All posts by Julia

July 2021 newsletter

This month‘s newsletter is all about paediatric rheumatology, with thanks to Dr Lucy Backhouse for editing it this month.  Raynaud’s, hypermobility and JIA with a quiz for you (and your CPD portfolio) and extra resources for your patients and families.  Do leave comments below!

June 2021 newsletter

With thanks to Dr Jackie Driscoll for a safeguarding theme again this month.  Burns, FII, CPC, FGM.  Do read the newsletter to verify the acronyms and bring yourself up to date with the current themes in child protection. 

May 2021 PDF

A mixture of topics this month again.  Estimating testicular volume without an orchidometer, correcting for gestational age on growth charts, Resus Council update and the ins and outs of using photographs in virtual consultations.  Do leave comments below.

April 2021 PDF – all about allergy

A visual guide to the most common food allergies this month and pointers to new guidance on when to introduce allergenic foods to babies.  The EATERS history is useful in ruling out allergy and there’s a good mnemonic about soap to stop us all misdiagnosing penicillin allergy.  Do leave comments below: 

Tammy’s useful (and well-used) allergy websites

Itchy Sneezy Wheezy- great for videos on techniques for nose spray, allergy tests, and other info for families & health professionals

Anaphylaxis UK: for campaigns, patient information and patient support

AllergyUK has lots of useful information sheets and resources

Allergy Academy- for courses and information

MedicAlert– this website has a range of different alert bracelets and tags

AsthmaUK– Excellent website, especially videos on technique

AllergyGoAway.com– An American site with good graphics

March 2021

Digging deep into safeguarding again this month with thanks to Nicci Wotton, head of safeguarding at Imperial, London, UK.  A reminder of useful apps for our young patients and pointers to documents that govern our safeguarding responsibilities in the UK and internationally.  Do leave comments below.

February 2021 newsletter

An emphasis on children’s psychological support this month, particularly around bereavement during Covid. A couple of useful links to PIMS-TS information for GPs and families, a bit more on bites with a safeguarding slant and what to do with constipation when Movicol is not the answer.

Do leave comments below.

Functional constipation – it’s not all about Movicol

with thanks to Dr Edward Dallas, paediatric registrar.

Constipation is <3 stools per week, often hard and large or rabbit droppings, often painful, possibly with overflow. Its prevalence is around 5-30%!

Most is idiopathic/functional, but the clinician must rule out red flag symptoms such as:

  • Constipation from birth
  • Delay in passing meconium <48 hours from birth, could suggest Hirschsprung’s or Cystic Fibrosis
  • Abdominal distension with vomiting, could suggest obstruction
  • Leg weakness or motor delay, could suggest neurological or spinal cord problem
  • Ribbon stool pattern, could suggest anal stenosis (usually presents <1 yr)
  • Faltering growth, could suggest coeliac disease or hypothyroidism

Remember that breast fed babies can have long periods between stooling.  The introduction of cow’s milk based formulas can lead to constipation. Constipation often plays a big part in bedwetting and daytime continence issues. Examine the abdomen and spine in a child with enuresis.

The aetiology of constipation is multifactorial and includes: pain, fever, inadequate fluid intake, reduced dietary fibre intake, toilet training issues, the effects of drugs, psychosocial issues, and a family history of constipation.  Primary school children who can’t quite organise themselves to empty their bowels before going to school and then won’t use the toilets at school often get bunged up quite quickly after starting school.

Management of idiopathic/functional constipation:

 The management of functional constipation has 6 main components:

1– Education (demystification)
2- Fluids and diet
3- Regular toilet habit (behavioural) and exercise (re-training)
4- Disimpaction (if in doubt, disimpact!)
5- Maintenance laxatives
6- Regular follow up and support

Diet and Lifestyle advice e.g., regular toilet breaks with praise, star chart etc.

Reassurance, with sources of information & support:

Longstanding constipation is unlikely to get better without medication.  If left, it gets worse so please ensure you start the child on treatment before considering referral.

 

Laxatives:

Usually start with a “Dis-impaction regime” which includes increasing doses of Paediatric Movicol, often adding Senna after a few days if the child still seems to not be passing the lumps.  See https://pathways.nice.org.uk/pathways/constipation.

(A parent’s guide to dis-impaction can be found here: https://www.eric.org.uk/pdf-a-parents-guide-to-disimpaction)

If Movicol is not tolerated, try:

Bisacodyl tablets e/c 5mg (swallow whole)

OR Sodium picosulfate liquid 5mg/5mL

See NHS Lothian formulary for age-appropriate dosing at https://www.ljf.scot.nhs.uk/LothianJointFormularies/Child/1.0/1.6/Pages/default.aspx

Once dis-impacted, the child should be switched to a Maintenance regime to allow muscles and nerves to return to normal.  This will take at least 6 months.  Don’t stop medications too early!

Paediatric Movicol 1-4 sachets/day

If over 12 years old, use adult Movicol / cosmocol 1-2 sachets per day

Lactulose and Senna – see BNFc or the NHS Lothian formulary for suitable doses.  Lactulose is bad for teeth.  All laxatives can be diluted with squash, fruit juice, water or milk.

Regular follow-up and support. Aim to wean off once the child has had soft stools for at least 6 months.

Resource: https://apps.nhslothian.scot/refhelp/guidelines/ResourcesLinks/Paediatrics%20G.I%20paed%20constipation-final.pdf

January 2021 PDF

A plea to not lose unwell children in this sea of Covid this month, antibiotic prescribing in animal and human bites, first aid for burns and important fluid adjustments for overweight children with diabetic ketoacidosis.  Do leave comments below.

December 2020 PDF

Raised intracranial pressure on the front line this month, menorrhagia in adolescents, psychological first aid and some normal reference values for children from Royal College of Paediatrics and Child Health.

Do leave comments below.