Paediatric Update CoursePaediatric Update CourseBeardmore HotelBeardmore Hotel
2020thth and 21 and 21stst October 2014 October 2014
Dr David GilmoreDr David GilmoreRegent Gardens Medical CentreRegent Gardens Medical Centre
KirkintillochKirkintilloch
Beardmore HotelBeardmore Hotel No fire alarm tests plannedNo fire alarm tests planned Coffee will be served outside auditoriumCoffee will be served outside auditorium Lunch served in hotel restaurantLunch served in hotel restaurant
Course AimsCourse Aims Improved knowledge and understanding of Improved knowledge and understanding of
child developmentchild development Improved knowledge and understanding of Improved knowledge and understanding of
(some) common child health problems(some) common child health problems
Course FeedbackCourse Feedback / Admin/ Admin
Please fill in a feedback form afterwardsPlease fill in a feedback form afterwards
Please remember to sign in each dayPlease remember to sign in each day
Course FormatCourse Format Mostly short lecturesMostly short lectures Time at the end of each talk for questionsTime at the end of each talk for questions Tuesday morning smaller groups for videosTuesday morning smaller groups for videos
The RCGPThe RCGPGP Curriculum StatementsGP Curriculum Statements
3.04 Care of Children and Young People3.04 Care of Children and Young People– Most healthcare for children delivered outside Most healthcare for children delivered outside
hospitalhospital– 20% average GP list under 15 – 1 in 4 consults20% average GP list under 15 – 1 in 4 consults– Schoolchildren visit the GP 2 – 3 times / yearSchoolchildren visit the GP 2 – 3 times / year– Under fives visit on average 6 times / yearUnder fives visit on average 6 times / year
Child Health Surveillance Child Health Surveillance ProgrammeProgramme
In the past was done by child health doctors In the past was done by child health doctors based in health centresbased in health centres
1990 contract saw GPs doing checks1990 contract saw GPs doing checks
2004 2004 ““New ContractNew Contract”” now part of now part of ““Global Global SumSum””
Child Health Surveillance Child Health Surveillance ProgrammeProgramme
Previously checks done at 6 weeks, 9 Previously checks done at 6 weeks, 9 months and 3 ½ yearsmonths and 3 ½ years
Hall 4 Report in 2002 radically changed the Hall 4 Report in 2002 radically changed the programmeprogramme
Routine checks now only carried out by GPs Routine checks now only carried out by GPs at 6 weeksat 6 weeks
30 month review by Health Visitors recently 30 month review by Health Visitors recently introducedintroduced
The 6 Week CheckThe 6 Week Check
Common ProblemsCommon Problems
Undescended testesUndescended testes HydroceleHydrocele Inguinal HerniaInguinal Hernia Umbilical HerniaUmbilical Hernia Vomiting / gastro-oesophageal refluxVomiting / gastro-oesophageal reflux Cow’s milk allergyCow’s milk allergy
Undescended TestesUndescended Testes
Important to distinguish between retractile / Important to distinguish between retractile / ectopic / incompletely descended testesectopic / incompletely descended testes
5% of full term babies have one or both testes 5% of full term babies have one or both testes undescendedundescended
1.5% undescended at 3 months1.5% undescended at 3 months 0.3% at one year0.3% at one year Refer if testes not in scrotum at 6 monthsRefer if testes not in scrotum at 6 months Surgery usually carried out between 1 and 2 yearsSurgery usually carried out between 1 and 2 years
HydroceleHydrocele Enlarged scrotum notedEnlarged scrotum noted Often testes cannot be felt separatelyOften testes cannot be felt separately Transluminence may be observedTransluminence may be observed Most infant hydroceles resolve Most infant hydroceles resolve
spontaneouslyspontaneously Referral not indicated until age 15 monthsReferral not indicated until age 15 months
Inguinal herniaInguinal hernia
Usually reducibleUsually reducible May be associated with painMay be associated with pain Present in groin and scrotumPresent in groin and scrotum Refer for surgical repairRefer for surgical repair Refer urgently if under 6 months oldRefer urgently if under 6 months old
Umbilical HerniaUmbilical Hernia Incomplete closure of umbilical ring after Incomplete closure of umbilical ring after
birthbirth May enlarge when active or cryingMay enlarge when active or crying Most resolve within first 3 to 4 years of lifeMost resolve within first 3 to 4 years of life Referral not indicated until age 3Referral not indicated until age 3
Gastro-oesophageal RefluxGastro-oesophageal Reflux Seems to be increasingly commonSeems to be increasingly common ? Related to changes in formula milks? Related to changes in formula milks Distress and regurgitation of milk after Distress and regurgitation of milk after
feeding or lying downfeeding or lying down Try Infant GavisconTry Infant Gaviscon Consider ranitidineConsider ranitidine Consider milk allergyConsider milk allergy
Reflux TreatmentReflux Treatment
Infant Gaviscon : one dose each feedInfant Gaviscon : one dose each feed– Half sachet below 4.5 kgHalf sachet below 4.5 kg– Dual sachet above 4.5 kgDual sachet above 4.5 kg
Ranitidine 1 – 3 mg/kg twice daily (15mg/ml)Ranitidine 1 – 3 mg/kg twice daily (15mg/ml)
Cow’s Milk AllergyCow’s Milk Allergy
Affects 2 – 7% of children under 1 yearAffects 2 – 7% of children under 1 year Second commonest childhood food allergySecond commonest childhood food allergy Less common in older children and adultsLess common in older children and adults
PresentationPresentation
IgE mediatedIgE mediated– Within 2 hours (usually within 20 minutes)Within 2 hours (usually within 20 minutes)– Angioedema / urticaria / rhinorrhoeaAngioedema / urticaria / rhinorrhoea– Vomiting / abdo pain / diarrhoeaVomiting / abdo pain / diarrhoea
Non-IgE mediatedNon-IgE mediated– More non-specific symptomsMore non-specific symptoms– Reflux / crying / diarrhoea / constipation / eczemaReflux / crying / diarrhoea / constipation / eczema– More difficult to diagnoseMore difficult to diagnose
Investigation / DiagnosisInvestigation / Diagnosis
Skin prick testingSkin prick testing Elimination dietElimination diet
ManagementManagement
Hypoallergenic formulasHypoallergenic formulas– Extensively hydrolysed formulasExtensively hydrolysed formulas
Nutramigen LIPIL 1 / 2Nutramigen LIPIL 1 / 2 Aptamil Pepti 1 / 2Aptamil Pepti 1 / 2
– Amino acid formulasAmino acid formulas Nutramigen AA LIPILNutramigen AA LIPIL Neocate LCPNeocate LCP
Yorkhill Paediatrics for Primary Care Yorkhill Paediatrics for Primary Care HandbookHandbook
http://www.clinicalguidelines.scot.nhs.uk/http://www.clinicalguidelines.scot.nhs.uk/Primary%20Care%20Handbook%20withPrimary%20Care%20Handbook%20with%20Updates%20nov04.pdf%20Updates%20nov04.pdf