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Paediatric Diseases

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Topics Covered

Introduction

The most common reason for a child to require healthcare intervention is for a respiratory condition. Fortunately, the majority of these conditions are mild and self-limiting in nature, however it is important to recognise these conditions and provide appropriate reassurance.

Conversely it is important to be able to recognise the more serious conditions so that a prompt referral is made.

These conditions can be split into 2 sections: Neonates (just born) and “older children.”

NEONATES

Respiratory Distress Syndrome (RDS)

  • What:
    • Due to a lack of surfactant – making many alveoli not be able to stay open – so not enough oxygen in lungs
  • Who:
    • Unplanned Premature neonates- since surfactant develops in later stages of pregnancy.
    • Antenatal steroids given if planned prematurity to avoid RDS
  • Symptoms:
    • Grunting – the forceful closing of epiglottis creates a positive airway pressure- body’s attempt to keep alveoli patent.
    • Symptoms of hypoxia – blue extremities and mouth
    • Rapid shallow breathing
    • Nostril flaring
  • Investigations:
    • Clinical diagnosis based on symptoms and prematurity
    • Standard monitoring can see baseline (ABGs, O2 sats)
    • CXR shows a cloudy appearance
  • Management:
    • If can’t breathe – don’t eat – need an orogastric tube
    • Kept warm
    • Nasal CPAP to keep alveoli patent
    • If severe – intubation – but want to avoid since can damage fragile lungs – especially if premature. – can lead to BPD
    • Definitive – Surfactant delivery (via mask) or if very mild is self limiting and surfactant will produce naturally over time.

Transient Tachypnoea of Newborn (TTN)

  • What:
    • Amniotic Fluid in Baby Lungs not cleared as it normally is (is cleared a short time before normal birth
  • Who:
    • Any baby that is delivered through a C-Section is at an increased risk as the same length of time of clearing amniotic fluid not passed so can still have fluid in lungs on delivery.
  • Symptoms:
    • Same kind of resp distress symptoms:
    • Grunting
    • Symptoms of hypoxia – blue extremities and mouth
    • Rapid shallow breathing
    • Nostril flaring
  • Investigations:
    • CXR to see fluid
    • Standard monitoring can see baseline (ABGs, O2 sats)
  • Management:
    • Just supportive care – SELF LIMITING – clears up after 48 hours max
    • Dehydrated= IV fluids
    • Hypoxic= Oxygen
    • Not feeding = OG Tube

Bronchopulmonary Dysplasia (BPD)

This is lung damage that has occured in pre-term babies due to their lungs not being fully developed.

Pre-term babies have very fragile lungs so invasive ventilation, especially at high pressures, can damage the lungs. This may be a necessary treatment however, especially in severe RDS.

Additionally any infection can also damage the lungs.

This is treated with at home oxygen usually, and usually results in a full recovery after 2-3 years.

OLDER CHILDREN

Bronchiolitis

  • What:
    • Caused by Respiratory Syncytial Virus (RSV).
  • Who:
    • Peak age under 1 year old
  • Symptoms:
    • Generic Resp infection symptoms:
    • Cough
    • SOB
    • Wheeze
    • Runny nose, sore head, fever
    • Typically worsen on 2nd/3rd night
  • Investigations:
    • Clinical diagnosis- No formal investigations needed as this is a common infection
    • Pulse Oximetry dictates if children are admitted to hospital (<92% = admission)
    • ABG+CXR not routinely performed
  • Management: Just supportive care – SELF LIMITING
    • Dehydrated= IV fluids
    • Hypoxic= Oxygen
    • Not feeding = NG Tube
  • NOT Salbutamol or antibiotics

Croup

  • What
    • VIRAL (usually) [parainfluenza]
    • “Laryngotracheobronchitis” – Upper Airway infection and swelling
    • Common
  • Who
    • Children around the age of 1
  • Symptoms
    • Stridor
    • BARKING COUGH – classic sign
    • “Bit of a cold and woke up in the middle of the night with this cough” – classic history
  • Investigations
    • Clinical diagnosis – if it sounds like croup- probably is
  • Management
    • Single dose of oral steroid – reduces inflammation in upper airway
      • Dexamethasone or prednisolone
    • Unlikely to need admitted – but if severe – may need oxygen and adrenalin

Epiglottitis

  • What
    • Inflammation of the epiglottis – due to Haemophilus B Bacteria
    • Uncommon – since the HiB B vaccine protects
    • MEDICAL EMERGENCY – if susected ACT
    • Since inflamed epiglottis can block the trachea
  • Who
    • Anyone unvaccinated – Children most common (not old enough or parents anti-vax)
  • Symptoms
    • NO COUGH
    • Drooling
    • Lethargic
    • STRIDOR
    • Difficulty Swallowing
  • Investigations
    • NONE – if drooling, lethargic child- don’t touch airway – immediately get an anaesthetist
  • Management
    • Securing of airway by anaesthetist by intubation
    • Supportive care + antibiotics – resolves rapidly after

Cystic Fibrosis

*ONLY FOCUSING ON RESPIRATORY – MANY SYSTEMIC SYMPTOMS AND TREATMENTS*

  • What:
    • Mutation in CFTR gene
      • Gene normally codes for a protein that stops Cl entering secretory cells and Na from leaving these cells.
      • Without proper function of gene – Cl able to enter cells and secreted from these cells.
      • Na leaves cells and carries water with it by osmosis
      • Overall all secretions by secretory cells is dehydrated – THICKER
        • This primarily effects the respiratory tract and GI tract (MUCOUS)
        • But also affects sweat and the exocrine and endocrine function of the pancreas
    • Due to thicker secretions – harder for the secretions to be cleared- so reduces the effectiveness of mucus from stopping infection – RECCURANT INFECTION LIKELY
  • Who:
    • Diagnosed in children
    • Chronic condition – affects are lifelong with no cure
  • Symptoms:
    • (RESPIRATORY SYMPTOMS ONLY) – there are many GI symptoms
    • Recurrent respiratory infections
    • Thick sputum
  • Investigations:
    • Screening with Faecal Elastase (FE-1) test (shows function of exocrine pancreas – cheap and easy to do)
    • If +ve : Sweat Test is diagnostic – since more chloride in all secretions – sweat has a high chloride content.
    • Spirometry, O2 sats, CXR, WBC and aspergillus serology (screening for common fungal infection in CF )
  • Management:
    • Better treatments being researched and trialled with limited prescriptions
    • But commonly done:
      • Airway clearance techniques
      • Mucoactive agents (aid mucous clearance)
    • Life long antibiotic prophylaxis – Azithromycin
      • If have infection stop and have oral steroids