fed: first I’d like to review how much you’re feeding the baby each time as sometimes overfeeding can cause reflux. It may be possible to reduce the volume of feeds if the current volume is excessive. If not, I’d like you to try giving small but more frequent feeds for 2w to see if that helps. If this doesn’t work, we can try special thickened formulas. * I’d like to catch-up in 2w to review your baby’s symptoms and check his weight.

Answer 16

* Intussusception is a condition where the bowel ‘telescopes’ in on itself. This causes a blockage in the bowel and leads to reduced blood flow, which in turn causes the symptoms your child is experiencing. Intussusception is the most common cause of bowel blockage in infants and young children. * We are worried that this blockage may cause more serious problems, such as permanent bowel damage, if left untreated. * Initially we would like to start your child on a fluid drip with a nasogastric tube (passed up the nose, down the food pipe into the stomach) and give them antibiotics. The first treatment is an air enema. In the X-ray department, a tube is passed into the child’s bottom and air is released into the bowel to correct the telescoped section. If the enema works well, they will be able to return home once they are well and feeding normally. * After the operation, you can give your child regular pain medications for discomfort. * Safety net: If you have any concerns, or if your child starts experiencing the same symptoms again, then please seek medical attention. You can read more about intussusception on patient.info website.

Answer 17

* Biliary atresia is a condition where the ducts connecting the liver to the gallbladder and intestines become inflamed and destroyed. We aren’t sure what causes the inflammation in the first place, but sometimes it is related to other genetic conditions. * This is a condition which requires immediate surgery to prevent further vomiting and poor weight gain. * What will happen next is that your child will stay in hospital so we can monitor him/her and arrange for him/her to have surgery. The surgery aims to remove some of the blockages in the bile ducts to restore normal functioning and relieve some of the symptoms your child has been experiencing. In some cases, if this first surgery doesn’t work, we will need to organise a liver transplant. However, this is something we can discuss later when necessary.

Answer 18

* Based on your child’s symptoms, we think he might have UC. Have you heard of this before? * UC is a long-term condition where the colon and rectum become inflamed. Small ulcers can develop on the colon lining and this can produce pus and blood. It is an autoimmune condition, so the immune system attacks healthy tissue by mistake. UC affects 1 in 500 people. * The symptoms you’ve been experiencing are likely a flare-up. Some people may go for weeks with mild symptoms or none at all, followed by flare-ups. These may be accompanied by pain in the joints, mouth ulcers, skin rashes and irritated eyes. * UC is treated to relieve symptoms and prevent them from returning using aminosalicylates, steroids and immunosuppressants. Mild flare-ups can be treated at home, but severe flare-ups need hospital treatment. If medicines are ineffective, surgery may be an option. * UC can lead to complications such as PSC, where the bile ducts of the liver become damaged, and there is an increased risk of bowel cancer. You’ll be screened for bowel cancer regularly from 10 years after diagnosis. * Living with IBD can be difficult at times due to disruptive and unpredictable flare-ups. Support is available from your care team and Crohn’s and Colitis UK. * I’d like to catch-up a month to review your symptoms and check your height and weight as UC can affect growth.

Answer 19

* Based on your child’s symptoms, we think he might have Crohn’s disease. Have you heard of this before? * CD is a long-term condition where parts of the digestive system become inflamed. It is an autoimmune condition, so the immune system attacks healthy tissue by mistake. CD usually starts in childhood or adolescence. * The symptoms you’ve been experiencing are likely a flare-up. Some people may go for weeks with mild symptoms or none at all, followed by flare-ups. * CD is treated to relieve symptoms and prevent them from returning using aminosalicylates, steroids and immunosuppressants. Mild flare-ups can be treated at home, but severe flare-ups need hospital treatment If medicines are ineffective, surgery may be an option. * CD can lead to an increased risk of bowel cancer. You’ll be screened for bowel cancer regularly from 10 years after diagnosis. * Support is available from your care team and Crohn’s and Colitis UK. * I’d like to catch-up a month to review your symptoms and check your height and weight as CD can affect growth.

