Importance of Red Reflex Assessment in Diagnosing Retinoblastoma

In cases where a patient presents with loss of the red reflex, it is crucial to rule out the development of a retinoblastoma. This is because retinoblastoma is the most common intraocular malignancy of childhood, and delay in diagnosis can have negative prognostic implications. Therefore, urgent referral to an ophthalmologist is necessary.

Diagnosis of retinoblastoma is typically confirmed through indirect dilated ophthalmoscopy under anaesthetic. Referral to a community optician or non-urgent referral to an ophthalmologist can result in significant delays in diagnosis, making both options inappropriate. While referral to an optician may seem like a viable option, testing the red reflex is a quick and easy procedure that a GP can perform themselves.

Re-examining the patient in six weeks is not a suitable course of action as it will only delay diagnosis. In situations where loss of the red reflex is present, reassurance is not appropriate, and urgent referral for further assessment is necessary. Therefore, it is essential to prioritize red reflex assessment in diagnosing retinoblastoma.

Childhood disintegration disorder

The recurrence rate of Down’s syndrome is typically 1 in 100.

Down’s Syndrome: Epidemiology and Genetics

Down’s syndrome is a genetic disorder that is caused by the presence of an extra copy of chromosome 21. The risk of having a child with Down’s syndrome increases with maternal age, with a 1 in 1,500 chance at age 20 and a 1 in 50 or greater chance at age 45. This can be remembered by dividing the denominator by 3 for every extra 5 years of age starting at 1/1,000 at age 30.

There are three main types of Down’s syndrome: nondisjunction, Robertsonian translocation, and mosaicism. Nondisjunction accounts for 94% of cases and occurs when the chromosomes fail to separate properly during cell division. Robertsonian translocation, which usually involves chromosome 14, accounts for 5% of cases and occurs when a piece of chromosome 21 attaches to another chromosome. Mosaicism, which accounts for 1% of cases, occurs when there are two genetically different populations of cells in the body.

The risk of recurrence for Down’s syndrome varies depending on the type of genetic abnormality. If the trisomy 21 is a result of nondisjunction, the chance of having another child with Down’s syndrome is approximately 1 in 100 if the mother is less than 35 years old. If the trisomy 21 is a result of Robertsonian translocation, the risk is much higher, with a 10-15% chance if the mother is a carrier and a 2.5% chance if the father is a carrier.

Common Elbow Injuries in Children and Adults

Radial head subluxation is a frequent injury in children under the age of 6 years. The rounded end of the radial head is still made of cartilage and can easily slip out of the encircling annular ligament when the arm is pulled. There is usually no history of trauma, but there may be a history of axial traction by a pull on the hand or wrist. Tenderness at the head of the radius may be present. Imaging is only necessary when a fracture is suspected. Manipulation can be done in the GP surgery by immobilizing the elbow with one hand and with the other hand applying axial compression while supinating the forearm and flexing the elbow. Alternatively, it can be done while pronating the forearm. A click indicates success.

Supracondylar fracture of the humerus is most commonly seen in children and usually results from a fall on to an outstretched arm. The patient usually has elbow swelling and pain.

Lateral epicondylitis (tennis elbow) is a chronic condition that peaks between 40 and 50 years of age. It is thought to be an overload tendon injury.

Radial neck fracture occurs due to trauma such as a fall onto the outstretched arm. The median age is 9–10 years. There is pain, swelling, and tenderness over the lateral side of the elbow.

In cases of suspected non-accidental injury, the explanation should be consistent with the injury, and in the absence of other features, non-accidental injury is unlikely.

Admission is recommended for patients with croup who exhibit audible stridor at rest. For further information, please refer to the guidelines provided by Clinical Knowledge Summaries.

Croup is a respiratory infection that affects young children, typically those between 6 months and 3 years old. It is most common in the autumn and is caused by parainfluenza viruses. The main symptom is stridor, which is caused by swelling and secretions in the larynx. Other symptoms include a barking cough, fever, and cold-like symptoms. The severity of croup can be graded based on the child’s symptoms, with mild cases having occasional coughing and no audible stridor at rest, and severe cases having frequent coughing, prominent stridor, and significant distress or lethargy. Children with moderate or severe croup should be admitted to the hospital, especially if they are under 6 months old or have other airway abnormalities. Diagnosis is usually made based on clinical symptoms, but a chest x-ray can show subglottic narrowing. Treatment typically involves a single dose of oral dexamethasone or prednisolone, and emergency treatment may include high-flow oxygen or nebulized adrenaline.

