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Flashcards in RTS - Paediatric Health Deck (46)
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what is oral thrush?

mild fungal infection affecting the mouth and throat - Candida albicans.
White patches in mouth that don't wipe off,
red sore mouth and discomfort when eating, and drooling


oral thrush treatments &directions

antifungals- Miconadazole - daktarin (brand) - oral gel, P med, for babies aged 4 months or above
Apply with a clean finger or cotton wool bud 2-4 times daily
Continue treatment for 7 days after the symptoms clear


lifestyle advice for oral thrush

To avoid re infection - sterilise bottles, feeding equipment, sterilise toys they put in mouth
- wash hands thoroughly after changing nappy
- advice to new parents- sometimes it clears up by itself and may not need treatment - it is a MILD infection
- Are they asthmatic? if so check inhaler technique


what is pyrexia / fever?

raised body temperature above the normal range of 36.5 - 37.5
Can be due to post immunisation, RTI or UTI infection, chicken pox
- Excess sweating, chills, headache


how is body temperature measured?

thermometer under armpit, tongue, ear


what are the red flag referral signs for pyrexia?

temperature of >38 if under 3 months, or >39 if 2-6 months
persistent vomiting
signs of meningitis/sepsis/pneumonia
treatment failure
fever >5 days
refusal to feed


treatment for pyrexia

- drink cool clear fluids, fruit juices, if breastfed continue as normal
- Keep cool 18 degrees and use light blanket and gage the environment they are in
- Antipyretics - para and Ibu
- Monitor temperature regularly
- No cold flannel
- Look out for warning signs


what are febrile convulsions?

seizures in young children when they have a fever.
Ranges from 6 months -6 years
Simple febrile - rapid rise int empire lasting <5 mins - If known and <5 mins. - GP
Complex febrile - last >15 mins and recur - 999 (and if its the first time)


treatments for pain in children? and referral points

Ibuprofen - only licensed NSAID for children - >3 months OTC. (caution in asthmatic)
Paracetamol - >2 months
Can use combination, do not use aspirin

REFER: if severe, recurring, treatment failed and if they are abnormally drowsy, loss of consciousness, hard to breath


What is teething?

new tooth breaking through the gums - 3 months to 3 years (typically 6 months old).
Swollen gums, red cheeks, dribbling, fever, tendency to chew, irritable


Treatments for teething

1. analgesics
2. Topical gels e.g Bonjela (the children one NOT adult)
3. Homeopathic that target immune system- not in prescription but an option


why can't the adult version of bonjela gel be used in teething?

The oral choline salicylate it contraindicated in the adults - it contains salicylate which lead to Reyes syndrome in children. (same as aspirin)


Lifestyle advice for teething

- teething rings (some can be cooled)
- Raw fruit and veg to Chew IF they have started weaning
- Hardened bread but not sugary rusks
- cool sugar free drinks
-Keep them occupied
- Wipe chin and face often to ensure they don't get a teething rash


what Is infant colic?

intense periods of crying lasting hours.
Baby may pull up or stiffen legs
Usually starts 2-4 weeks old
CAUSES: maybe problems with digestion, intolerance to lactose, trapped wind


treatment for colic

1. gripe water mixtures - of dill, caraway, fennel & ginger
antacids (e.g sodium carbonate), must be alcohol free

2. colic drops - simeticone (infacol), and Dimeticone (dentinox - disperses trapped wind)

3. Enzyme lactase - colief - breaks down lactose


lifestyle advice for colic

- sit baby upright when feeding
- Check the size of the teat on bottle - shouldn't be too big as air will get in (if bottle fed)
- hold the bottle so the teat is full of milk so avoids sucking air in
- Burp them during and after feed
- Baby massage


Referral symptoms for colic?

weak, high pitched continuous cry for several hours
breathing issues
vomiting green fluid
Not feeding
treatment failure


What is nappy rash?

inflammation of the skin in the nappy area - red and raw and white or red pimples which spread out to the folds of the skin
- Sore an itchy when area is wiped and baby unsettled

CAUSES: reaction of skin to urine and faeces mainly. but could be due to - eczema, psoriasis, fungal infections, allergies


treatments for nappy rash

1. Barrier creams - Dimethicone & white soft paraffin,
or - titanium dioxide/peroxide, titanium salicylate, - Brand = metanium ointment

2. Antiseptics - cetirimide
3. Astringents - zinc oxide e.g sudocrem
4. antifungals - clotrimazole cream - canister 1% cream if fungal is suspected or other treatments failed


what warning should be given when using barrier creams (white soft paraffin) for nappy rash?

White soft paraffin is flammable


lifestyle advice for nappy rash

- change nappy frequently
- clean bum with warm water and cotton wool not wipes
- Dry area thoroughly
- leave nappy off for as long aspossible
- avoid talcum powder
- drink plenty of fluids
- dress them in loose fitting bottoms


what is threadworm?

happens in children >2 years.
White threadlike worms in the stool, itchy bottom
easily spread


treatments for threadworm

MEBENDAZOLE - Ovex brand.
Tablet or suspension - from 2 years OTC.
- Single dose, repeat after 2 weeks if infection persists
- treat the WHOLE family (except preg/BF)
Must also use strict hygiene measures.


lifestyle advice for threadworm

Keep nails short and clean
- Careful washing & scrubbing of hands and nails after toilet and before eating
- wash bed linen daily
- Shower first thing in morning
- Wear underwear or mittens to stop scratching
- dust damp surfaces, vacuum daily
- discourage nail biting, finger sucking


referral points for threadworm

<2 years
signs of secondary bacterial infection
doubts about diagnosis
fever, bedwetting, discharge
vomiting, dioarrhoea, weight loss
recent travel abroad


What is constipation?

difficulty or strain passing stools, pass less often than normal and stools are hard, large and pellet like

Also have tummy ache, poor appetite, irritability, restlessness, nausea

(a) idiopathic - common and can be due to anything, diet, stool holding, emotions, random

(b) underlying disease - uncommon, e.g could be due to hypothyroidism, CF, side effects of medication


treatments for constipation children

1. lactulose - osmotic laxative, stool softeners - 1 year (MACROGOLS)

2. Ispaghula husk - bulk forming laxative >6 years old

3. Senna syrup >12 years, Macrogols (POM)

4. Glycerin suppositories - Lubricant and irritant, osmotic laxative
- 1g <12 years
- 2 g >12 years

continue treatment at the maintenance dose for several weeks after regular habit is established


lifestyle advice for constipation

increase fluid and fibre intake (fruit, veg, bran)
Change milk if there is a possible intolerant to cows milk protein
encourage to go toilet regularly


referral for constipation

severe abdominal pain
rectal bleeding or blood stain stool
severe pain on defacation
persistence despite treatments


Nausea and vomiting, and treatments

Vomiting episodes caused by e.g gastroenteritis, respiratory condition, feeding, meningitis, emotion

Treatment - oral rehydration - boiled and cooled drinking water, and correct volume dilution
regular sipping
if don't use - throw away after an hour, but if keep in fridge - throw after 24 hours