Answer 20

* Based on your child’s symptoms, we think he might have coeliac disease. Have you heard of this before? * Coeliac disease is an autoimmune condition where your immune system attacks your own gut tissue when you eat gluten. This damages the gut, so you are unable to take in nutrients. It is not clear why this happens. * Gluten is found in 3 types of cereal- wheat, barley and rye. Foods containing these include pasta, cakes, most bread, certain sauces and breakfast cereals. * Coeliac disease can lead to complications such as malnutrition, problems getting pregnant, nerve damage and disorders of coordination. * There is no cure for coeliac disease, but a gluten-free diet should control symptoms and prevent complications. Even if your symptoms are mild, you should change your diet because continuing to eat gluten can lead to serious complications such as weak bones, anaemia and bowel cancer. A recent increase in the range of available gluten-free foods has made it possible to eat a healthy and varied gluten-free diet. * I’d like to catch-up to review your symptoms and do some blood tests in a month. In the meantime, here are some leaflets with information about gluten-free alternatives. You can also access Coeliac UK; this is a charity with helpful resources including diet information and local support groups. They also have a helpline which may be useful when you’re eating out.

Answer 21

* Our investigations have shown that your child has liver failure. This means that the liver has been damaged and not working as well as it should be. * We are worried about some of the complications associated with liver failure, which can be quite serious. However, we have medications that we can give to your child to treat these complications if they should arise. * Your child will have to stay in hospital where we can closely monitor them as necessary. Our top priority is supporting your child now, and this may be through giving medications to manage some of the complications and pain relief if required. Most children will also need a liver transplant to improve their quality of life. * Liver failure is a serious condition and can sometimes get worse very quickly. If you have any concerns, then you need to seek urgent medical attention and ideally be seen by a paediatric liver specialist. You can read more about liver failure and what will happen next on the Nationwide Childrens.org website.

Answer 22

* Constipation is common in childhood, particularly during potty training. It is usually caused by not eating enough fibre or drinking enough fluids or feeling pressured or anxious. Sometimes there’s no obvious reason. * Getting constipated and soiling is not something children do on purpose. It might be stressful for both of you but staying relaxed is best for helping your child. * First, we’d recommend some medication to dislodge the constipation. We can give some laxatives to help with this, but these may at first increase the tummy pain and soiling before the stool is able to pass. Then it’s important to continue the laxatives until soft regular stools are produced consistently. This might take several weeks. We can try different types of laxative but if none of them work, we might have to refer you to hospital for special treatment. * To prevent constipation, make sure your child has plenty of water to drink; we recommend 2L. Your child should also have plenty of fruit and vegetables for fibre. Get your child into the routine of regularly sitting on the potty or toiler after meals or before bed and praise them with a reward chart regardless of whether or not they pass stool. Make sure they can rest their feet flat on the floor or on a step to get in a good position. * Stay reassuring so that your child does not see the toilet as a stressful situation and learns that passing stool is a normal part of life. * I’d like to catch-up in a week to see how the symptoms are improving and whether we need to make any changes to the medication. * Safety net:

Answer 23

* Bed-wetting occurs because the volume of urine produced at night exceeds the capacity of the bladder to hold it, and the sensation of a full bladder does not wake the child. * Many children aged 5-7 take longer to achieve dryness at night. Bedwetting resolves as children get older because they develop an increased bladder capacity, and/or produce less urine at night, and/or learn to wake to the sensation of a full bladder. * Firstly, you should ensure your child has a balanced diet and adequate fluid intake and you should avoid giving them caffeinated drinks especially before bed. You can also use a positive reward system to encourage good behaviours such as using the toilet before bed. Avoid punishing or waking your child during wet night. If this doesn’t work, then the next treatment is the use of a bedwetting alarm which has a sensor to detect wetness and a noise box to produce wake your child up to go to the toilet. This is very good at establishing long term night dryness. If your child is going on a sleepover or school trip, a medication which stops them producing as much urine at night can be given on a short-term basis. * I’d like to catch up in 4 weeks to assess the response to treatment; if this is working then continue until 2 weeks uninterrupted night dryness achieved. If bedwetting recurs after this, please do get in contact with us again. * Safety net: If you notice your child is having painful urination or a change in odour of urine with a fever, then please come back sooner.

