Transcript Document
Paediatric Update Course Beardmore Hotel 20th and 21st October 2014 Dr David Gilmore Regent Gardens Medical Centre Kirkintilloch Beardmore Hotel No fire alarm tests planned Coffee will be served outside auditorium Lunch served in hotel restaurant Course Aims Improved knowledge and understanding of child development Improved knowledge and understanding of (some) common child health problems Course Feedback / Admin Please fill in a feedback form afterwards Please remember to sign in each day Course Format Mostly short lectures Time at the end of each talk for questions Tuesday morning smaller groups for videos 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 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” 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 The 6 Week Check Common Problems Undescended testes Hydrocele Inguinal Hernia Umbilical Hernia Vomiting / gastro-oesophageal reflux Cow’s milk allergy 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 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 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 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 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 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) Cow’s Milk Allergy Affects 2 – 7% of children under 1 year Second commonest childhood food allergy Less common in older children and adults Presentation 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 Investigation / Diagnosis Skin prick testing Elimination diet Management Hypoallergenic formulas – Extensively hydrolysed formulas Nutramigen LIPIL 1 / 2 Aptamil Pepti 1 / 2 – Amino acid formulas Nutramigen AA LIPIL Neocate LCP Yorkhill Paediatrics for Primary Care Handbook http://www.clinicalguidelines.scot.nhs.uk/Pri mary%20Care%20Handbook%20with%20U pdates%20nov04.pdf