Accidents and Preventive Healthcare

Accidents are a common cause of childhood deaths, with road traffic accidents being the most common cause of fatal accidents. Boys and children from lower social classes are more likely to have an accident. Around 15-20% of children attend Emergency Departments in the course of a year due to an accident. Preventive healthcare can be divided into primary, secondary, and tertiary prevention strategies. Primary prevention aims to prevent accidents or diseases from happening, while secondary prevention aims to prevent injury from the accident or disease. Tertiary prevention aims to limit the impact of the injury. Examples of preventive healthcare strategies include teaching road safety, wearing seat belts, and teaching parents first aid. Some strategies, such as reducing driving speed, may have a role in both primary and secondary accident prevention. By implementing these strategies, we can reduce the number of accidents and improve the overall health and safety of children.

Tetanus Vaccination and Management of Wounds

The tetanus vaccine is a purified toxin that is given as part of a combined vaccine. In the UK, it is given as part of the routine immunisation schedule at 2, 3, and 4 months, 3-5 years, and 13-18 years, providing a total of 5 doses. This is considered to provide long-term protection against tetanus.

When managing wounds, the first step is to classify them as clean, tetanus-prone, or high-risk tetanus-prone. Clean wounds are less than 6 hours old and non-penetrating with negligible tissue damage. Tetanus-prone wounds include puncture-type injuries acquired in a contaminated environment, wounds containing foreign bodies, and compound fractures. High-risk tetanus-prone wounds include wounds or burns with systemic sepsis, certain animal bites and scratches, heavy contamination with material likely to contain tetanus spores, wounds or burns that show extensive devitalised tissue, and wounds or burns that require surgical intervention.

If the patient has had a full course of tetanus vaccines with the last dose less than 10 years ago, no vaccine or tetanus immunoglobulin is required regardless of the wound severity. If the patient has had a full course of tetanus vaccines with the last dose more than 10 years ago, a reinforcing dose of vaccine is required for tetanus-prone wounds, and a reinforcing dose of vaccine plus tetanus immunoglobulin is required for high-risk wounds. If the vaccination history is incomplete or unknown, a reinforcing dose of vaccine is required regardless of the wound severity, and a reinforcing dose of vaccine plus tetanus immunoglobulin is required for tetanus-prone and high-risk wounds.

Screening and Diagnostic Tests for Newborns

Newborns undergo several tests to ensure their health and development. These tests include auscultation of the heart, examination for developmental dysplasia of the hip, congenital cataracts, and undescended testicles. However, some heart murmurs may not be detected until the ductus arteriosus closes early in life. A hearing test, specifically the automated otoacoustic emission test, is often performed before discharge from the hospital or during the first 4-5 weeks of life. The cover test for squint is not usually done during the newborn stage as it requires the child to fixate on an object held away from the eyes. Blood-spot screening for conditions such as congenital hypothyroidism, phenylketonuria, cystic fibrosis, and sickle cell disease is ideally carried out at five days. A urine test is a diagnostic test rather than a screening test at this age and is usually done if a urinary infection is suspected.

Screening and Diagnostic Tests for Newborns

Importance of Examining Adjacent Joints in Orthopaedic Cases

It is crucial to examine the joints above and below when an orthopaedic problem presents. This principle applies to all age groups, including paediatric cases. For instance, when a child presents with right knee pain, the clinician should also consider hip and ankle pathology.

In cases where the patient has a history of left slipped upper femoral epiphysis (SUFE) and no signs of knee pathology, the clinician should pay particular attention to adjacent joints, especially the hip. According to NICE CKS, urgent assessment is necessary if a child over nine years old experiences painful or restricted hip movements, especially internal rotation, to exclude slipped upper femoral epiphysis. This condition is more common in this age group and requires immediate investigation, including AP and lateral X-rays of the hips.

In summary, examining adjacent joints is crucial in orthopaedic cases, and clinicians should pay attention to any relevant history and symptoms to ensure prompt and accurate diagnosis and treatment.

When it comes to children with fevers, healthcare professionals consider appearing unwell to be a red flag. Additionally, not responding appropriately to social cues is an amber flag, as is poor feeding. In children over 12 months old, a respiratory rate exceeding 40 breaths per minute is an amber flag, while a rate over 60 is a red flag. Finally, a heart rate over 150 beats per minute is an amber flag for children between 12 and 24 months old.

