Download The sick child and common presentations

Recognising the sick
child and common
paediatric presentations
Natasha Hawkins
GP
Learning objectives
 Recognising sepsis, traffic light
system and cases
 UTI in children.
 CMPI and lactose intolerance.
 Nocturnal enuresis.
Spotting sepsis in the sick
child
 Re-ACT Talks: Spotting Sepsis in the Sick Child (3 min
video) NHS England.
 Red Flags (The Sepsis Trust leaflet)
 Traffic Light system refresher.
IF YOUR CHILD HAS:
AMBER
symptoms
www.sepsistrust.org
www.sepsistrust.org
This information is derived,
with permission, from the
SAM leaflet produced by
NHS England (South West)
to improve recognition of sepsis
in children. Contributors include
paediatricians, sepsis experts,
nurses, GPs and parents of children
who’ve had sepsis.
Spotting sepsis
in children
The UK Sepsis Trust
is here to support you.
ASK FOR
MEDICAL ADVICE
www.sepsistrust.org
Protect your child’s health.
Think sepsis.
RED
symptoms
GET YOUR CHILD TO
HOSPITAL QUICKLY
Dial 999 for an ambulance
if necessary
This information relates to the law and procedures
in England and Wales. All information included within
this booklet is correct at time of print, June 20 16.
The UK Sepsis Trust registered charity number
(England & Wales) 1158843.
Company registration number 8644039.
Sepsis Enterprise company number 9583335.
VAT reg number 225570222.
Kind thanks to 11-London for the design of
this leaflet – we hope you found it helpful.
Photography by AminArt. www .aminart.co.uk
Red Flags
 Temperature.
 Breathing.
 Skin, lips, tongue
 Eating and drinking
 Nappies
 Activity.
 See Handout.
Traffic Light Sytem
Common viral illnesses
 Duration of symptoms of RTI in children-resolution of symptoms Acute Otitis Media: 50% by day 3, 90% by day 7-8
 Common cold: 50% by day 7-8, 80% by day 14.
 Cough: 50% by day 10, 90% by day 25.
 Croup: 50% by day 1, 80% by day 2
 Bronchiolitis: 50% by day 13, 90% by day 21.
BMJ 2013: 347:f7027
Case 1
 5 month old
 2/7 history of runny nose, snuffly, noisy breathing
 ‘Think she’s got a chest infection’
 What do you want to know?
 What would be your diagnosis and management?
Bronchiolitis

Affects 1 in 3 children by the age of 1.

Infectious disease of the lower respiratory tract. Usually viral (RSV)

Most commonly 3-6 months.

Fever >39 is unusual (consider bacterial)

NICE recommend safety netting information for parents to take away. Particularly
as may get worse before get better.

-(Patient.co.uk, NHS choices)
When to refer
 Poor feeding (<50% usual intake over the
previous 24 hours) which is inadequate to
maintain hydration
 Lethargy
 History of apnoea
 Signs of respiratory distress
 Sats <94%
 Where home care or rapid review cannot be
assured
Case 2
 3 year old with noisy breathing last 2 days.
 Snuffly, well in herself
 ‘Thinks has a chest infection’
 What do you want to know?
 What is your diagnosis
and management?
Viral Induced wheeze
 Wheeze- high pitched whistling sound usually on expiration.
 6months-5 years.
 Viral wheeze is a similar but different condition from asthma, but some
children will go onto develop asthma as they get older.
Children with asthma can get wheezy even when they do not have a
cough or cold. Children with asthma are often wheezy when they do lots
of exercise. Children with asthma usually have a family history of asthma
and allergy.
If none of these apply to your child it is unlikely they will go on to develop
asthma.
 Only recommend treatment in acute episode. 2-10 puffs up to 4 hourly.
Managing wheeze in preschool children
BMJ 2014; 348
 Summary points
 Preschool wheeze should be divided into “episodic viral” and
“multiple trigger” according to the history, and these categories,
which can change over time, should be used to guide treatment
 No treatment has been shown to prevent progression of preschool
wheeze to school age asthma, so treatment is driven solely by
current symptoms
 In all but the most severe cases, episodic symptoms should be
treated with episodic treatment
 Prednisolone is not indicated in preschool children with attacks of
wheeze who are well enough to remain at home.
Viral Induced Wheeze
Case 3
 4 year old not quite himself last 2 days.
 Fever 37.8
 No cough or coryza
 What do you want to know?
 What is your diagnosis and management?
UTI in children

NICE recommends that all children without a focus of infection should have a urine
sample tested within 24 hours. (A potty washed in hot water with washing up liquid
is a good way to get a clean catch).

Advise to be vigilant for future infections…............

If <6 months follow up USS within 6 weeks of treated infection or USS at time if
complicated/atypical.

6months-3 years- only require imaging/referral if an atypical UTI or recurrent UTI

>3 years- USS during infection if atypical. Non-urgent USS and DMSA if recurrent
UTI.

Non-E.Coli UTI is classed as an atypical UTI>>>>> needs f/u

Recurrent - 2 UTI if complicated, 3 if uncomplicated.
Cow’s milk protein allergy
Cows' milk allergy (CMA), is one of the most common childhood food allergies. It
is estimated to affect between 2% and 7.5% of babies under one, though most
children grow out of it by the age of five.
 CMA typically develops when cows' milk is first introduced into your baby's
diet either in formula or when your baby starts eating solids.
 More rarely, it can affect babies who are exclusively breastfed because of
cows' milk from the mother's diet passing to the baby through breast milk.
 There are two main types of CMA:
 Immediate CMA – where symptoms typically begin within minutes of having
cows' milk
 Delayed CMA – where symptoms typically begin several hours, or even days,
after having cows' milk
Dorset Guidelines
Lactose Intolerance
Lactose intolerance is another type of reaction to milk, when the body can't digest lactose, a
natural sugar found in milk. However, this is not an allergy.
Lactose intolerance can be temporary – for example, it can come on for a few days or weeks
after a tummy bug.
Symptoms of lactose intolerance include:

diarrhoea

vomiting

stomach rumbling and pains

Wind

Treatment depends on the extent of intolerance. Some children with lactose intolerance
may be able to have small amounts of dairy products without having symptoms.
Nocturnal enuresis
 Up to the age of five, wetting the bed is normal. It
usually stops happening as your child gets
older without the need for any treatment.
 up to 1 in 5 five-year-olds wet the bed
 1 in 20 10-year-olds wet the bed
 about 1 in 50 teenagers wet the bed
 Need investigation if daytime.
 MSU to exclude infection only if started recently.
 Try to prevent anger/blame towards child.
 www.eric.org.uk
 Alarm is 1st line treatment (can be purchased from eric
shop)
Any Questions?