1. Dr Alice Devall Falkland Surgery Monday 16th October 2017
Children’s healthcare:
Managing common childhood illnesses in children under 5 yrs
Dr Alice Devall
Falkland Surgery
Monday 16th October 2017

2. What will we talk about this evening?
Who am I? Why am I giving this talk?
Signs and symptoms of common illnesses including viral URTIs (“colds”), chest infections, ear and throat infections.
Rashes including chickenpox, hand foot and mouth and scarlet fever.
How to manage these common illnesses at home
How to assess if your child is unwell
Spotting serious illness including meningitis and sepsis
What evidence or guidance am I using to advise you?

3. The common cold
What are the symptoms? Runny nose, blocked nose, coughing, sneezing, sore throat, sore ears.
Peaks at 2-3 days. Lasts 7-14 days. Cough can last up to 3 weeks in young children.
“Back to back” colds are common in children. Up to 12 in a year. Over 200 viruses! Commonest is rhinovirus.
Normal fluids, increased if feverish or very runny nose.
Paracetamol or ibuprofen
Steam, vapour-rubs, honey and lemon, saline drops

4. The ear
Middle ear
Outer ear
Inner ear

5. How do I know it is not a chest infection, ear infection, tonsillitis or other more serious illness?
Getting worse rather than better especially after 2-3 days
Lasting more than 7 days
A persistent high temperature
Poor fluid intake, nappies not as wet, drowsy, listless, “doesnt seem right”
Seems worse than their usual cold
It can be difficult to tell especially in “pre-verbal” children….that is what your GP is there for
Underlying illnesses, ex-Premature babies, previous hospital admissions - we want to know they are ill sooner.

6. How does my GP assess what is wrong?
We listen to your history of the illness in the child you are an expert on!
What am I interested in? Are they drinking? Are they peeing? Are they playing?
Are they vomiting? Are they drowsy? Are they making unusual noises? How long have they been ill for?
We examine them: Observing your child as soon as they enter the room, temperature, breathing rate, pulse rate, hydration status, then checking the different body areas.
Safety-netting

7. Table 1 . NICE 'traffic light' system for identifying the risk of serious illness in children.
Green — low risk
Amber — intermediate risk
Red — high risk
Colour
Normal colour of skin, lips, and tongue.
Pallor reported by parent or carer.
Pale, mottled, ashen, or blue.
Activity
Responding normally to social cues. Content, smiling. Stays awake or awakens quickly. Strong normal cry or not crying.
Not responding normally to social cues. Waking only with prolonged stimulation. Decreased activity. Not smiling.
No response to social cues. Appears ill to a healthcare professional. Unable to rouse or if roused does not stay awake. Weak, high-pitched, or continuous crying.
Respiratory —
Nasal flaring. Tachypnoea: 6–12 months of age: RR* > 50 breaths per minute. > 12 months of age: RR* > 40 breaths per minute. Oxygen saturation =< 95% in air. Crackles.
Grunting. Tachypnoea (RR* > 60 breaths per minute). Moderate or severe chest indrawing.
Hydration and circulation
Normal skin and eyes. Moist mucous membranes.
Dry mucous membrane. Poor feeding in infants. CRT† >= 3 seconds. Reduced urine output‡. Tachycardia: >160 beats/minute under 1 year of age. >150 beats/minute 1–2 years of age. >140 beats/minute 2–5 years of age.
Reduced skin turgor.
Other
None of the amber or red symptoms or signs.
Fever for >= 5 days. Rigors 3–6 months of age, temperature >= 39°C.
0–3 months of age, temperature >= 38°C.
Swelling of limb or joint. Non-weight-bearing/not using an extremity.
Non-blanching rash. Bulging fontanelle. Neck stiffness. Status epilepticus. Focal neurological signs. Focal seizures.

