1. T. Cymes Stage 3 student doctor University of Cambridge

2.  Examination  tips  differences from adults  red flags  Asthma  Bronchiolitis  Pneumonia  Cystic fibrosis  Other diseases

3.  Get to their level!  Let young children play with your stethoscope  Great toy!  Lets them get used to it  Let parents undress the child only when needed  Start with least invasive examination  Show on parents, toy etc  Auscultate early  Save percussion until the end ▪ Start on arm or knee – they get used to it!

4.  Position  Infants – lying on couch  Toddler – on parent's lap  Pre-school – while at play  Initial impression important  ?unwell child  Look for dysmorphic features  Percussion can be omitted  Little information in infants

5.  Accessory muscles  Wheeze  Stridor  Grunting  Silent chest  Tachypnoea / tachycardia  Intercostal recessions  Harrison’s sulcus  Cyanosis  Nasal flaring Source: BMJ Source: Wikipedia Source: englishclass.jp Source: gponline.com Source: lumen.luc.edu Source: quickbase.intuit.com

6.  Epidemiology  15% prevalence  Associated with atopy  History  Wheeze & cough  Worse a night  Ask about ▪ Triggers ▪ Frequency ▪ Interval symtpoms  Examination out of attack  ± wheeze  Reduced PEFR  Examination during attack  Signs of respiratory distress  Hyperexpansion  Ascultate  Reduced PEFR  SpO2

7.  Acute attack – O SHIT!  O xygen  S albutamol  H ydrocortisone  I pratropium  T heophylline  ! – get help!  Monitor SpO2 and PEFR  Chronic management ladder Mild SABA ≥ 3 week Inhaled steroids at conventional dosage Poor control LABA Reasses No response Leukotriene antagonists Theophylline Poor control Maximise inhaled steroids Refer Poor control Oral steroids Immunosuppression / immunomodulation

8.  By RSV  Epidemiology  Winter  1-9 months old  Symtpoms  Initially coryza  SOB  Sharp dry cough  Signs  Tachypnoea  Wheeze & crackles  Hyperinflated  Investigations  CXR  Nasopharyngeal aspirate  Management  Humidified O2  ± fluids  ± parenteral feeding Source: Wikipedia

9.  History  Often URTI  Cough  Poor feeding  “Unwell child”  Examination  Tachypnoea  Nasal flare  Chest indrawing  Investigations  CXR  Nasopharyngeal aspirate  Management  Usually at home  Oxygen & anaelgesia as needed AgePathogensEmpirical antibiotics NeonateGBS E. coli Ampicillin + gentamicin > 5 years old Viral Strep. pneumoniae H. influenzae B. pertussis Ampicillin Ceftriaxone > 5 years old Strep. pneumoniae H. influenzae GAS Mycoplasma Amoxicillin Erythromycin

10.  Part of Guthrie test  Autosomal recessive  1:2500 live births  1:25 are carriers  History  Meconium ileus (10-20%)  Persistent cough  Recurrent/chronic chest infection  Bronciectasis in children  Malabsorption  failure to thrive  Male infertility  Signs  Hyperinflated  Wheeze  Coarse crackles  Management  Monitor lung function  Prophylactic + rescue antibiotics  Physiotherapy  Bilateral lung transplant when end-stage  Nutrtional ▪ Pancreatic enzyme supplements ▪ 150% healthy calorie intake

11.  Croup  Parainfluenza virus  URTI  barking cough + stridor  Improve over 24h  Symptomatic management  ?Steroids  Acute epiglottitis  H. influenzae type b  Very painful throat  Sits up with open mouth  Drooling  DON’T examine throat  Intubate, then: ▪ Blood culture ▪ Cefuroxime IV

12.  Whooping cough  B. pertussis  Coryza  Coughing paroxysms ▪ Inspiratory whoop  Erythromycin  Acute otitis media  RSV, pneumococci, Hib, GBS  Earache in older children  Fever  Exclude via otoscopy in any ill oddler  Management ▪ Symptomatic ▪ amoxicillin