Paediatric Update Course Beardmore Hotel 20th and 21st October 2014

Dr David Gilmore Regent Gardens Medical Centre Kirkintilloch

Beardmore Hotel No fire alarm tests planned Coffee will be served outside auditorium Lunch served in hotel restaurant

Course Aims Improved knowledge and understanding of child development Improved knowledge and understanding of (some) common child health problems

Course Feedback / Admin Please fill in a feedback form afterwards Please remember to sign in each day

Course Format Mostly short lectures Time at the end of each talk for questions Tuesday morning smaller groups for videos

The RCGP GP Curriculum Statements 3.04 Care of Children and Young People Most healthcare for children delivered outside hospital 20% average GP list under 15 – 1 in 4 consults Schoolchildren visit the GP 2 – 3 times / year Under fives visit on average 6 times / year

Child Health Surveillance Programme In the past was done by child health doctors based in health centres 1990 contract saw GPs doing checks 2004 “New Contract” now part of “Global Sum”

Child Health Surveillance Programme Previously checks done at 6 weeks, 9 months and 3 ½ years Hall 4 Report in 2002 radically changed the programme Routine checks now only carried out by GPs at 6 weeks 30 month review by Health Visitors recently introduced

The 6 Week Check

Common Problems Undescended testes Hydrocele Inguinal Hernia Umbilical Hernia Vomiting / gastro-oesophageal reflux Cow’s milk allergy

Undescended Testes Important to distinguish between retractile / ectopic / incompletely descended testes 5% of full term babies have one or both testes undescended 1.5% undescended at 3 months 0.3% at one year Refer if testes not in scrotum at 6 months Surgery usually carried out between 1 and 2 years

Hydrocele Enlarged scrotum noted Often testes cannot be felt separately Transluminence may be observed Most infant hydroceles resolve spontaneously Referral not indicated until age 15 months

Inguinal hernia Usually reducible May be associated with pain Present in groin and scrotum Refer for surgical repair Refer urgently if under 6 months old

Umbilical Hernia Incomplete closure of umbilical ring after birth May enlarge when active or crying Most resolve within first 3 to 4 years of life Referral not indicated until age 3

Gastro-oesophageal Reflux Seems to be increasingly common ? Related to changes in formula milks Distress and regurgitation of milk after feeding or lying down Try Infant Gaviscon Consider ranitidine Consider milk allergy

Reflux Treatment Infant Gaviscon : one dose each feed Half sachet below 4.5 kg Dual sachet above 4.5 kg Ranitidine 1 – 3 mg/kg twice daily (15mg/ml)

Cow’s Milk Allergy Affects 2 – 7% of children under 1 year Second commonest childhood food allergy Less common in older children and adults

Presentation IgE mediated Non-IgE mediated Within 2 hours (usually within 20 minutes) Angioedema / urticaria / rhinorrhoea Vomiting / abdo pain / diarrhoea Non-IgE mediated More non-specific symptoms Reflux / crying / diarrhoea / constipation / eczema More difficult to diagnose

Investigation / Diagnosis Skin prick testing Elimination diet

Management Hypoallergenic formulas Extensively hydrolysed formulas Nutramigen LIPIL 1 / 2 Aptamil Pepti 1 / 2 Amino acid formulas Nutramigen AA LIPIL Neocate LCP

Yorkhill Paediatrics for Primary Care Handbook http://www.clinicalguidelines.scot.nhs.uk/Primary%20Care%20Handbook%20with%20Updates%20nov04.pdf