CAM304 - Clinical Specialties Paediatrics 1) Introduction to Child Health 2) The Unwell Child 3) Child Development and Wellbeing and Immunisation 4) Neonatal examination tuteIntroduction to Child Health Dr Tom Clemens Know how to take a comprehensive Child Health History To come to a diagnosis. + Hi - 80% + Examination - 15% + Investigations. 5% Hx of the Presenting complaint Past Medical and surgical history Medications Allergies Immunisations Pregnancy Birth and neonatal period Feeding ‘Onset Duration, frequency, severity ‘What makes it batter or worse ‘Seasonal variation Effect on normal activities such as school and sport Previous consultations and treatment for the problem and its effect Associated symptoms ‘Significant illnesses Hospital admissions including datas, reasons and outcomes Injuries ‘Childhood infectious diseases ‘Current mads (dose and frequency) ‘OTC and non-prescription meds ‘Complamentary meds Compliance with meds Any resistance to the meds from child/parent (Causes of allergic reactions Type of reaction Are they up-to-date with immunisations as per the current childhood immunisation schedule? Was the pregnancy planned? Details of antenatal care llinesses and medical problems during pregnancy’ Exposure to smoking, aloohol, medications and illicit drugs Gestation (eg. NVB at term) Duration of labour Birth weight (kg, g) Any resuscitation needed? Ask APGAR scores, admission to NICU Breathing problems, feeding prablems, jaundice Vitamin K {IM or oral) and newborn screening tests (heel-prink, hearing, pulse oximetry} Did mother and baby leave hospital together? Look at child health record if mother brought in Mother's past natal health Past nalal depression screening Breast fed? Current feeding - breast, formula, solid Is growth normal (check percentilas in blue book? If feeding issue —> go through a typical days intake, including drinks such as juice and waterGrowth and development Family history Psychosocial history Systems review Plot height, weight, head circumference on percentile charts ‘Ask about major milestones - compare with siblings and peers ‘Ask about attendance at day care Parents health status (alive and well, medical problems that run in the famil, marital status, age, ethnicity) ‘Age, sex and PMHx of siblings Detaiis/dates about miscarriages, stilbirths and deaths of siblings Any FHX of the presenting problem ‘Who livas at home with you? Family stability, safety at home? Parental emplayment and occupation ‘Type of home Alfendance at day care, schoo! Academic progress ‘Childrens play and participation in sports Relationships with peers Financial and social problems Family support Child's personality ‘Overseas visits or contact with overseas visitors W required Know how to assess a Child’s development Gross Motor Fine motor Language Social 6-8 weeks Lifts chin when Pulls at clothes Babbling noises, Smiles prone, holds head respends to erect when held sounds, recognises upright mothers voice 6 months Sits up with Reaches and Repitition of sounds | Stranger anxiety support, rolls over, grasps objects with (da-da-da) ull head-control ulnar grasp, can transter abject tram hand to hand 12 months Stands alone, first bangs blocks speaks first words Drinks with cup. steps together, stacks (23 bayand Mama, objects, throws Dada), associates objects onto floor, words with has pincer grip meaning, responds to no, knows awn 18 months Walks alone, Builds tower with — Speaks 10-25, Can use spoan jumps, climb steps 3-4 blocks: words, says awn with support name, knaws name ‘of familiar people! body parts 3.5 years Gan ride tricycle Copies a circle Speaks in Can dressiundress: sentences, follows except buttons! a9 stepinstruction lacesKnow how to assess a Child's feeding and growth + Breast feeding or formula feeding + 4-6 months - introduction of solids + If over 4 months, ask what solids they are eating + Normal weight gain + Ist week - can lase up to 10% body weight + then weight stabilises and increases + weight gain approx 150-200 g/week + Assess growth on percentile charts + weight, length, head circumference + Specific BMI charts available + Adjust for prematurity (<37/40) until 2 years + Take into account parents height and weight + Always include percentiles in child health history + Worry + if line crosses percentiles + below 3rd percentile or above 97th gentile (failure to thrive or childhood obesity) + low percentiles associated with other medical or feeding problems Know the Childhood Immunisation Schedule, the benefits of Immunisation and the side effects Childhood immunisation Schedule injected into thigh until 12 menths, then upper arm Birth hep 2months + 4 months (2 injections and drops) hep DTPa (diphtheria, tetanus and acellular pertussis) 6 months (2 injections, no Rotavirus) Hib (Haemophilus influenza type B) IPV (Inactivated poliamyelitis) 18VPCV (pneumococcal conjugate) Rotavirus 12 months (2 injections, Hib-MenG combined + Hib (Haemephilus influenza type B) MMB) MenfC¥ (Meningoesccal C) MMR (Measias, mumps, rubella) 12.24 months ATS! in high risk areas Hepatitis A 23VPPV (pneumococcal polysaccharide) 18 months MMRV (combined MMF and VZV - Varicella) DTPa (diphtheria, tetanus, acellular pertussis) Ayoars DTPa/IPV (diphthoria, tetanus, acellular pertussis -combined with inactivated poliomyelitis) Benefits of immunisation include immunity of the child against preventable and patentially life threatening or debilitating diseases, and herd immunity. For the family, lass time off work, financial incentives for immunisation and cost of caring for sick child. Side effects: Local side effects - discomfort, redness, lump at site of infection Generalisedsystemic side effects - fever, rash, drowsiness, reduced feeding Allergic reactions/anaphylaxis - occurs within 10 min, can’t breathe and potentially life threatening ‘What is each disease we immunise against?Hepatitis B is a viruses that causes serious liver intections that can progress to chronic: liver failure. Passed by blood-blood contact. Diphtheria causes obstruction to breathing, and can cause severe permanent damage to heart and nervous system, Mortality 1/10. Tetanus is caused by bacteria infecting a wound. The disease affects the nervous systam causing spasms and paralysis and often leads to death. Pertussis or Whooping cough is a highly infectious disease of coughing spasms that can interfere with breathing. Can last for wks/months and life threatening in very young and very old. Poliomyelitis is a gastrointestinal virus that causes permanent paralysis of limbs. Haemophilus influenza type B is a bacteria infecting children younger than 5. It infects brain covering, the meninges or the epiglattis swells in the throat obstructing breathing. Develops very ‘quickly and can be life threatening Pneumococcal disease can be invasive or non-invasive. Invasive pneumococcal can be life threatening - meningitis, septicaemia, pneumonia. Middle ear infection is common in the nan- invasive form. Most vulnerable is very young or very old. Rotavirus is a viral infection causing gastroenteritis, particularly in kids <2. Sudden onset vomiting, diarrhoea, fever for approx 7 days. Some children become very dehydrated and need hospitalisation, Meningococeal infection is rare but can be Ife threatening at any age. Infections can include meningitis, septicaemia, Symptoms include fever, vomiting, headache, initability, seizures, neck stiffness, rash Measles is a contagious viral illness causing high fever, rash, runny nose, cough and conjunctivitis: Mumps is a viral illness causing fever, headache ant ‘with mumps develop painful swollen testis, iflammation of the salivary glands. In M, 1/5 Rubella also known as German measles, is characterised by mild fever, swollen glands, arthralgia, ssh on face and neck that spreads to body, lasting a few days. Gan cause serious complications if ‘contractad by foetus during pregnancy. Varicella also known as chickenpox, is high contagious causing fever, runny nose, cough, fatigue, general rash. Sores start as