paediatric update course beardmore hotel 20 th and 21 st october 2014
TRANSCRIPT
![Page 1: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/1.jpg)
Paediatric Update CoursePaediatric Update CourseBeardmore HotelBeardmore Hotel
2020thth and 21 and 21stst October 2014 October 2014
![Page 2: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/2.jpg)
Dr David GilmoreDr David GilmoreRegent Gardens Medical CentreRegent Gardens Medical Centre
KirkintillochKirkintilloch
![Page 3: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/3.jpg)
Beardmore HotelBeardmore Hotel No fire alarm tests plannedNo fire alarm tests planned Coffee will be served outside auditoriumCoffee will be served outside auditorium Lunch served in hotel restaurantLunch served in hotel restaurant
![Page 4: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/4.jpg)
Course AimsCourse Aims Improved knowledge and understanding of Improved knowledge and understanding of
child developmentchild development Improved knowledge and understanding of Improved knowledge and understanding of
(some) common child health problems(some) common child health problems
![Page 5: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/5.jpg)
Course FeedbackCourse Feedback / Admin/ Admin
Please fill in a feedback form afterwardsPlease fill in a feedback form afterwards
Please remember to sign in each dayPlease remember to sign in each day
![Page 6: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/6.jpg)
Course FormatCourse Format Mostly short lecturesMostly short lectures Time at the end of each talk for questionsTime at the end of each talk for questions Tuesday morning smaller groups for videosTuesday morning smaller groups for videos
![Page 7: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/7.jpg)
The RCGPThe RCGPGP Curriculum StatementsGP Curriculum Statements
3.04 Care of Children and Young People3.04 Care of Children and Young People– Most healthcare for children delivered outside Most healthcare for children delivered outside
hospitalhospital– 20% average GP list under 15 – 1 in 4 consults20% average GP list under 15 – 1 in 4 consults– Schoolchildren visit the GP 2 – 3 times / yearSchoolchildren visit the GP 2 – 3 times / year– Under fives visit on average 6 times / yearUnder fives visit on average 6 times / year
![Page 8: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/8.jpg)
Child Health Surveillance Child Health Surveillance ProgrammeProgramme
In the past was done by child health doctors In the past was done by child health doctors based in health centresbased in health centres
1990 contract saw GPs doing checks1990 contract saw GPs doing checks
2004 2004 ““New ContractNew Contract”” now part of now part of ““Global Global SumSum””
![Page 9: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/9.jpg)
Child Health Surveillance Child Health Surveillance ProgrammeProgramme
Previously checks done at 6 weeks, 9 Previously checks done at 6 weeks, 9 months and 3 ½ yearsmonths and 3 ½ years
Hall 4 Report in 2002 radically changed the Hall 4 Report in 2002 radically changed the programmeprogramme
Routine checks now only carried out by GPs Routine checks now only carried out by GPs at 6 weeksat 6 weeks
30 month review by Health Visitors recently 30 month review by Health Visitors recently introducedintroduced
![Page 10: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/10.jpg)
The 6 Week CheckThe 6 Week Check
![Page 11: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/11.jpg)
![Page 12: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/12.jpg)
![Page 13: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/13.jpg)
Common ProblemsCommon Problems
Undescended testesUndescended testes HydroceleHydrocele Inguinal HerniaInguinal Hernia Umbilical HerniaUmbilical Hernia Vomiting / gastro-oesophageal refluxVomiting / gastro-oesophageal reflux Cow’s milk allergyCow’s milk allergy
![Page 14: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/14.jpg)
Undescended TestesUndescended Testes
Important to distinguish between retractile / Important to distinguish between retractile / ectopic / incompletely descended testesectopic / incompletely descended testes
5% of full term babies have one or both testes 5% of full term babies have one or both testes undescendedundescended
