Role Of The Pharmacist In Infant Care (1.6) Flashcards
(24 cards)
What is Colic? At what times does it occur in the day and during a babys life? Is it a normal part of a childs development?
Describes episodes of uncontrollable, extended crying in an healthy, thriving baby
- most commonly in the late afternoon and evening and can last for hours
- Most common in young babies (2wks to 4 months old) – peaks at 6-8 weeks
- Yes, its a normal part of a child development
- Equally likely in bottle or breastfed babies
What are some of the signs/symptoms of colic?
- crying for long periods of time = 20-30%: cry>3hrs/day for >3days/week
- drawing up of legs, clenched fists, red face
- may have wind, may refuse to feed or are fussy about feeding
- difficult to settle to sleep and stay asleep :generally unsettled
- Little evidence to say it is related to gut issues
Reassurance is key, as well as strategies to cope
What are some common worries to rule out for colic?
- Hunger?
> early days – feed on demand
>Issue with breast feeding (refer)
>Decreased number of soiled nappies, decreased weight
- Too Hot or Cold?
>Dressing guides
- Soiled Nappy? – uncomfortable, nappy rash?
- Sick? – refer or treat
- Tired? – look at guides for how long babies should be awake for (baby routine books e.g. contented little baby)
- Reflux? – often confused with colic
> 2/3rds of children (Doesn’t mean its GORD, just GOR)
> Normal amount or projectile (may need to investigate)
- Food intolerance? cow’s milk (CMA), lactose intolerant (LI) or an allergy (mum’s diet?)
- Teething - some experts don’t believe it exists
What are some of the ways to manage colic
- Reassurance and empathy to parents. Plan for it to occur!
- GP for diagnosis: e.g. GORD, CMA, LI, UTI, Otitis media, not gaining weight, never happy
- SLEEP/FEED/CRY Diary (sleep, feed, play = best routine) –> establish a feeding and settling routine
- Formula: change warranted ONLY if proven CMA or LI
- B/Fed: diarise mother’s diet, try posture feeding ( ↓fast flow)
- Baby massage, warm bath, rocking, patting, baby sling
- Minimise wind
- Pacifier / Dummy – controversial but comforting and protection against SIDS
What are some medications to give a child that has colic? Are they proven to work?
Simethicone
- Surfactant, coalesces bubbles
- Administer to mouth or bottle
Gripe Water
- herbal ingredients
- alcohol- free now, efficacy?
Homeopathic Formulations: Chamomile
None of these treatments are proven
What is wind? how to manage it?
Swallowing of excess air during feeding
Management
- Find root cause (guzzler, quick flow breast (change position of feeding), change teat size if bottle fed)
- Burp baby well
- Infacol drops (simethicone)
What is reflux? What is the common age group when babies get it? When to refer?
- food is swallowed into the stomach, but then regurgitates back into the oesophagus
- 1st 12 months whilst muscular valve develops
Refer:
- Baby cries excessively after feeds/pain
- Weight gain is affected
- Excessive coughing after feeds
What are some management tips for reflux
- small regular feeds
- keep baby upright 30mins after feeds
- angle bed/cot
- thicken feeds (Guarcol®)
- Infant Gaviscon®
- if formula fed use AR (thickened formula)
- Consider mothers diet (diary)
- Refer (ranitidine, omeprazole)
what are some management tips for vomiting and diarrhoea?
- Rehydration is key (infants continue to breast/bottle feed, offer water)
- If eating solids offer frequent small meals (bread, crackers etc.) and gradually re-introduce foods when feeling better. No need to exclude dairy from diet.
- Treat fever if present. Monitor child for signs of dehydration - # of wet nappies, urine dark and strong smelling
- Refer if showing dehydration or if persists > 24hrs
- Hygiene reminder (kids have poor hygiene)
A) What is normal for babies in terms of pooping when they are breastefeeding or taking a formula?
B) What are some of the symptoms that a child may have during constipation?
C) When does constipation usually occur?
D) Treatment options
A)
- Breast-fed infants may poo after each feed or only poo every 7-10 days
- Bottle-fed infants and older children usually poo every 2 days (but this can vary)
B)
- child may experience pain, abdominal pain, irritability and reduced appetite
C)
- Very common when solids are introduced into the diet
- If formula-fed or >6mths –> supplement feeds with water
- If breast-fed offer more frequent feeds
D)
- Coloxyl® drops, prune juice, pears, glycerol suppositories (avoid certain foods)
When to introduce solids into the baby’s diet? What are some of the signs that a baby will give that it wants solids?
- No earlier than 4 months. Ideally at/by 6 months
- interested, lost tongue-thrust reflex, hungrier, neck/back control
- Milk is primary source of food <12mths
- First foods should be smooth, lump free and similar thickness to custard
- Their eating skills will quickly develop and they can then progress to mashed, minced or finely shredded foods
- Allergies usually appear with 30 minutes of ingestion
What is nappy rash?
It is a form of irritant contact dermatitis
- Skin barrier breakdown from prolonged contact with moisture and ammonia from urine and faeces breakdown
- Burn-like red in nappy area only (c/f eczema, seb derm), not in folds .
