Paediatric Pearls

With apologies for missing March – time management issues….

Functional abdominal pain this month with a link to a handy patient information leaflet, pubertal and growth issues, neonatal spots and some not-for-the-faint-hearted youtube videos on intraosseous line insertion for the ED practitioners amongst you.  Do leave comments!

This is the first time in ages I’ve managed to get the finalised version on line in time for the end of the month!  NICE on autism this month, a bit on the use of corticosteroids in croup with help from the Cochrane Library, update on secondary prevention of meningococcal disease and a pointer to our local educational psychologist service which is hoping to make stronger links with the borough’s GPs (see also below).  Our feeding series continues with an article on colic from one of the junior paediatricians with lots of useful links and updates.

It’s the last day of September today so I’ve just got in by the skin of my teeth…  In this month’s edition I have done a bit on BCG vaccination from the recently updated NICE guideline on TB, reminded you of where to get the new growth charts from and how to plot ex-prem babies on them and featured a somewhat depressing paper from Archives of Disease in Childhood this month on the effects of maternal obesity on the baby.  Do leave comments and questions below.

Well the BMJ produces 2 journals in one in August so why can’t I?  All the topics featured this month are relevant for both GPs and ED doctors – for once – so you have a joint newsletter.  I have covered headache this month, Vitamin D (by popular request) and we have started the “Feeding” series requested by my ED senior colleagues.  It seems appropriate to have covered breastfeeding first.  Do leave comments below.

This month I have reproduced some immunisation myths and truths from Dr Ravindran’s excellent summary published in full somewhere on this blog (use the search function if you can’t find it below). NICE’s UTI guideline has just been reviewed; did you know there was a section called “Do not do recommendations”? Worth a look as we are all guilty of doing some of what we are not supposed to. Our new list of local breastfeeding drop-in groups is out, reduced unfortunately since the cutting back of Childrens centres’ funding. The GMC have clarified parental responsibility nicely and, as a step-parent myself, I was quite pleased to see the sensible point on the end too. Lastly, it is a bit depressing to be told that it takes 3 times longer in the UK for a child with a brain tumour to be diagnosed than in the US. Do leave comments below.

January reminds us all of the NICE guideline on head injury and specifically when a child is supposed to be referred for a CT.  We continue our 6-8 week baby check series with information on undescended testes.  There are also links to agreed blood test reference ranges and resources to help with the identification of asthma inhalers.  Download January 2011 GP PDF here.

School refusal is often a symptom of an underlying anxiety disorder.  The child may get anxious on separating from their primary caregiver and this manifests itself in different ways depending on the age of the child as much as anything.  There are 2 peak age groups who develop school refusal, 5-7 year olds and 11-14 year olds.  25% of school children refuse to attend school at some point in their school career but it becomes a routine problem in about 2% and the longer it goes on, the harder it is to reverse.  It is not the same as truancy.  It is not a mental illness in itself but many children who feel unable to attend school over a long period do have an underlying mental health issue.  Unfortunately funding for CAMHS is being eroded and  it is difficult to find good, and timely, help for school refusers.  The websites I have listed in December 2010 Paediatric Pearls for GPs may help give parents pointers for why it is happening and how to set about managing it.

December’s Paediatric Pearls (GP edition) reminds us all of the NICE guideline on antibiotic prescribing in respiratory tract infections.  I would like to do a bit more of the “delayed prescribing” in the Emergency Department but it would require either the family coming back (ie. a “no antibiotic” policy really) or their putting a bottle of amoxicillin in their fridge and potentially not using it as we give out the actual antibiotic in A and E, not prescriptions.  We’ve also featured a couple of papers showing that chest x-rays add very little to the management of a child with a respiratory illness which I think most GPs know but it doesn’t harm to remind trainees still in the hospital that, just because the radiology department is at the end of the corridor, it doesn’t mean you have to use it!  We continue our 6-8 week baby check series with information on sacral dimples and I have also put in a couple of websites with sensible, empathetic information and advice on school refusal.  The beginning of term is stressful for children who find it hard to go to school and parents may find these sites helpful when trying to understand why their child is behaving in that way.  Happy New Year to you all!

November’s Paediatric Pearls is now published and is available for download here.  It sees the start of our 6 week check series, kicking off with information on heart murmurs.  There is also a bit on bronchiolitis as the season is upon us now and a feature on the NICE guideline on nocturnal enuresis which was published at the end of October 2010.

The October edition features eczema herpeticum, the 2009 NICE guideline on coeliac disease and a useful table of infant formulas suitable for cows’ milk protein allergic children.  Click here!