Common Paediatric Problems seen in GP they might not have taught you at Medical School Kate Snook

Nappy Rash Can look really awful Irritant dermatitis Candidiasis Red, flexural sparing, worse when has diarrhoea Candidiasis Bright red, less or no sparing/oral infection Seborrhoeic dermatitis Erythematous scaling, may also have on scalp, neck, trunk, flexures

Treatment General measures Zinc based barrier cream - Sudocrem Nappy off Regular washing and changing keep dry Zinc based barrier cream - Sudocrem If that’s not working consider antifungal or if no signs of candida then Timodene can be helpful

Umbilical Cords Fold nappies down to stop them getting dirty Clean with warm water Should fall off within 5-15 days They look a bit sore after the stump falls off Then takes another 7-10 days to heal Don’t use antiseptic creams/powders

BCG vaccinations Given to at risk babies whilst still on the ward Intradermal injection live attenuated vaccine Get a reaction that may takes months to fully heal Can look awful – hold off on flucloxacillin Cover only if oozing with dry dressing The main risk groups are infants under one year of age living in areas where the incidence of TB is 40 cases per 100,000 people or higher, infants under one year of age whose parents or grandparents were born in a country with an incidence of TB of 40 cases per 100,000 people or higher, and new immigrants from countries with a high incidence of TB who have not already been vaccinated.

Verrucas and Warts High rates of recurrence with excision, diathermy and curettage Verrucas 50% heal in a year, 67% in 2 Parents worry - verruca socks Leave them alone If painful Keratolytic agents – salicylic acid eg 3% formalin solution as a foot soak Cryotherapy – probably more effective irritants, e.g. podophyllin, but not in pregnancy = warticon In theory, lactic acid will increase the effectiveness of each of these. For mosaic and multiple foot warts, consider the use of a 3% formalin solution as a foot soak.

Worms Thread worms most common type in the UK Cause itchy bottoms, particularly at night, can cause vaginitis in girls Can see small thread like worms, about 1cm in length, blunt head Treat with mebendazole, single dose tab or 5ml per family member May be repeated at 2 weeks Facinatingly the eggs can survive for up to 2 weeks in dust and then can be inhaled so don’t forget to remind parents to hoover throughly!

Feeding Breast is best Are they getting enough? Most likely Weaning starts around 6 months No added salt or sugar Water – if giving boil under 6m Cows milk as a drink – avoid until 1yr Recommended that babies under 6months only have one gram of salt a day, children aged 1-3 2g, and children aged 4-6 3g

Infants and children If pyrexial need full examination a recording of HR/RR CRT Temp Sats Chest/abdo/ENT/lymph Document if signs of respiratory distress