bumps which become blisters for a few days. Be able to appropriately communicate with a parent with regard to their child Building rapport ‘Show interest in child from start Set desk up so you aran't behind it Have valuable equipment or dangerous objects out of reach ‘Observe child playing with toysListening Asking questions Talking with children Respect parents views Parents often accurate with observations Parents are tired and anxious Validate the parents point of view “I can see that you are worried, but from my point of view, children with this condition usually improve” Parents know their children best Initially ask open ended questions Then more specific Don't suggest an answer in your question Take a moment to engage child ‘Smile and talk about things they are interested in From 6-7 years can give a bit of a history ta listen to their points of view Communicating Effectively with Kids Dr Nick Cooling Birth to 6 months 6-18 months 18 months - 3 years 3-6 years. 6-12 years. No stranger anxiety Non verbal communication is key - facial expressions, tone of voice Make faces and talk baby talk! Stranger anxiaty! Try to keep child with caregiver Communication mostly non-verbal but talk to the child anyway Use stimulating abjects to catch attention for distraction of assessment Motor skills much more advanced than ‘communication skills More explorative but still shatter with parents Will understand mare words than can say Constantly moving Play and curiosity are big motivators Use tools and toys Talkative! Starting to understand about being sick and people ‘will ry and help thom. Magical thinking ‘Worry about being in trouble Like to have chaices Fear failure, want to be treated as big kids, but feel baby insecuritias ‘Want to be accepted and bland in Body-conscious and modest May fea! pain intensely Question the child directly and in simple, but not babyish terms Use common interests to build trust (sports, TV and movie characters} Offer limited chaices‘What parents want? ~ treat children as people ~ get their name right = Intraduce sel to parents, check they are the parent ~ Check the Childs name and what they like to be called ~ Get the gender right ~ Treat every child as if they were the most special, beautiful, smartest child in the world ~ Get down to Childs level Know how to conduct an appropriate examination of children throughout their various ages Newborn to 12 months APGAR Scoring System Used at 1 min and § min after birth to assess CNS status and general adaptation of the baby to ‘external environment. APGARS identify where there is a need for resuscitation. Normal APGAR is 9 - babies stay blue for a few days APGAR Scoring Table ign ‘Points |i Point | 2 Pointe (00m) espry | Abs a on ‘ale Minette [Faced me ies | Astor oe a Retox No meponse [Crime | Vigmeme ‘oa a ‘Calms Pale | Gremio | Eaiy ny Neonatal problems + Breathing problems - oxygen, resuscitation, admission to NPICU + Feeding problems (breast or bottle) + Neonatal jaundice + usually physiologically due to high Hb counts. —> breakdown into unconjugated bilirubin (deposited in skin) + Vitamin K Deficiency Bleeding (VKDB) + Vit Kis an essential vitamin for praducing clotting factors + 1/10000, + Results in intracranial bleeding + Prevented by giving 1 injection of Vit K at birth + Alternative - 3 oral doses of Vit K (birth, 3-5 days, 28 days - not as effective) + No evidence Vit K is linked to childhood cancer + Newbom screening tests + Wary from state to state + 99% of newborns tested + 1/1000 have a metabolic disorder + Includes newbom hearing screening and pulse oximetry screeningNewborn Screening Tests Cystic Fibrosis Autosomal recessive, mutation in Cystic fibrosis transmembrane conductance regulator (CFTR) protein. Affecting exocrine glands, causing abnarmally thick mucous leading to obstruction of pancreatic ducts, intastines and bronchi (predisposing to respiratory intaction) Phenylketonuria Inherited error af metabolism, rosults in decreased metabolism of the amina acid (PKU) Phenylalanine. If untreated, phenylalanine builds up causing intellectual disability and ather serious health problems. Congenital Lass activa, siaep more than normal, difficulty feedin hypothyroidism disability and slow growth. constipation, intellectual Galactosemia Autosomal recessive genetic mutation affecting haw galactose: is broken down. Develop feeding difficulties, lethargy, failure to thrive, jaundice, liver damage, bleeding, cataracts. Other Rare Aminaacidopathies, organic acidemias, fatty acid oxidation defects conditions Neonate examination tutorial Examine from head to toe = general appearance - colour (jaundica), behaviour ~ head - fontanelles (anterior + posterior), sutures, haematomas Mouth - thursh, suck, cleft palate ~ Ears CVS/Resp - RR, HR, Pulses (femoral and brachial), heart sounds, breath sounds ~ Abdomen - masses, distension, umbilicus ~ Take off nappy = hernia, extemal genit: = Hips - for congenital hip dislocation Musculoskeletal - moving all imbs and examining spine CNS - tone, head control (test for head lag) Primitive reflexes - sucking, grasp, Moro, stepping ~ Eyes - sed reflex using ophthalmoscope Weight (bare), length, head circumference (tested should be fully descended), anus 2 week check > Any concems - Review family history - Medical, early eye problems, hearing loss + Cansider if increased risk of CHD - Fhx, breech birth Toddler + Some infants may refuse examination all together + These children rarely seriously ill + Toys may distract + Leave ear and throat examination until last + Keep it quick Observation Colour Alertness ‘Type and rate of breathing Cough or wheezo Developmental state (apprapraite tar age?)Abdo: Difficult in crying child Inspection Palpation ‘Organamegaly Feel for bladder cvs Pulses BP (appropriate size cuff for age) Palpate for anex and thrills (implies murmur is pathological) Hear sounds Murmurs (children can have soft, systolic murmur which is innocent) Resp ‘Observe breathing - rate, use of accessory musclas Chest shape (hyperinflation, pigeon chest) Peroussion Braath sounds (vesicular or bronchial) ‘Added sounds (crackles or wheeze) Head and neck Anterior fontanella can be palpated until 18 months (tension increases with increased intraoaratsral pressure, eg crying, decreases with dehydration Head circumference Lymph node palpation Mouth - tonsil, gums, teeth, palate Ears - use olascope - draw pinna straight backwards to lack at tympanic membrane Other Check temp Neuro exam Musculoskeletal systarn Extemal genitalia Hips checked until 18 months Developmental assessment Height, waight (BMI), head circumference ‘Older Child + Not usually a problem if approached in a friendly manner + From head ta too - Can asses pubertal stage in older child + Height, weight, BMI Additional Info Investigations: + Not always required - will it alter management + Throat swab/nasopharyngeal aspirate —> MCS or specific POR + Venepuncture usually traumatic! + FBE if anaemia suspected + Urine samples can be difficult + Xeray suspected fractures luenze, pertussis, RSV) Prescribing: + Always weigh child!! - Paracetamol 1Smg/kg 4 hourly + Ibuprofen 10 mg/kg + Think about children not being able ta swallow tablets - need syrupThe Unwell Child CAM304 - Clinical Specialties Recommended resources + Royal Children's Hospital Clinical Practice Guidelines + Spotting the sick child —> free online module + Basic Child Assessment + Symptoms 7 modules - do the first 5 3 minute Toolkit Airway Secrations Stridar Foreign body Breathing Resp rate Repessioniaccessory muscle use 2 saturation ‘Auscuttation Circulation Colour (pale, mottled) Heart rata Capillary refill ‘Temperature of hands and feat Disability Pupils Limb tone and mavement AVPU scare/GCS (Alert, responding to weice, responding to pain, unresponsive) Ears, nose and theaat exam Temperature Tummy I drowsyfunwell include DEFG (Don't ever forgat glucase) Girculation - blood pressure Paediatric Vital Signs Age RR HR Systolic BP <1 year 30-40 110-160 70-90 25 years. 