8. A note on fever Does the number matter?
Any child under 3 months old with a temperature of 38 deg or more - “red flag”
Child 3-6 months more than 39 degrees - “amber flag”

9. Bronchiolitis Caused by RSV (respiratory syncytial virus)
Affects 1 in 3 babies during their first year of life. Especially premature babies.
Peak age is 3-6 months. November - March peak time of year.
Symptoms similar to a cold - runny nose, cough, mild temperature
Last up to 14 days with the “peak” illness at day 4-5.
Tiny airways in the lungs called bronchioles produce mucus and become narrowed and this causes a runny nose and may cause breathing difficulties.

10. Bronchiolitis 2
Some babies will develop breathing difficulties or aren’t able to drink enough however and 2 in 100 babies who get bronchiolitis will therefore require a hospital admission.
Treatment in hospital is “supportive” - oxygen is given via tiny prongs up the nose and babies are fed with a nasogastric tube.
As it is a virus antibiotics don’t help. Unfortunately babies can get it multiple times.
Manage it as any other viral illness at home
Beware babies taking <50% of their usual fluids, a dry nappy for more than 12 hours, signs of breathing difficulties

11. Croup 1 Caused by a any number of viruses
Symptoms start as a cold then after a few days:
1) barking cough 2) noisy breathing-in called “stridor” 3) hoarse voice
Usually last 48 hours, worse at night
GPs tend to treat with a single dose of steroids
Otherwise manage with paracetamol at home (steam not of benefit)
Sitting upright, avoiding getting agitated

12. Croup 2
When would a child need hospital admission (either via the GP or calling 999):
Increasing breathing rate (especially if >60/minute)
Episodes of “cyanosis” - going blue or the child is very pale or grey
Increasing “work of breathing”
“Apnoeas” - the child stops breathing for a few seconds at a time
Very distressed - unable to calm down quickly
Any drooling or trouble swallowing

14. ?

15. Chicken Pox 1
Usually a mild illness in young children caused by the “Varicella Zoster virus”
Fever plus a rash: “papules” (red spots) then “vesicles” (little blisters) then crusting over
Incubation period is days
Rash lasts 5-10 days
May have cold like symptoms such as sore throat, cough, runny nose
Highly contagious - 80% chance of catching it if non-immune and exposed to someone with chickenpox

16. Chicken Pox 2
Complications include pneumonia, dehydration and encephalitis
Off nursery or school until all the vesicles have crusted over (at least day 5)
Avoid contact with young babies, pregnant women* and “immunocompromised” persons
Vaccination
Chickenpox and shingles

17. ?

18. Hand, foot and mouth disease
Generally a mild illness, can be safely managed at home in most cases
Not related to Foot and mouth disease in farm animals!
Caused by a number of viruses usually the Coxsackie virus
Spread from person to person via droplets in the saliva, faeces and fluid in the blisters
Starts off with a temperature, generally unwell, abdominal pain, coughing
About day 2 of feeling unwell spots or blisters tend to appear on the hands and feet and ulcers appear in the mouth. These can be quite painful
Manage as with any other viral illness. Stay off school or nursery until feeling better. Rash may last up to 10 days (but not exclusion).

19. ?

20. Scarlet fever Caused by bacteria called Streptococcus or “strep”
Fever, sore throat, headache
Red blotchy “sandpaper” rash appears on tummy then spreads around the body
Cheeks often very red
Tongue may develop a white coating which comes off to reveal a very red sore “strawberry tongue”
Symptoms may last 7-10 days
We always recommend seeing a GP if you suspect it
Usually antibiotics are given to reduce the risk of complications, reduce spreading the infection and reduce the duration of the illness
Sometimes a throat swab is taken to confirm the illness

21. The “glass test”

22. Reducing the spread of infection
Washing hands especially after toileting, sneezing or coughing
Not sharing towels or utensils
Wiping down surfaces and toys
Staying off school or nursery for the recommended time (see nhs choices website)

23. ? ?

24. Impetigo
Verrucas

25. Meningitis and septicaemia
CALL 999

26. Questions?