Answer 24

* We think your child has a urine infection or UTI – have you heard of that before? This can be very common in children and usually resolves completely with a course of antibiotics. * In some cases, the infection travels upwards causes a serious infection of the kidney. If your child has recurrent infections, it can cause scarring and permanent kidney damage so it’s important we treat infections before they get to that stage. * If < 3 months old or pyelonephritis in older child – we will urgently send you to the paediatricians in the hospital today who will admit your baby, take a urine sample and give your baby antibiotics through a drip. * If > 3 months old – we will do a urine dip today in the GP to see if there are markers for infection. Depending on these results we may send a urine sample to the lab and start some oral antibiotics or 7-10 days or 3 days if lower UTI. * We advise adequate fluid intake, drinking cranberry juice can help, paracetamol for pain. To avoid recurrence, encourage high fluid intake, regular toileting and encourage them to empty bladder a second time and ensure wiping from front to back. * Come back to the GP if the symptoms come back again- we may need to refer your child for some more tests to see why they’re getting numerous UTIs . * Safety-net: seek urgent medical attention if the child is still unwell after 24-48 hours of antibiotic treatment, symptoms worsen, or child becomes systemically unwell.

Answer 25

* Your child’s kidney function is decreasing, and we think they have an acute kidney injury – have you ever heard of that before? This means that something has caused the kidneys to suddenly stop working as well as they should. We think this was caused by dehydration/sepsis/medication/blockage/inflammation. * Kidney injury can range from minor loss of function to complete kidney failure. Without treatment, salt and chemicals can build up in the body as the kidneys are not producing enough urine. If the kidneys shut down completely, this may require temporary dialysis support. * The treatment we give depends on the cause of the kidney injury. Your child will need to be admitted so we can monitor his kidney function with blood tests as well as by weighing him and measuring how much urine he is making. We will stop any medications that can cause kidney injury, if he’s dehydrated, we will give him fluids through a drip. Unless your child is dehydrated, we will restrict fluid intake to avoid excess water retention – sometimes we can give medications to help with fluid overload. If a blockage is the cause, we may need to put in a catheter and the urologists will be called to assess your child. If the kidney function is really poor, we may have to start temporary dialysis where they remove waste products from the blood using a machine. * There is a risk of your child developing high blood pressure and long-term kidney damage after they recover from the acute kidney injury, so we will follow him up for 2 or 3 years to detect if this does occur.

Answer 26

* Your child has chronic kidney disease – have you heard of this before? This is a long-term condition where they kidneys don’t work as well as they should. In children, the cause of chronic kidney disease is usually due to repeated infections, polycystic kidneys or inflammation of the kidneys (glomerulonephritis). * Chronic kidney disease usually gets worse over time and sometimes may stop working completely. At that stage, your child would need dialysis or a kidney transplant. Your child is at risk of complications due to anaemia, bone disorders and electrolyte imbalances. * Your child may need an ultrasound scan of the kidneys to help us find the cause of the chronic kidney disease. Whilst there is no cure of chronic kidney disease, we have treatments to stop it from getting worse and prevent complications. The main treatment is to ensure a healthy lifestyle, your child may need calorie supplements and should continue to have protein in their diet. We can refer you to a paediatric dietician for further advice. They will need to maintain good hydration and may need salt supplements. They should reduce the amount of milk in their diet and we can give some vitamin supplements to prevent bone disease from occurring. Lastly, your child’s growth may slow down – we may prescribe growth hormone to support their growth and give another hormone called EPO to prevent anaemia. * If your child’s ankles start to swell, their skin becomes itchier or they start to lose weight, this may mean their kidney function is getting worse and will need to be reviewed by a doctor.

Answer 27

* You child has a kidney disease called glomerulonephritis – have you heard of this before? What this means is there is inflammation of the kidneys causing protein to leak out in the urine. The most common type in children is called minimal change disease and this usually resolves with treatment. * The kidneys are not working properly which can lead salt and water to build up in the body which can lead to high blood pressure and in some cases kidney failure. * Your child will need to take steroid medication every day for the next 6 weeks, then we will reduce the dose of the steroid and ask them to take it every other day for another 6 weeks. Limiting their fluid and salt intake until this kidney issue resolves will help to lower their blood pressure. Your child will be on steroids for a few weeks; we will give you a steroid card to show any health care professionals looking after them. The side-effects of short-term steroid therapy includes mood swings, weight gain, changes to blood sugar levels, thinning of the skin, longer wound healing, increased risk of infections. * Safety-net: if they develop a fever seek medical attention. Speak to your GP nurse before immunisations to avoid giving live vaccines whilst on the steroids.

