paeds Flashcards
(38 cards)
common cause of cough in infants
viral
structural airway
tracheo-oesophageal fistula
vascular rings
common cause of cough in toddlers
viral
FB
viral induced wheeze
common cause of cough in older kids
viral
asthma (if wheeze or dyspnoea)
chronic rhinitis
common cause cough adolescents
viral
asthma (wheeze and/or dyspnoea)
psychogenic
paediatric cough red flags
sudden onset without prodrome ?FB
associated with feeds
poor growth
loss of muscle bulk and subcut fat
abnormal cardiac exam
clubbing
differential air entry
causes of cough for >4weeks
Normal if well
pertussis (paroxysmal)
asthma
FB
sinusitis
supperative lung disease
pertissus greatest risk to
kids under 6 months
infectious period of pertusis
just prior to cough developing and for next 21 days if untreated
history of pertusis
cough and coryza 1 week (catarrhal)
cough in spells (paroxysmal)
convalescent stage (months)
pertussis incubation period
days 4-21
pertussis investigations
aboratory confirmation is not necessary for diagnosis, but may be helpful for infection control
A nasopharyngeal aspirate/swab for PCR is the investigation of choice. The test is usually negative after 21 days, or 5-7 days after effective antibiotic therapy has been commenced
Pertussis serology (IgA) may be detectable 2 weeks after the onset of the illness but rarely affects clinical management
pertussis treatment considered if?
Consider antibiotics if:
Diagnosed in catarrhal or early paroxysmal phase (may reduce severity)
Cough for less than 14 days (may reduce spread; reduces school exclusion period)
Admitted to hospital
Complications (pneumonia, cyanosis, apnoea)
Pertussis antibiotics:
Neonates:
Azithromycin 10 mg/kg oral daily for 5 days
Children who cannot swallow tablets:
Clarithromycin liquid 7.5 mg/kg/dose (max 500 mg) oral BD for 7 days
Children who can swallow tablets:
Azithromycin (for children = 6 months old): 10 mg/kg (max 500 mg) oral on day 1, then 5 mg/kg (max 250 mg) daily for 4 days
If macrolides are contraindicated:
Trimethoprim-sulphamethoxazole (8-40 mg per mL)
0.5 mL/kg (max 20 mL) BD for 7 days
infection control with pertussis
Exclude from school and presence of others outside the home (especially infants and young children) until received 5 days of therapy, or coughing for more than 21 days
will pertussis infection preclude vaccination
no, infected kids still need to complete schedule
is prophylaxis indicated in pertussis close contacts?
yes, if:
- contact with case while infections
AND
- first contact within 14 days (or 21 if under 6m)
AND
- age <6m OR
- incomplete vaccination
- member of house <6m
- attend childcare in same room as infants
criteria for adult pertussis prophylaxis
Expectant parents in last month of pregnancy OR
Health care worker in maternity hospital or newborn nursery OR
Childcare worker in close contact with infants <6 months OR
Household member aged <6 months
definition protracted bacterial bronchitis
wet cough daily for >4 weeks
no other alt cause
responds to ABX
common demographic for protracted bacterial bronchitis
ATSI kids
diagnosis of protracted bacterial bronchitis
sputum MCS if able to expectoate (age >7 yrs)
likely + haemophilus influenzae
most common cause of limping in kids
transient synovitis
acute myositis
minor trauma
severe localised joint pain and fever =
septic arthritis
red flags in the limping child
- duration >7days
- severe localised pain
- change to urine or bowels
-complete inability to weight bear - nocturnal pain symptoms
- constitutional symptoms
- generalised wasting
- fever
- petichae/purpura (HSP/malig/haem)
common differentials of limping a 0-4 years of age
transient hip synovitis
acure myositis
toddlers fracture
developmental hip dysplasia
