PAEDIATRICS FOR GPS Dr Laura Weidner MBChB MRCGP PGCMDE GP partner / new trainer at Southmead Surgery

Introduction Who am I & who are you? Plan for the afternoon: Quiz, Cases, Rashes Please share you own cases / experience Resources

How are GPs unique? Gatekeepers to hospital – know when to refer Deal with all the minor childhood illnesses Supporting parents in caring for their children day-to-day Practicalities of life as a GP – top things I think you need to know

WHAT DOES A GP HAVE TO KNOW ABOUT PAEDIATRICS? Team quiz…

Common GP Problems Case stories…

My child is constipated… Red flags – blood, faltering growth, meconium Think coeliac / hypothyroidism NICE - Movicol 1 st line +/- stimulant Movicol –licensed >5 faecal impaction and >2 chronic constipation Maintenance = half dis-impaction dose Ask diet / fluids / behavioural rewards / regular toileting NICE guidelines [CG99] Published date: May 2010

My son’s foreskin doesn’t retract …. By 3y 90% have retractile foreskins Of those that are not, 90% improve by age 15y Diprosone od 4-6w 70% success

My babies eyes are always sticky … Imperforate valve of Muller 90% clear spontaneously Try lacrimal massage tds 20 squeezes for 3m Refer 12m for probing (success greatest <2y) Sooner if >3 conjunctivitis

My daughter has sore bits… Worms? Thrush? Contact dermatitis - Bubble baths? Tights? Think child protection

My baby cries a lot… Physical exam to exclude organic cause Growth chart Screen for maternal depression Colic? = Paroxysmal uncontrollable crying in an otherwise healthy baby 3h crying / day in >3d / wk for >3w

My baby vomits a lot… Think about organic causes e.g. pyloric stenosis, volvulus Behavioural measures – feed propped up, feed volumes, winding Trial gaviscon / ranitidine Refer if failing to thrive despite simple measures Reassure and review

I think my baby has a food allergy… Top food allergens – milk (CMP 2-7% children), eggs, nuts, wheat Consider if multi-system sx or dose dependent sx or failure to respond to rx for eczema / GORD / constipation IgE within 20m – urticaria / angiooedema Non IgE – eczema / GORD / diarrhoea Rx – elimination (4-6w), dietician Refer if – IgE mediated, severe, failure to thrive, atopic, multiple food allergies, diagnostic uncertainty, non- resolution Most outgrow – 3y for non IgE and 5y for IgE 1° lactose intolerance rare (except after gastroenteritis) NICE guidelines [CG116] Published date: February 2011

My child ‘just isn’t right’ doc… E.g. headache, tummy aches Try to pin them down Acute or chronic Ask about red flags eg sweats, failure to thrive Examine – glands, organomegaly Height / Weight Document Review

SPOT DIAGNOSIS My picture quiz…

Anyone share any stories… What’s the oddest thing you’ve ever been asked?

Survival tips… How do you deal with all the odd questions you are asked – paeds, colleagues, personal experience, friends, super nanny! Be aware of local funding priorities e.g. tonsillectomy

Resources NICE: febrile child, UTI in children, food allergy in children Local hospital or CCG guidelines Local support: – Colleagues – GPwSI? – Paeds line Mon-Fri 1-2pm

References Google images Dr Martin Kittel (Forest End Medical Centre – Bracknell)