Answer 28

* Usually towards the end of pregnancy, the baby’s testicles will gradually travel down from the abdomen into the scrotum. However, in some babies the testicles cannot be felt in the scrotum and we would say it is an undescended testicle. This may be because it is stuck in the canal or abdomen. This is quite common and affects up to 1 in 20 boys. * If we leave the testicles in the abdomen then they do not mature properly and there is a risk of future infertility (due to higher temperatures). There is also an increased risk of testicular cancer if it is not treated. * (Dependent on presentation) We will watch and wait/refer you to specialist services which will provide you more information on what happens next. This will usually involve a corrective operation under general anaesthetic. Your child can usually go home the same day. * Safety net: If you have any concerns or notice that the scrotum is red/inflamed or child generally unwell then go to A&E.

Answer 29

* Explain diagnosis: we think your child has iron deficiency anaemia – have you heard of this before? It means your child doesn’t have enough iron stored in their body which we all need in order for our red blood cells to carry enough oxygen around the body. * Explain risk: lack of iron can make you feel more tired, can make you more prone to infections, can make your hair and nails weaker and can cause your heart to have to work harder to pump enough oxygen and blood around the body. * Explain management: we recommend you increase the amount of iron in your diet by eating iron-rich foods such as dark-green vegetables like kale, meat, fish, fortified cereals and breads and dried fruits such as raisins, apricots and prunes. We can also prescribe an oral iron tablet to take twice a day. Continue taking the oral iron tablet until 3 months after the blood tests are back to normal to build up their iron stores. * We will recheck your child’s blood tests after 2-4 weeks of treatment to see if they are improving. Stools may become dark and black and you may feel constipated or nauseous. It is really important to continue taking the medication but do let us know as we can switch the type of tablet we give or can also prescribe some laxatives.

Answer 30

* Your baby has something called glucose-6-phosphate deficiency or G6PD – have you heard of this before? This means that your baby has low levels of an enzyme needed to protect red blood cells from damage. It is a genetic condition on the X chromosome which means that boys are more commonly affected. * Certain foods and medications can cause damage to your child’s red blood cells which cause them to be broken down and cause yellowing of the skin and eyes due to high levels of a substance called bilirubin which can affect the brain. * main treatment is to avoid the foods and substances that can trigger the damage to red blood cells. These triggers are fava beans, mothballs, henna, infections and certain drugs. We can provide you with a list of drugs that must be avoided such as aspirin, primaquine and certain types of antibiotics. It is also really important your child gets all their vaccinations on time to avoid getting infections. It is also really important your child takes folic acid supplements. If their skin does become yellow, we may need to give them light therapy and/or exchange blood transfusions for the levels of bilirubin to decrease. We can also offer you genetic screening to see what type of G6PD your child has as certain types may require us to remove your child’s spleen to avoid complications. * Safety-net: If you notice your child’s skin or eyes becoming yellow, dark urine or pale stools then go to A&E immediately.

Answer 31

* Your child has sickle cell disease – have you heard of this before? It is a genetic condition which causes red blood cells to change shape when there are low levels of oxygen. * Children with sickle cell disease can experience very painful crises when red blood cells get stuck. This can cause painful swollen hands/feet, tummy pain, blood clots in the brain causing strokes. Boys can get persistent painful erections. They can also get chest pain, difficulties breathing and are more vulnerable to infections. * If acute crisis: we will give your child some pain medication and oxygen and regularly monitor them. * If stroke/acute chest/priapism: they may need exchange blood transfusions. * To prevent acute crises: it is important your child takes daily penicillin antibiotics to prevent infections and that they get all their immunisations. There are some extra vaccines they should get including the annual flu vaccine and pneumococcal vaccine at 2 years repeated every 5 years. * They must also take daily folic acid supplements. It is important you minimise exposure to cold weather, stress and prevent excessive exercise. It is important they stay well hydrated with enough fluid intake. * Long term treatment will be managed by a paediatrician, specialist and the GP but it’s important that you and the school are also involved. * We can teach you how to assess the size of your child’s spleen and to recognise unusual pallor. * Specialists will review your child every 3-6 months. * Regular blood transfusions to avoid stroke (treatment to stop iron building up) * Hydroxycarbamide for recurrent painful crises. * Only cure is a stem cell transplant under age 17. * Psychological support * Any concerns over school attendance or development, make an appointment with GP. * Safety-net: seek urgent medical help if (fever, respiratory symptoms, signs of infection, unusual pallor, an enlarged/ing spleen, signs of stroke (weakness, tingling, or loss of speech), or painful crises and swollen hands/feet.