The NICE Feverish illness in children guidelines were introduced in 2007 and updated in 2013 to provide a ‘traffic light’ system for assessing the risk of febrile illness in children under 5 years old. The guidelines recommend recording the child’s temperature, heart rate, respiratory rate, and capillary refill time, as well as looking for signs of dehydration. Measuring temperature should be done with an electronic thermometer in the axilla for children under 4 weeks or with an electronic/chemical dot thermometer in the axilla or an infra-red tympanic thermometer. The risk stratification table categorizes children as green (low risk), amber (intermediate risk), or red (high risk) based on their symptoms. Management recommendations vary depending on the risk level, with green children managed at home, amber children provided with a safety net or referred to a specialist, and red children urgently referred to a specialist. The guidelines also advise against prescribing oral antibiotics without an apparent source of fever and note that a chest x-ray is not necessary if a child with suspected pneumonia is not being referred to the hospital.

MMR Vaccination and Immunoglobulin Therapy

The MMR vaccination is not recommended for individuals with a history of anaphylaxis, concurrent febrile illness, neomycin and gelatin allergy. However, a family history of atopy is not relevant. The MMR vaccine is typically administered at around one year of age in the NHS vaccination schedule and there is no benefit in giving separate vaccines for measles, mumps, and rubella. It is important to note that the MMR vaccine contains live attenuated strains of these viruses, while vaccines for diseases such as diphtheria and tetanus are killed vaccines.

In regards to immunoglobulin therapy, there is no indication for children with epilepsy. It is important to consult with a healthcare professional to determine the appropriate course of treatment for any medical condition.

Conditions That Necessitate Surgical Intervention

1. Hirschsprung’s Disease:
   • Description: Hirschsprung’s disease is a congenital condition characterized by the absence of ganglion cells in a segment of the colon, leading to bowel obstruction due to a lack of peristalsis in the affected area.
   • Surgical Intervention: Surgery is required to remove the aganglionic segment of the colon. This is typically done through a procedure called a pull-through surgery, where the diseased segment is removed, and the healthy bowel is connected to the anus.

Conditions That May or May Not Require Surgical Intervention

2. Tongue Tie (Ankyloglossia):
   • Description: Tongue tie occurs when the lingual frenulum (the band of tissue under the tongue) is too short or tight, restricting tongue movement.
   • Surgical Intervention: A frenotomy or frenuloplasty may be performed if the tongue tie significantly affects breastfeeding, speech, or oral hygiene. However, not all cases require surgery, and some may resolve as the child grows.

Conditions That Typically Do Not Require Surgical Intervention in Newborns

3. Umbilical Hernia:
   • Description: An umbilical hernia is a protrusion of the intestine or other tissue through a weakness in the abdominal muscles near the belly button.
   • Management: Most umbilical hernias in newborns close spontaneously by the age of 1-3 years. Surgery is usually only considered if the hernia persists beyond this age or if complications arise (e.g., incarceration or strangulation).
4. Non-retractile Prepuce (Phimosis):
   • Description: Non-retractile prepuce is common in newborns and infants, where the foreskin cannot be retracted over the glans penis.
   • Management: This is typically physiological and resolves naturally as the child grows. Surgery, such as circumcision, is generally only considered if there are recurrent urinary tract infections or other complications.
5. Capillary Haemangioma (Infantile Hemangioma):
   • Description: Capillary hemangiomas are benign vascular tumors that appear as red or purple skin lesions in newborns.
   • Management: Most infantile hemangiomas do not require surgical intervention and tend to regress spontaneously over time. Surgery or other treatments may be considered if the hemangioma causes complications, such as obstruction of vision or airway, ulceration, or bleeding.

Summary

• Surgical intervention is necessary for Hirschsprung’s disease in the newborn period.
• Tongue tie may require surgery if it affects feeding or speech, but many cases do not.
• Umbilical hernia, non-retractile prepuce, and capillary hemangioma generally do not require immediate surgical intervention in newborns unless complications occur.

MMR Vaccine: Information on Administration, Contraindications, and Adverse Effects

The Measles, Mumps and Rubella (MMR) vaccine is given to children in the UK twice before they enter primary school. The first dose is administered at 12-15 months, while the second dose is given at 3-4 years old. This vaccine is part of the routine immunisation schedule for children.

