Little evidence for efficacy 120 children aged 1-5y given prednisolone or placebo No effect on parental reported respiratory symptom score at 7 days 700 preschool children given prednisolone or placebo No effect on duration of hospitalisation No effect on respiratory symptom score in first 24 hours Steroids in preschool VIW
Short burst therapy probably should be reserved for clinical features suggestive of atopic asthma History of multi-trigger wheeze Severe eczema Family history of atopy Steroids in preschool VIW
What determines need for admission?
Oxygen requirement (SpO2 <93%) Respiratory effort Hydration concerns Social complications What determines need for admission?
Preschool wheeze appears to have multiple phenotypes Short burst oral steroids no longer the cornerstone of management for all preschool wheeze Questions? Take home points
Unwell for 2 days with runny nose and cough Feels hot Mum noticed lump in neck Micah, 2 years
What do you want to know?
Well/unwell Location Size Heat Other lymphadenopathy Spleen/liver What do you want to know?
4-5cm diameter firm swelling in upper cervical chain Non-fluctuant A few other small lymph nodes No swallowing issues Well otherwise Micah, 2 years
Plan of action?
Do nothing? Investigations? Oral antibiotics? Intravenous antibiotics? Plan of action?
“Reactive” Infection Bacterial Atypical mycobacterium TB Other Causes of acute cervical lymphadenopathy
Fluctuant node Incision & drainage/excision Well Oral antibiotics for 7-10 days – review in 48-72h Unwell IV antibiotics Investigations probably only indicated for persistent adenitis (>2 weeks) Plan(s) of action
Acute adenitis If collection suspected, needs I&D Oral antibiotics & review appropriate for the majority of well children Questions? Take home points
Awoke complaining of left hip and thigh pain Previously fit and well apart from an upper respiratory tract infection 7 days previously Bethany, 6 years
What else do you want to know?
Characteristics of the pain Systemic features Recent travel or systemic illness Medication history (Trauma)
Bethany, 6 years Refused to weight bear Became very distressed at attempted examination Temperature 38.7 Flushed & tachycardic