Lots about diarrhoea this month. Also ADHD and no need any more for an ECG prior to starting medication. Obesity in A&E; can we at least start the journey towards a more healthy future in the Emergency department?
Burns this month – with much discussion amongst the editorial group prior to publication. There are lots of different children’s burns protocols it transpires. RCEM’s is not aligned with the London and South East Burns Network’s. The message is “use your own burns referral unit’s guideline”. The other important message about burns is watch out for NAI but, even if the burn is accidental, refer all children to their health visitor as HVs in the UK are responsible for talking to families about safety in the home.
Also, complications of Kawasaki Disease, ADHD and the updated MAP guideline (managing cows milk allergy in primary care) which emphasises that 98% of crying babies do not have CMPA. Do leave comments below.
with thanks to Dr Monika Bajaj, neurodevelopmental paediatrician practising privately in east London.
ADHD is a chronic life long disorder of self-regulation with symptoms persisting in >70-80% adolescents and >50% adults.
It is real disorder with real long-term risks, just to quote a few impacts….
- Up to 30% of children may have depression and up to half of girls with ADHD may attempt self-harm
- Children with untreated ADHD are >5 times more likely to participate in fights and underachieve at school
- Adults with ADHD are 9 times more likely to end up in prison, more likely to experience financial problems and being fired from a job.
- Adults with ADHD have a higher mortality compared to those without mainly due to causes such as driving accidents, substance abuse, obesity and co-morbid problems (Dalsgaard et al. Lancet 2015, May;385(9983):2190-6)
- Organisational skills problems (time management, memory, late and unfinished homework and projects)
- Erratic work and academic performance
- Family/marital problems
- Poor sleep and other household routines
- Difficulty managing finances, impulsive shopping
- Compulsive addictions – sex, gambling, video gaming, exercise, eating
- Frequent accidents secondary to recklessness
- Speeding tickets, car and motorbike accidents
- First degree relatives with ADHD
- Low self-esteem, chronic under-achievement
ADHD is usually diagnosed after the age of 6 years to allow for the child to mature. Almost all children have times when their behaviour seems unacceptable and age inappropriate. However, when behaviours happen many times a week or daily, ADHD ought to be looked for. NICE guidance allows children to be treated after the age of 5 years and medication makes a huge and quick difference along with psychoeducation and behavioural management.
Resources: The Canadian ADHD Resource Alliance (www.caddra.ca is an excellent resource for professionals with free downloads).
US guidelines have recently changed to allow treatment of some 4 year olds with debilitating features of ADHD (https://www.healthychildren.org/English/news/Pages/Practice -Guideline-for-the-Diagnosis-Evaluation-and-Treatment-of- ADHD.aspx)
UK support group: https://www.borntobeadhd.co.uk/