However, there are certain contraindications to the MMR vaccine. Children with severe immunosuppression, allergies to neomycin, or those who have received another live vaccine by injection within four weeks should not receive the MMR vaccine. Pregnant women should also avoid getting vaccinated for at least one month following the MMR vaccine. Additionally, if a child has undergone immunoglobulin therapy within the past three months, there may be no immune response to the measles vaccine if antibodies are present.

While the MMR vaccine is generally safe, some adverse effects may occur. After the first dose of the vaccine, children may experience malaise, fever, and rash. These symptoms typically occur after 5-10 days and last for around 2-3 days. It is important to note that the benefits of the MMR vaccine far outweigh the risks, as it protects against serious and potentially life-threatening diseases.

Differential Diagnosis of Abdominal Pain in Children: Intussusception as the Most Likely Diagnosis

Intussusception is a common cause of intestinal obstruction in young children. It occurs when a section of bowel invaginates into the section next to it, leading to the sloughing off of ischaemic bowel mucosa and the characteristic redcurrant jelly stool. In most cases, the cause of intussusception is unclear, but in some cases, a pathological lead-point may be present. Meckel’s diverticulum is the most common lead-point, but an enlarged Peyer patch caused by a viral infection may also be a factor.

Other potential causes of abdominal pain in children include intestinal duplication, appendicitis, and Henoch-Schönlein purpura (HSP). Intestinal duplication is a rare congenital malformation that may present as a solid or cystic tumor, intussusception, perforation, or bleeding. Appendicitis is most common in older children and typically presents with central abdominal pain that localizes to the right iliac fossa. HSP may cause abdominal pain, nausea, vomiting, and bloody diarrhea, but it is typically accompanied by a purpuric rash, which is absent in this scenario.

Overall, given the age of the patient and the presence of a tender mass in the upper abdomen and emptiness in the right lower quadrant, intussusception is the most likely diagnosis. A lead-point may be present, making non-operative reduction unlikely.

Understanding Benign Rolandic Epilepsy

Benign rolandic epilepsy is a type of epilepsy that commonly affects children between the ages of 4 and 12 years. This condition is characterized by seizures that usually occur at night and are typically partial, affecting only certain parts of the body such as the face. However, in some cases, the seizures may progress to involve the entire body. Despite these symptoms, children with benign rolandic epilepsy are otherwise healthy and normal.

One of the key diagnostic features of benign rolandic epilepsy is the presence of centrotemporal spikes on an electroencephalogram (EEG). This test measures the electrical activity in the brain and can help doctors identify the specific type of epilepsy a child may have.

Fortunately, the prognosis for children with benign rolandic epilepsy is excellent. Most children will outgrow their seizures by the time they reach adolescence. While the condition can be concerning for parents, it is important to remember that it is a relatively mild form of epilepsy and doesn’t typically cause any long-term complications.

Newborns who are found to have bilateral undescended testes during their initial examination should be urgently reviewed by a senior paediatrician within 24 hours, as per the current guidelines from Public Health England. This is crucial as bilateral undescended testes may indicate underlying endocrine disorders or ambiguous genitalia, and early intervention can help prevent complications such as infertility, torsion, and testicular cancer.

It is not appropriate to monitor bilateral undescended testes in primary care, unlike unilateral undescended testes which may be monitored. Waiting for 4 months, 12 months, or 24 months is too long and can increase the risk of complications.

Arranging an ultrasound and waiting for the results is also not appropriate as it can take too much time. Urgent referral to a paediatrician is necessary to ensure timely diagnosis and management.

Undescended testis is a condition that affects approximately 2-3% of male infants born at term, but is more common in premature babies. Bilateral undescended testes occur in about 25% of cases. This condition can lead to complications such as infertility, torsion, testicular cancer, and psychological issues.

To manage unilateral undescended testis, it is recommended to consider referral from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age. Orchidopexy, a surgical procedure, is typically performed at around 1 year of age, although surgical practices may vary.

For bilateral undescended testes, it is important to have the child reviewed by a senior paediatrician within 24 hours as they may require urgent endocrine or genetic investigation.

Infant Weight Loss and Monitoring

It is normal for infants to experience weight loss during the early days of life. However, if an infant loses more than 10% of their birth weight, it is important to assess for dehydration, underlying illness, and feeding problems. Monitoring the infant closely is also recommended, but weighing should not be done more frequently than daily according to NICE guidelines. If there is evidence of illness or failure to respond to feeding support, referral to paediatric services should be considered.

