1. Paediatric Update Course Beardmore Hotel 20th and 21st October 2014

2. Dr David Gilmore Regent Gardens Medical Centre Kirkintilloch

3. Beardmore Hotel No fire alarm tests planned
Coffee will be served outside auditorium
Lunch served in hotel restaurant

4. Course Aims Improved knowledge and understanding of child development
Improved knowledge and understanding of (some) common child health problems

5. Course Feedback / Admin
Please fill in a feedback form afterwards
Please remember to sign in each day

6. Course Format Mostly short lectures
Time at the end of each talk for questions
Tuesday morning smaller groups for videos

7. The RCGP GP Curriculum Statements
3.04 Care of Children and Young People
Most healthcare for children delivered outside hospital
20% average GP list under 15 – 1 in 4 consults
Schoolchildren visit the GP 2 – 3 times / year
Under fives visit on average 6 times / year

8. Child Health Surveillance Programme
In the past was done by child health doctors based in health centres
1990 contract saw GPs doing checks
2004 “New Contract” now part of “Global Sum”

9. Child Health Surveillance Programme
Previously checks done at 6 weeks, 9 months and 3 ½ years
Hall 4 Report in 2002 radically changed the programme
Routine checks now only carried out by GPs at 6 weeks
30 month review by Health Visitors recently introduced

10. The 6 Week Check

13. Common Problems Undescended testes Hydrocele Inguinal Hernia
Umbilical Hernia
Vomiting / gastro-oesophageal reflux
Cow’s milk allergy

14. Undescended Testes
Important to distinguish between retractile / ectopic / incompletely descended testes
5% of full term babies have one or both testes undescended
1.5% undescended at 3 months
0.3% at one year
Refer if testes not in scrotum at 6 months
Surgery usually carried out between 1 and 2 years

15. Hydrocele Enlarged scrotum noted
Often testes cannot be felt separately
Transluminence may be observed
Most infant hydroceles resolve spontaneously
Referral not indicated until age 15 months

16. Inguinal hernia Usually reducible May be associated with pain
Present in groin and scrotum
Refer for surgical repair
Refer urgently if under 6 months old

17. Umbilical Hernia Incomplete closure of umbilical ring after birth
May enlarge when active or crying
Most resolve within first 3 to 4 years of life
Referral not indicated until age 3

18. Gastro-oesophageal Reflux
Seems to be increasingly common
? Related to changes in formula milks
Distress and regurgitation of milk after feeding or lying down
Try Infant Gaviscon
Consider ranitidine
Consider milk allergy

19. Reflux Treatment Infant Gaviscon : one dose each feed
Half sachet below 4.5 kg
Dual sachet above 4.5 kg
Ranitidine 1 – 3 mg/kg twice daily (15mg/ml)

20. Cow’s Milk Allergy Affects 2 – 7% of children under 1 year
Second commonest childhood food allergy
Less common in older children and adults

21. Presentation IgE mediated Non-IgE mediated
Within 2 hours (usually within 20 minutes)
Angioedema / urticaria / rhinorrhoea
Vomiting / abdo pain / diarrhoea
Non-IgE mediated
More non-specific symptoms
Reflux / crying / diarrhoea / constipation / eczema
More difficult to diagnose

22. Investigation / Diagnosis
Skin prick testing
Elimination diet

23. Management Hypoallergenic formulas Extensively hydrolysed formulas
Nutramigen LIPIL 1 / 2
Aptamil Pepti 1 / 2
Amino acid formulas
Nutramigen AA LIPIL
Neocate LCP

24. Yorkhill Paediatrics for Primary Care Handbook