PAEDIATRICS FOR GPSDr Laura Weidner

MBChB MRCGP PGCMDEGP 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 1st 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 <3m age with >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…

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=wr-xeckmcqnJSM&tbnid=M8fH5qRfUIoB9M:&ved=0CAUQjRw&url=http://mommyhood101.com/baby/rashes-with-pictures.html&ei=6ymjUsXYD-bW0QXCo4GICQ&psig=AFQjCNECuWWrPTQHpTZu5FPwrrrerMi12Q&ust=1386511131072726

http://www.dermnetnz.org/common/image.php?path=/arthropods/img/threadworms.jpg

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=unPIPhRPDWBqYM&tbnid=VTsjAsU0oLoStM:&ved=0CAUQjRw&url=http://keratosiscatnip.com/16317/home-remedy/amlactin-ultra-keratosis-pilaris&ei=ryajUuTQLeHG0QXNsoDICA&bvm=bv.57752919,d.ZG4&psig=AFQjCNHcIF4Y2rSjUx1z40HNUTArsH67Zg&ust=1386510364799256

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 07919-175643

References

• Google images

• Dr Martin Kittel (Forest End Medical Centre – Bracknell)