Supplementation with infant formula may result in the cessation of breastfeeding, so it is advised to support the mother to continue breastfeeding. The RCGP recommends testing for normality and sometimes, monitoring or reassurance may be the answer to questions related to infant weight loss. By closely monitoring and addressing any concerns, infants can return to their birth weight by 3 weeks of age.

Approach to Constipation in Children: Consider Systemic Disease and Avoid Stimulant Laxatives and Enemas

Constipation in children can have various organic causes, such as anorectal malformations, but when a systemic disease is the underlying issue, other symptoms of that disease are likely to be present. Therefore, it is important to check for related symptoms of systemic disease. For instance, hypothyroidism may cause constipation along with a goitre, slow growth, weight gain, and intolerance to cold. Diabetes mellitus or diabetes insipidus may cause constipation due to associated polyuria.

Stimulant laxatives may be necessary in some cases, but macrogols should be the first-line treatment for constipation in children. Hirschsprung’s disease is a possible cause of chronic constipation, but it usually presents early in life, and functional constipation is more common. Reassuring parents that their child will grow out of constipation is not advisable, as prompt treatment can help resolve symptoms sooner.

Enemas should be avoided if possible, as they can cause emotional and physical trauma. If necessary, the child should be admitted to the hospital for this procedure. Overall, a thorough evaluation of the child’s symptoms and medical history is necessary to determine the best approach to managing constipation.

Exceptions aside, metabolic conditions are typically inherited in an autosomal recessive manner, while structural conditions are usually inherited in an autosomal dominant manner. However, it should be noted that hereditary spherocytosis is an example of a condition that is inherited in an autosomal dominant fashion.

Autosomal recessive conditions are often referred to as metabolic conditions, while autosomal dominant conditions are considered structural. However, there are notable exceptions to this rule. For example, some metabolic conditions like Hunter’s and G6PD are X-linked recessive, while some structural conditions like ataxia telangiectasia and Friedreich’s ataxia are autosomal recessive.

Autosomal recessive conditions occur when an individual inherits two copies of a mutated gene, one from each parent. Some examples of autosomal recessive conditions include albinism, cystic fibrosis, sickle cell anemia, and Wilson’s disease. These conditions can affect various systems in the body, including metabolism, blood, and the nervous system. It is important to note that some conditions, such as Gilbert’s syndrome, are still a matter of debate and may be listed as autosomal dominant in some textbooks.

• Infected burns are rarely a sign of abuse:
  • Incorrect: Infected burns can indeed be a sign of abuse. Neglect in treating burns can lead to infection, which may indicate a lack of proper care and potentially abusive behavior.
• Burns from hot water where there are no splash marks are rarely a sign of abuse:
  • Incorrect: Burns from hot water without splash marks are often a sign of abuse. These burns may indicate forced immersion, where the child is held in hot water intentionally, resulting in clear demarcation lines instead of splashes.
• Burns on the back are rarely a sign of abuse:
  • Incorrect: Burns on the back can be indicative of abuse, as accidental burns typically occur on accessible areas like the front of the body, arms, and legs. Unusual burn locations, such as the back, should raise suspicion for abuse.
• There is no pathognomonic pattern of burns in child abuse:
  • Correct: There is no single pathognomonic pattern of burns that definitively indicates child abuse. However, certain patterns, such as immersion burns, cigarette burns, and patterned burns (e.g., from an iron), are highly suspicious for abuse but not exclusively diagnostic. The absence of a single definitive pattern underscores the need for careful assessment and consideration of the context in which the burns occurred.
• Burns with discrete edges are rarely a sign of abuse:
  • Incorrect: Burns with discrete edges can be a sign of abuse, especially when they are from forced immersion in hot water or contact with a hot object. These burns typically show clear boundaries, unlike accidental burns, which often have irregular edges.

Tetracycline and Other Drugs to Avoid During Pregnancy and Breastfeeding

Tetracycline is a medication that should be avoided by breastfeeding mothers due to the risk of staining the infant’s teeth. Other drugs to avoid during pregnancy and breastfeeding include amiodarone, lithium, chloramphenicol, and vitamin A derivatives. The FDA has assigned tetracycline to pregnancy category D, as it has been associated with congenital defects and maternal hepatotoxicity. When used during tooth development in the second half of pregnancy, tetracycline can cause permanent yellow-gray-brown discoloration of the teeth and enamel hypoplasia. Therefore, the use of tetracycline during pregnancy is generally not recommended, especially during the last half of pregnancy.

