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

2. 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

3. 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

4. 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

5. 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.

6. 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.

7. 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!

8. 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

9. 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