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