Tetracycline is excreted into human milk in small amounts, which may pose theoretical risks of dental staining and inhibition of bone growth, although these risks are unlikely. It is important for pregnant and breastfeeding women to consult with their healthcare provider before taking any medication to ensure the safety of both the mother and the baby.

Pertussis: Diagnosis and Symptoms

Pertussis, commonly known as whooping cough, is most contagious during the first 7-14 days of the illness, which is called the catarrhal phase. During this phase, there is an increase in lymphocytes in the blood. Diagnosis of pertussis can be made by taking blood for pertussis serology or by isolating the organism from nasal secretions. It is important to note that an inspiratory whoop may not always be present, but complete apnoeic episodes can occur.

The pneumococcal vaccine is now administered at 3 months and 12-13 months, instead of the previous schedule of 8 weeks. The 8 week vaccines now include DTaP/IPV/Hib/HepB, Men B, and rotavirus, while the 12 week vaccines include DTaP/IPV/Hib/HepB, pneumococcal vaccine, and rotavirus. There are no vaccines given at 6 weeks.

The UK immunisation schedule recommends certain vaccines at different ages. At birth, the BCG vaccine is given if the baby is at risk of tuberculosis. At 2, 3, and 4 months, the ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B) and oral rotavirus vaccine are given, along with Men B and PCV at specific intervals. At 12-13 months, the Hib/Men C, MMR, PCV, and Men B vaccines are given. At 3-4 years, the ‘4-in-1 Preschool booster’ (diphtheria, tetanus, whooping cough and polio) and MMR vaccines are given. At 12-13 years, the HPV vaccination is given, and at 13-18 years, the ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio) and Men ACWY vaccines are given. Additionally, the flu vaccine is recommended annually for children aged 2-8 years.

It is important to note that the meningitis ACWY vaccine has replaced meningitis C for 13-18 year-olds due to an increased incidence of meningitis W disease in recent years. The ACWY vaccine is also offered to new students up to the age of 25 years at university. GP practices will automatically send letters inviting 17-and 18-year-olds in school year 13 to have the Men ACWY vaccine, while students going to university or college for the first time should contact their GP to have the vaccine before the start of the academic year.

The Men C vaccine used to be given at 3 months but has now been discontinued as there are almost no cases of Men C disease in babies or young children in the UK. All children will continue to be offered the Hib/Men C vaccine at one year of age, and the Men ACWY vaccine at 14 years of age to provide protection across all age groups.

Nightmares are a frequent and distressing side effect of montelukast. It is recommended that children take the medication in the morning instead of at night if they experience this issue. Montelukast is not associated with exacerbating coughs (which are usually caused by ramipril), blurred vision (which can be caused by Olanzapine), ringing in the ears (which is often caused by furosemide), or increased appetite (which is often a side effect of antidepressants like sertraline).

Preschool Wheeze in Children: Classification and Management

Wheeze is a common occurrence in Preschool children, with around 25% experiencing it before they reach 18 months old. Viral-induced wheeze is now one of the most frequently diagnosed conditions in paediatric wards. However, there is still ongoing debate about how to classify wheeze in this age group and the most appropriate management strategies.

The European Respiratory Society Task Force has proposed a classification system for Preschool wheeze, dividing children into two groups: episodic viral wheeze and multiple trigger wheeze. Episodic viral wheeze occurs only during a viral upper respiratory tract infection and is symptom-free in between episodes. On the other hand, multiple trigger wheeze can be triggered by various factors, such as exercise, allergens, and cigarette smoke. Episodic viral wheeze is not associated with an increased risk of asthma in later life, while a proportion of children with multiple trigger wheeze may develop asthma.

For parents who smoke, it is strongly recommended that they quit smoking. The management of episodic viral wheeze is symptomatic, with first-line treatment involving short-acting beta 2 agonists or anticholinergic via a spacer. If symptoms persist, the next step is intermittent leukotriene receptor antagonist or inhaled corticosteroids, or both. Oral prednisolone is no longer considered necessary for children who do not require hospital treatment. For multiple trigger wheeze, a trial of inhaled corticosteroids or a leukotriene receptor antagonist is typically recommended for 4-8 weeks.