25.35 95-140 80-100 5-12 years 20-25 80-120 80-110Fever + Common, especially if under 2 years + Highest risk if less than 3 manths + Mostly mild viral infections, self limiting + Infection is one cause, there are other non infectious causes + Significant benefit from immunisations Cammon acute serious causes of fever Cause ‘Age group: Description Skin infections Infants - 6 months UTlipyelonapheitis, Infants - 2 years Preumania Infants - 5 years Meningitis Infants - 12 years Rarer causes Septic arthnitist Infants - 2 years osteomyelitis Orbital eotultis Infants - 5 years Kawasaki disease 6 months - 5 years ‘System onset juvenile 6 months - 12 years idiopathic arthritis Moningococeal Infants - 12 years septicaemia Herpes simplex Infants - 12 years encephalitis Epiglottitis Infants - 12 years Mostly Staph Features often non IV antibiotics (gentamicin specific (fever, irtabilty, and benzylpeniciliin) poor feeding, vomiting). Children with ‘gastroantaritis are at increased risk Persistent fever Cultures to identify ‘Tachypnosa causative agent Cough Increased WOB Ifo severe - oral Lethargy/unwell amoxicillin Crackles on auscultation Non specific symptoms Perform LP, FBG, BG. (lever, iritabiity, UEC, bload cultures: lethargy, voriting and. diarrhoea) Post infectious inflammatory response in -chiliren 6 months - 5 ‘years. Prolonged fever. Look up signs = strawberry tongue Classic rach = non blanching (purpura) Haemophilus influenza type B (HIB vaccine)Another way of looking at fever top to toe Meningitis Otisi media Tonsiltis Phaumenia Bronehiolits Septic arthritisiosteomyelitis Surgical causes um How bad is fever + colour + Activity + Respiratory + Hydration + No blanching rash, bulging fontanelle, 0-3 months fever above 38 + History + Younger children - symptoms are much more vague + always consider meningitis + more concern if <3 months + Concern if fever is =5 days + Any relevant birth history/past medical history + Ifpremi- immune system less well developed + Intake/output + History of a particular focus of infection + Examination - General inspection + Activity/alertness: + Breathing + Consolability + Colour - Hydration + Peripheral and central perfusion + Rash + Vital signs Meningitis Revise causative agents Epigiotitis - hameophilus influenza type B (HIB v: Signs + Fever + Vomitintg + Consistent headache + Infants - bulging fentanelie + Older children - stiff neck? Photophobia? (dislike of lights) + Sleepy/vacanviditficult to wake + Confusedidelirious + Seizure ne)Mening L mi + Faver (or hypothermia) + Rigors + Non blanching rash - Tachypnoea + Tachycardia + Pale or mottled skin + Cold hands and feet + Sleepy/vacanviditficult to wake + Confusedidelirious nt-condition!!) Difficulty in breathing + Mostly infections: + Mostly viral, self limiting + More serve in <3 months - causing hospital admission + Step pneumonia + Hemophilus influenza + Pertussis: + Mycoplasma + Influenza Diagnosis + History - fever, runny nose, cough (barking, wet dry), added sounds (wheeze, stridor) + Relevant child health history (hx of CF) + URTI vs LRTI + Generalised vs Localised signs Asthma Recurrent Triggered by viral Cough and wheeze Beta agonists episodes of infections in (Salbutamal) via hyperactive airways younger Generalised chest puffer and spacer. ‘Also allergies and signs across all Steroids. spart lung fields Not usually in children <1-2 years Branchioltis: LATI-viral (RSV) More.common in Increased WOB Supportive winter and spring Wheeze management = Up to 1-2 years Cough supplemental Runny nasa ‘oxygen or fluids Sometimes fever Generalised signs - wheeze and crackles (crepitations} Choking (Inhaled foreign body) Apnoea Asthma AnaphylaxisPneumonia LATI Bacterial More unwell, more pneumonia lethargic Lethargic Tamp > 38.5 reduced oral intake Cough Usually WOB isn't as elevated Increased RR and HR (out ef proportion to degree af fever] Croup UAT! - viral Characteristic Selt-imiting barking cough and flarynogiracheabro hoarse voice May need stercids chats) (oral Can have stridor dexamethosone or