Answer 32

* Explain diagnosis: We think your child has a genetic condition called thalassaemia, have you heard of this before? It’s a genetic condition where the substance called haemoglobin in the blood is faulty which means it doesn’t carry enough oxygen in the blood. * Explain risks: Depending on the type and severity: may not get any or only mild symptoms of anaemia such as tiredness. If very severe: may need lifelong blood transfusions. * Explain management: Your baby will require regular blood transfusions so that they are not anaemic. This can cause a build-up of iron in the body so your child will also need some treatment to remove excess iron. Your child will need regular monitoring of growth and development. If we detect that they have a large spleen we may need to remove it. There is no cure for thalassaemia, and it can be passed on to subsequent children. We can refer you for genetic counselling to find out what type of thalassemia your child may inherit and to help you plan your future. * We will review your child in a month but you have concerns about your child’s growth then do seek medical advice.

Answer 33

* Your son has a bleeding disorder called haemophilia – have you ever heard of this before? This is a genetic condition which means a particular protein needed to stop bleeding is deficient which is why he has prolonged and deep bleeding. * This means your son is unable to stop bleeding in a suitable amount of time. This means he could suffer life-threatening blood loss. Recurrent bleeding into joints can cause joint disease. * Your son will need regular infusions of the clotting factor 8 or 9 to prevent prolonged and severe bleeding. We can teach you how to do this at home. If really severe prolonged bleeding into joints and muscles occurs, come to A&E where we can give him more treatment. Make sure you avoid giving him intramuscular injections or painkillers such as ibuprofen or aspirin – use paracetamol when he is in pain. * Safety-net: If severe and profuse bleeding occurs, go to A&E.

Answer 34

* We’ve run some tests and we’ve found that your child has a low platelet count – do you understand what this means? Platelets allow blood to clot – when there are low platelet levels profuse bleeding can occur. * The condition that has caused this low platelet level usually resolves spontaneously in children after 6-8 weeks. However, in the meantime if they sustain an injury that causes them to bleed, they may lose significant amounts of blood or may bleed internally – in their brain or gut. * As the platelet levels usually increase by themselves after 6-8 weeks, we usually don’t need to give children any treatment. However, if they have any major bleeding go to A&E as they may need some steroid treatments or platelet or antibody infusion. We will check the platelets levels in a week to see if they are increasing to a normal level. In the meantime, your child must avoid contact sports to prevent injuries taking place when their platelet levels are low. They should also avoid using aspirin and ibuprofen as these decrease platelet levels even more. * Safety-net: If your child has any severe injuries, take them to A&E as they will not be able to form blood clots so may lose significant amounts of blood. If you notice bruising, a rash that looks like small red dots, nosebleeds, blood in the urine or stools seek urgent medical attention.

Answer 35

* We’ve done a blood test, and this has shown that your child has acute lymphoblastic leukaemia – have you ever heard of this before? It can be difficult to find this out and we will support your child and your family through this. This diagnosis means that your child has a cancer of the white blood cells. * The bone marrow is where blood cells are made; it is making too many immature white cell blasts and not enough red blood cells or platelets which means that your child becomes anaemic, may have prolonged bleeding or bruising and is susceptible to infections. * We will do some more tests to find out which type of white blood cells are affected to tailor the treatment for your child. The mainstay of treatment is with chemotherapy which is usually need for an average of 2 years for girls or 3 years for boys. Regular monitoring will take place to see how the cancer is responding to the chemotherapy. Antibiotics and platelet infusions can be given if infections or major bleeding occurs. * Safety-net: If your child develops a fever or has significant bleeding, seek urgent medical attention by taking them to A&E.

Answer 36

* Hodgkin’s lymphoma is a cancer of cells in the lymphatic system (lymph glands and channels throughout the body). We do not know the exact cause, but we do know that it arises from abnormal cells. HL is not a genetic condition. * The prognosis for HL is generally very good for most people as it often responds very well to treatment and is one of the most curable forms of cancer. About 80-90% of people with the disease will have permanent remission. * Usually the treatment will involve chemotherapy and maybe radiotherapy. You will be looked after by a specialist team (oncology) who will be able to tell you more about the sort of chemotherapy you’ll receive. * Safety net: If you have any concerns or feel like you can’t manage at home, then seek medical attention. If you experience any complications from your chemotherapy (high fever, changes in sensation, feeling very unwell) then go to A&E. Follow-up with the specialist team.