- (NB Weepy, crusty, pustules= bacterial inf.)
- Treatment for nappy rash? When to refer?
- New barrier required: Thick, water repellent, apply each change
- Effective nappy cream will be there at next nappy change
- Disposable nappies best (absorbency): change frequently
- Nappy free time: nappy area can breathe and dry
- Hydrocortisone: very inflamed. Short term use only, sparingly
Refer
- broken skin, infection signs, other body areas, or if persists or worsens
What is fungal nappy rash
- As per nappy rash, plus Candidal infection (moisture, warmth)
- Bright red in nappy area
- may be shiny –> in folds
- border –> satellite lesions
Treatment for fungal nappy rash?
(referral same as nappy rash)
- Antifungal Cream/Ointment plus Nappy Cream
- Hydrocortisone: if very inflamed. Short term use only, sparingly, cease once inflammation ↓↓
- Nappy Cream plus antifungal
- Antifungal plus hydrocortisone
- Antifungal plus anti-inflammatory
What are some other rashes that occur?
- Viral –> usually start of stomach/back and other warmer areas. Consider other symptoms, immunisation status, daycare contact etc, does it blanch?
- Heat –> Harmless, common in summer, small red dots/bumps. Check no other symptoms
- Skin folds –> moist red rashes when not dried properly in creases/lack of movement
- Milk –> Acne appearance on face at ~6 weeks. No treatment required
- Food –> Allergies, contact dermatitis (tomato, strawberry)
What is cradle cap? What are some potential treatments? When to refer?
- A form of seborrhoeic dermatitis that affects baby’s scalp
- Appears as thick, yellow crusts or scales and flakes on the scalp.
- Doesnt cause pain/discomfort
Treatment
- loosen or soften crusts by massaging with olive oil or mineral oil (baby oil)
- Can use salicylic acid product (Egozite®) or olive oil
- Brush with soft baby brush
Refer
- If symptoms persist for >3 mths +/- is very itchy
- spreads to face and body may be eczema
When does teething start? What are some of the symptoms? What are some treatment options?
Occurs most commonly at 6-8 months of age (can start at 3mo – 3years)
Symptoms
- Drooling/ dribbling
- Chewing/gnawing
- Unsettled, change in sleeping pattern
- Gum redness/eruptions
- May + nappy rash, ?? Fever, ?? Runny Nose
Treatment
- Cooling/teething rings/flannel in freezer/rusks
- Gels: short acting
- Oral analgesics: night-time relief
What temperatures do fevers occur? Why do fevers occur? What to do to treat a fever? When to refer?
- Fever is when body temp > 38oC (consensus)
- Natural response to infection (sometimes don’t mess with it –> e.g. chicken pox)
- if child is happy and well, do not treat
- child is unhappy/unwell - can treat with paracetamol or Ibuprofen ( DO not give ibrupofen to someone who has chicken pox)
- Comfort child with fluids, rest, dress in light clothing
- Paracetamol OR Ibuprofen (>3m)
Refer to DR
- fever >40o
- child is under 3 mths (fever in <1 mo can be serious)
- paracetamol given for 2 days with no improvement
What are febrile convulsions? What ages do the y occur in? How long do they usually last for? How to prevent them?
- Seizures caused by fever due to a sudden change in the child’s body temperature
- Occurs in 1 in 20 children usually between ages of 6mths to 6 years
- Can last for a few minutes to usually up to 15 minutes (if a seizure last more than 5 minutes –> call an ambulance)
- reassure parent to stay calm and ensure the child is taken to see a doctor immediately after the seizure
- Paracetamol and Ibuprofen have not been shown to prevent seizures
Key tips to adminstering meds to babies
- Always calculate dose by weight:( 6 month old baby girl on average can vary between 5.7kg-9kg, 2 yr olds girl varies 10-15kg)
- Syringe, measuring cup (Not spoon)
- Diluting with juice, hiding in food. Caution!!
- Issues with vomiting after admin of med (consider time <30 mins, look at vomit)
- Ear/Eye drops – wrap up in towel first
Where to find immunisations schedule?
• http://www.immunise.health.gov.au
What are some common adverse effects and what are some serious reactions?
- Usually mild and temporary
- Usually in the first few days after vaccination (some exceptions)
- Specific treatment is not usually required
- If unexpected, persistent and/or severe – advise to see doctor asap or go directly to a hospital – report to the Therapeutic Goods Administration (TGA)
Serious Reactions
- Anaphylaxis – completely reversible if treated quickly
- Febrile convulsion
- bowel blockage (intussusception) – this occurs in the seven days following the first and second dose of rotavirus vaccine; rare 1 in 17,000 babies
What does strive for five refer to?
5 degrees Celsius (°C) –midway between 2-8°C which is T°C range recommended for vaccine storage
Vaccines are delicate biological substances that can become less effective or destroyed if they are either:
- frozen
- allowed to get too warm
- exposed to direct sunlight or UV light, including fluorescent light.