Comman in prednisolone takes teddlers Tend to be worse in 48 hours to work) middle of night Severe - may need nebuliser adrenaline and admission for ‘observation ‘Signs of increased work of breathing: ~ Recession of rib + Tracheal tug + Supracivicular/sternalintercostalsubcostal recession + Head bob + Nasal flaring, grunting (babies) The vomiting child and assessment for dehydration + Rotavirus causes gastroenteritis (vomiting and diarrhoea) Note can predispose to UTI! Check out any fever Vomiting ~ brain tumour - classically early morning vomiting (when intracranial pressure is at its highest) Dehydration ~ fluids in vs fluids out = red flags - loss than 6 months, gaing on 52 days - how many wet nappies? Warry if none in past 12 hours: ~ Examination = Activity level - peripheral eyes - reduced skin turgor, reduced cap refil, dry mucous membranes, sunken ‘eyes, sunken fontanelle + Oliguria > weight loss = Mild (only 1 or 2 features) - Sovere dehydration (= 2 features) - tachyeardia, hypotension, peripheral vasoconstriction Red flags - DIKA fluid resuscitationFebrile Convulsions + Small number of § months - 5 year old child with a fever will have a febrile convulsion + Short, self limiting convulsion (20 sec - 2 min). Generalised convulsion involving alll 4 limbs and loss of consciousness + Eyewitness account: + No warning signs + Conscious level (generalised vs partial) + Abnormal limb movements + Eyes rolling up + Blueness of lips + Stiff or floppy + Incontinence + Tongue biting/injuries. + Ask - duration of fit, how long it togk child to come around properly, did they have a headache? + Benign condition that deosn't predispose to epilepsy, BUT terrifying tor parants - Triggered by things that cause fever - viral infections + But important to assess child to look for other signs to check it isn't caused by something more serious + Cause + Hx of symptom of infection + any symptoms of serious bacterial infection (meningitis, pneumonia) + Relevant birth history, family history etc etc + Usually in context of simple viral infection. but can be meningitis/pneumor + Ddx + 3% will davalop epilepsy (Several times higher than normal population) + Ahigh temperature predisposes to it + Status epilepticus + Absences: + Focal fits - partial seizure (CT/MRI) Case Charlotte + YOu perform a newborm examination priar to discharge on day 3 + Normal pregnancy + Normal vaginal birth at tarm (40 weeks) + Agpars + 1 min - HR 120, crying vigorously, flexed posture, centrally pink + Simin - HR 140, regular respirations, active movement, cries in response to vit K injection, centrally pink (acrocyanosis) + Apgar score of 9 - see table Apgar Scoring System Indicator CD ey ce ony Pago+ Plot on growth charts. ~ What immunisations should she of had? + Hep 8 —> for prevention of vertical transmission 3 Weeks old she comes into ED with both parents with a fever of 39 dagress WHAT HISTORY QUESTIONS DO YOU WANT TO ASK? + How long has she had the fever? + Other symptoms? Upset? Lethargic? Feeding poorly? - Wet nappies? HISTORY FINDINGS + She's just not hersetf today, unsettled, 8 small milk vomit + Term baby by normal vaginal birth + Breast feeding, slow weight gain + No unwell contacts - Immunisations should she of had by now + Hep B at birth ‘WHAT EXAMINATION DID YOU WANT TO. D0? + Take temperature again + Vitals + Listen to lungs, compare one side te the other EXAMINATION FINDINGS ~ Appearance - aslegp in father's arms, distressed by examination + Breathing - RF 50m, no increased WOB, chest clear (crying) O2 sat 98% + Circulation - HR 170, capillary rafill 2-4 seconds (oy pressing on stamum with thumb), slightly mottled + Moving all four limbs, normal muscle tone, normal anterior fontanelle: + No skin rash, temp 38.8 degrees WHAT NEXT? + Send her home? + Full septic work up? Blood, urine (suprapubic aspirate), lumbar puncture, chest x-ray + Commence antibiotics + Call paediatric team to admit to hospital? ‘Charlotte now § manths old + Retum back to ED + Cough - Nasal discharge + Difficulty