Overall, the classification and management of Preschool wheeze in children is an ongoing area of research and debate, with the aim of providing the most effective and appropriate care for these young patients.

Hypertension, or high blood pressure, can also affect children. To measure blood pressure in children, it is important to use a cuff size that is approximately 2/3 the length of their upper arm. The 4th Korotkoff sound is used to measure diastolic blood pressure until adolescence, when the 5th Korotkoff sound can be used. Results should be compared to a graph of normal values for their age.

In younger children, secondary hypertension is the most common cause, with renal parenchymal disease accounting for up to 80% of cases. Other causes of hypertension in children include renal vascular disease, coarctation of the aorta, phaeochromocytoma, congenital adrenal hyperplasia, and essential or primary hypertension, which becomes more common as children get older. It is important to identify the underlying cause of hypertension in children in order to provide appropriate treatment and prevent complications.

Neonatal Jaundice: Differential Diagnosis

Biliary atresia is a congenital condition that causes obstructive jaundice due to the obliteration of the extrahepatic biliary system. It presents soon after birth with persistent jaundice, pale stools, and dark urine. Physiological jaundice, which appears after 2-3 days of age, is a different condition that doesn’t cause changes in stool and urine color. Gallstones and Rhesus incompatibility can also present with obstructive jaundice, but they are less likely. Vitamin K deficiency is not a likely cause of neonatal jaundice if the child has received vitamin K soon after birth. Any term infant who is still jaundiced after 14 days (or preterm infants after 21 days) should be investigated for the underlying cause of their jaundice.

Pneumococcal Vaccines

There are two types of pneumococcal vaccines available – the pneumococcal conjugate vaccine (PCV) and the pneumococcal polysaccharide vaccine (PPV). The PCV vaccine is given to children under the age of 2, with a booster at 1 year old. On the other hand, the PPV vaccine is given to individuals over the age of 2, particularly those who are 65 years old and above.

Moreover, individuals with certain medical conditions are also eligible for the pneumococcal vaccine. These include those with asplenia or splenic dysfunction, cochlear implants, chronic respiratory or heart disease, chronic neurological conditions, diabetes, chronic kidney disease stage 4/5, chronic liver disease, immunosuppression due to disease or treatment, and complement disorders (including those receiving complement inhibitor treatment).

Getting vaccinated against pneumococcal disease is important in preventing serious illnesses such as pneumonia, meningitis, and blood infections. It is recommended to consult with a healthcare provider to determine the appropriate vaccine and schedule for each individual.

Best Antibiotic Choice for Children

When it comes to choosing an antibiotic for children, it’s important to consider their age and potential side effects. In this circumstance, Amoxicillin would be the best choice due to its effectiveness and safety profile. Quinolones and tetracyclines should be avoided in childhood, while co-trimoxazole has limited indications and nitrofurantoin would not be effective. It’s crucial to consult with a healthcare professional before administering any medication to children.

Management of Bronchiolitis in Infants

Bronchiolitis is an acute infectious disease of the lower respiratory tract that commonly affects infants aged between two and six months. It is caused by respiratory syncytial virus (RSV) and peaks during the winter months. Supportive measures such as fluid input, feeding, and temperature control are the mainstay of treatment. Antibiotics are not indicated as bronchiolitis is usually caused by a virus. Hospital admission is only necessary in severe cases or if there are significant comorbidities. Salbutamol via a spacer is not indicated in bronchiolitis. Careful safety netting is important to teach parents to spot deterioration and seek medical attention if necessary. Most infants with bronchiolitis have a mild, self-limiting illness that lasts for seven to ten days.

Understanding Measles

Measles is a highly contagious disease that is characterized by a rash with maculopapular lesions. The onset of the disease is marked by a prodromal phase, which includes symptoms such as fever, malaise, loss of appetite, cough, rhinorrhea, and conjunctivitis. This phase typically lasts for one to four days before the rash appears.

The rash usually starts on the head and then spreads to the trunk and extremities over a few days. The fever usually subsides once the rash appears. The rash itself lasts for at least three days and then fades in the order of appearance. In some cases, it can leave behind a brownish discoloration and may become confluent over the buttocks.

It is important to note that measles is a serious disease that can lead to complications such as pneumonia, encephalitis, and even death. Vaccination is the best way to prevent measles and its complications.