Answer 37

* Your child has a condition called osteomyelitis – have you ever heard of this before? This means they have an infection of the bone which x-rays have shown is causing some damage to the bone. * Without treatment, a ball of pus may develop which could require surgery to drain it. The infection of the bone may also spread to the blood and cause sepsis. It may be very difficult to clear the infection and so your child may have chronic osteomyelitis. * Your child will be admitted to hospital so that we can give them antibiotics into a vein using a drip usually for 2-4 weeks. After this, your child may need to continue taking oral antibiotics at home. If the infection damages the bone or is not clearing, surgery may be necessary, it is really important that his leg is immobilised, and no weight is put on it for the time being. Once the infection clears, he may need physiotherapy to support his recovery. * It is important that your child finishes the complete course of antibiotics even if they are feeling better as any lasting bacteria may continue to infect the bone. * Safety net: if they complain of a hot, painful, swollen joint again, seek urgent medical attention.

Answer 38

* Your child has a condition called septic arthritis – have you heard of this before? This is a serious infection of their joint which is causing the swelling and pain and needs to be treated as soon as possible. * Without treatment, the infection could destroy the joint or could spread to the blood causing sepsis. * Your child will be admitted to the hospital. We will need to take a sample of the fluid in the joint to send to the lab. We will also give antibiotics directly into a vein through a drip – usually will have to stay in hospital for 2 weeks. We will drain the fluid in the joint as necessary. Your child will then be given oral antibiotics to take at home for 4 weeks. To start, your child won’t be able to move this joint but as they recover, we will start to mobilise it to prevent stiffness. * It is important that your child finishes the complete course of antibiotics even if they are feeling better as any lasting bacteria may continue to infect the joint. * Safety net: if they complain of a hot, painful, swollen joint again, seek urgent medical attention.

Answer 39

* Your child has Perthes’ disease – have you heard of this before? This is a condition where the top of the thigh bone, the femur, loses its blood supply and becomes damaged. This is shown on the x-rays we took. * Whilst the bone does gradually heal, it may not reform in the correct shape which can cause permanent hip joint damage and stiffness. There is an increased likelihood of developing arthritis earlier if there is lasting damage. * The younger a child gets Perthes’, the better the outcome. Depending on their age – may need mobilisation with physiotherapy and monitoring, splints, surgery to cut the bone for realignment, remodelling of the joint, joint replacement. * If your child has continued pain, limping or limb shortening, a reassessment with a specialist bone doctor is needed.

Answer 40

* Your child has a slipped upper femoral epiphysis – have you heard of this before? This is a condition where the growth plate which is at the top end of the thigh bone (femur) slips off the femur causing it to be dislocated. * There is a risk of the blood supply to the bone being compromised which can cause death of the bone. * The main treatment is surgery to stabilise the bone using screws. Sometimes we may also stabilise the other hip even if it is unaffected to prevent it from slipping too. After surgery, your child will need to rest and limit putting weight on their hip. They may need to use crutches and we can refer them for physiotherapy too. If your child is in pain do give simple painkillers. * Safety net: if the other hip is not also screwed, there is a risk of the epiphysis slipping on that side. If your child begins limping again then please seek urgent medical attention.

Answer 41

* We think your baby has developmental dysplasia of the hip – have you heard of this before? This is a problem with how the hip joint forms which causes hip joint dislocation. There is an increased likelihood of this happening if your baby was breech at 36 weeks, baby is over 4kg or there is a family history of hip problems at birth. * Without treatment, your baby may develop early arthritis of the hip joint, significant pain and difficulty moving. * We will be monitoring the hip using ultrasounds every month. The main treatment is to use a Pavlik harness which keeps the hip joint in the ideal position to heal. It is important that you don’t remove this harness even when changing your baby’s nappies or cleaning them. * We will review your baby at 6 months, if the hip is still dislocated, we may need to put a cast on the hip whilst under anaesthetic or perform surgery to fix the dislocation. If you have any concerns about your baby, discuss them with the health visitor or your GP who can advise you further.

Answer 42

* JIA is an autoimmune condition in which the body attacks its own joints and causes joint inflammation. We are not sure why some children develop this condition, but we do know that unfortunately it is a chronic condition (no cure). * There are some long-term complications, such as fractures and osteoporosis, which we would like to prevent with early treatment. * You will be referred to the specialist paediatric rheumatology services and the MDT will help you with mobilising and strengthening the muscles, understanding your condition, and give you some medications to help with your symptoms. * Safety net: If you experience any complications (fracture, uveitis, macrophage activation syndrome) then go to A&E. Follow-up with the specialist team.

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