1.5% undescended at 3 months1.5% undescended at 3 months 0.3% at one year0.3% at one year Refer if testes not in scrotum at 6 monthsRefer if testes not in scrotum at 6 months Surgery usually carried out between 1 and 2 yearsSurgery usually carried out between 1 and 2 years
![Page 15: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/15.jpg)
HydroceleHydrocele Enlarged scrotum notedEnlarged scrotum noted Often testes cannot be felt separatelyOften testes cannot be felt separately Transluminence may be observedTransluminence may be observed Most infant hydroceles resolve Most infant hydroceles resolve
spontaneouslyspontaneously Referral not indicated until age 15 monthsReferral not indicated until age 15 months
![Page 16: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/16.jpg)
Inguinal herniaInguinal hernia
Usually reducibleUsually reducible May be associated with painMay be associated with pain Present in groin and scrotumPresent in groin and scrotum Refer for surgical repairRefer for surgical repair Refer urgently if under 6 months oldRefer urgently if under 6 months old
![Page 17: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/17.jpg)
Umbilical HerniaUmbilical Hernia Incomplete closure of umbilical ring after Incomplete closure of umbilical ring after
birthbirth May enlarge when active or cryingMay enlarge when active or crying Most resolve within first 3 to 4 years of lifeMost resolve within first 3 to 4 years of life Referral not indicated until age 3Referral not indicated until age 3
![Page 18: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/18.jpg)
Gastro-oesophageal RefluxGastro-oesophageal Reflux Seems to be increasingly commonSeems to be increasingly common ? Related to changes in formula milks? Related to changes in formula milks Distress and regurgitation of milk after Distress and regurgitation of milk after
feeding or lying downfeeding or lying down Try Infant GavisconTry Infant Gaviscon Consider ranitidineConsider ranitidine Consider milk allergyConsider milk allergy
![Page 19: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/19.jpg)
Reflux TreatmentReflux Treatment
Infant Gaviscon : one dose each feedInfant Gaviscon : one dose each feed– Half sachet below 4.5 kgHalf sachet below 4.5 kg– Dual sachet above 4.5 kgDual sachet above 4.5 kg
Ranitidine 1 – 3 mg/kg twice daily (15mg/ml)Ranitidine 1 – 3 mg/kg twice daily (15mg/ml)
![Page 20: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/20.jpg)
Cow’s Milk AllergyCow’s Milk Allergy
Affects 2 – 7% of children under 1 yearAffects 2 – 7% of children under 1 year Second commonest childhood food allergySecond commonest childhood food allergy Less common in older children and adultsLess common in older children and adults
![Page 21: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/21.jpg)
PresentationPresentation
IgE mediatedIgE mediated– Within 2 hours (usually within 20 minutes)Within 2 hours (usually within 20 minutes)– Angioedema / urticaria / rhinorrhoeaAngioedema / urticaria / rhinorrhoea– Vomiting / abdo pain / diarrhoeaVomiting / abdo pain / diarrhoea
Non-IgE mediatedNon-IgE mediated– More non-specific symptomsMore non-specific symptoms– Reflux / crying / diarrhoea / constipation / eczemaReflux / crying / diarrhoea / constipation / eczema– More difficult to diagnoseMore difficult to diagnose
![Page 22: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/22.jpg)
Investigation / DiagnosisInvestigation / Diagnosis
Skin prick testingSkin prick testing Elimination dietElimination diet
![Page 23: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/23.jpg)
ManagementManagement
Hypoallergenic formulasHypoallergenic formulas– Extensively hydrolysed formulasExtensively hydrolysed formulas
Nutramigen LIPIL 1 / 2Nutramigen LIPIL 1 / 2 Aptamil Pepti 1 / 2Aptamil Pepti 1 / 2
– Amino acid formulasAmino acid formulas Nutramigen AA LIPILNutramigen AA LIPIL Neocate LCPNeocate LCP
![Page 24: Paediatric Update Course Beardmore Hotel 20 th and 21 st October 2014](https://reader034.vdocuments.us/reader034/viewer/2022051619/56649e5d5503460f94b55c94/html5/thumbnails/24.jpg)
Yorkhill Paediatrics for Primary Care Yorkhill Paediatrics for Primary Care HandbookHandbook
http://www.clinicalguidelines.scot.nhs.uk/http://www.clinicalguidelines.scot.nhs.uk/Primary%20Care%20Handbook%20withPrimary%20Care%20Handbook%20with%20Updates%20nov04.pdf%20Updates%20nov04.pdf