breathing + Poor feeding + Descreased wet nappies + Other family members have a cold + Immunisations + Infanrix Hexa (DPTa/Hib/HepBAPV) + Prevenar 13 (against pneumococcus) - Rotarix (oral vaccine against Rotavirus) + 5: month old development + Smiling at 6 weeks - Recognising parents facas + Reaching and grabbing (fine motor} - Head control - anticipation, no head lagee eee + May be able to sit with some support + Some attempt at ralling - Examination + RR 55 - HR 160 - T3728 + 02 91% + Moist cough + Clear nasal discharge + Moderate increased WOB (driven by hypercapnia) + Subcostal and intercostal ribs + Tracheal tug + Head bob (intants who haven't got complete head control have neck flexion with each breath when using neck muscles such as SCM to breathe) + Na clinical features of dehydration ~ Naxt steps? + Liston to chest + Give oxygent! ‘Charlotte. + Now 14 months + Watery, green stool x 10 in last 24 hours + Vomiting everything + Lethargic, miserable + Reduced wet nappies + Older brother has had similar illness. + Immunisations? - MMR + Hib/Men © + Davelopment? + walking + saying a few words - Symmetrical pincer grips + Examination + Dry mucous membranes + Normal skin tutor + No tears (can be a sign of reduced fluid in body} + Fontanolle not palpable (narmal to feal to 12-13 months) + Eyes sunken (feature of dehydration) + Central capillary refill < 2 sec - Management + Oral rehydration - hydralyte, gastrolyte (small amount of sugar and salthelps to absorb more water) Case Charlotte - 3 years old ~ presents with mather to GP with 2 day history of fever and cough = What history do you want to know? ~ What temperature? - Nature of the cough? Barking? Moist? - Any other assaciated signs? ~ Maintaining oral intake? Vomiting? tory = unwell for 2 days with fever, cough, runny nose, other members all have URTI= today - struggling to breathe + Phx born at tarm, previous brenchiolatis, has milk eczema ~ Fix - strong history of hay fever and childhood asthma in bath parents ~ Six- both parents smoke outside ~ Immunisations - varicella = Development - active, talking, running, jumping, climbing, speaking in relatively full sentences ~ What examination would you do? - Appearance - flushed cheeks, coryza ~ Breathing - RR 40. moderately increased WOB, widespread wheeze, O2 sats 93% = Circulation - pink, HR 140, brisk capillary refll, warm peripheries + ENT- enlarged red tonsils, TMs red ~ What would you do next? Potential OSCE Scenarios Paediatric General Practice Presentations 1) Ha is due for his needles! (Alsa assess feeding, growth and davelapment) 2) She's got a high fever. Give a differential diagnosis for tever and explain what signs you would bbe looking for. 3) She has been unwell with a cold (UAT! vs LATI) 4) She is pulling at her ears, does she need antibiotics (Viral vs Bacterial Otitis Media) 5) He has a bad cough! (barking cough/won't stop coughing/coughs until ha vornits/coughs all night) 6) I'm worried about his breathing, he sounds really chesty 7) She sounds wheezy, do you think i's asthma. Explain what signs you wauld look for. 8) She’s been vomiting and complaining of tummy pain 4/- Ive noticed she cries when she does a ‘wee (nead to exclude UT!) 9) He has been complaining of a sore tummy, could it be appendicitis 10) She has been vomiting and now has started having diarrhoea - I'm worried she is dehydrated 11) He's come out with this rash - is it meningocaceal? 12) She fell and hit her head, does she need stitches 13) Fell and landed on her arm..could it be broken? 14)Do you think it is ADHD? 15) Sarah Jones presents with 12 month old baby son for his routine check up. Take a ‘comprehensive child health history. ‘Comman paediatric DEM Presentations: 1) Respiratory difficulty 2) Febrile illness (bacterial meningitis, otitis media, URTI) 3) Gastroenteritis - diarrhoea 4/- vomiting, assess for dehydration 4) Abdominal pain 5) Seizures (febrile convulsions) 6) Rash (think meningitis)mt ge ee 7) Injury (head injury, fractures, burns, lacerations}