A selection of fairly random points from the Pulse on-line learning module in child health:
- A fever over 38 degrees in a baby less than 3 months or over 39 degrees in a 3 – 6-month-old is a red flag for referral. Fever for over 5 days is an amber flag which should be investigated and referral considered.
- Clinical problems to look for in the screaming child include testicular torsion, abdominal examination for possible intussusception, long bones for fractures, and hair tourniquet around finger or toe.
- Frequent vomits can look bright yellow due to normal stomach contents – bilious vomiting is dark green-brown (and indicates obstruction and need for urgent surgical referral).
- It’s probably OK to be relaxed about a non-blanching rash if the child is well and afebrile. (Though do consider ITP.)
- Spiking fevers (i.e. once or twice a day at regular times) are very typical of systemic arthritis. They are usually accompanied by a salmon-pink rash, typically on the trunk/extremities, lasting only a few hours and occasionally extremely pruritic. Check for lymphadenopathy and hepatosplenomegaly, and remember that anterior uveitis is present in approximately 20% of these children.
- If suspecting arthritis, check ANA as well as inflammatory markers and RF. Refer urgently to rheumatology.
- The neonatal CF test is not 100% sensitive – check out clinical suspicions even if the test was negative.
- Differential diagnosis of abdominal pain in under-5s includes intussusception and HSP.
- Differential diagnosis of abdominal pain in boys includes testicular torsion. The testicle itself may not be painful although it may be tender. Absence of cremasteric reflex on that side is 100% sensitive and 66% specific for torsion.
- Most children with FTT do not need referral. High-calorie supplements are also not indicated as they can induce diarrhoea and make the problem worse. Encourage more food, add butter & cream to food, etc.
- Chlorhexidine or hydrogen peroxide 1% can be used to treat impetigo.
- Impetigo normally forms a scab when healing – leave that be and don’t mistake it for crust.
- Individual molluscum lesions take around eight weeks to heal. The whole area normally takes around eight months.
- Haemangiomas near to the eye, mouth, or neck should be urgently referred as the proliferative phase can cause dangerous obstruction (of sight or feeding).