Turner’s syndrome is the likely diagnosis for a patient with short stature and primary amenorrhoea. Hypothyroidism may also cause these symptoms, but the presence of a high-arched palate makes it less likely. While gonadal dysgenesis (46, XX) can cause primary amenorrhoea, it doesn’t typically present with the characteristic dysmorphic features seen in Turner’s syndrome.

Understanding Turner’s Syndrome

Turner’s syndrome is a genetic condition that affects approximately 1 in 2,500 females. It is caused by the absence of one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes. This condition is identified as 45,XO or 45,X.

The features of Turner’s syndrome include short stature, a shield chest with widely spaced nipples, a webbed neck, a bicuspid aortic valve (present in 15% of cases), coarctation of the aorta (present in 5-10% of cases), primary amenorrhea, cystic hygroma (often diagnosed prenatally), a high-arched palate, a short fourth metacarpal, multiple pigmented naevi, lymphoedema in neonates (especially in the feet), and elevated gonadotrophin levels. Hypothyroidism is also more common in individuals with Turner’s syndrome, as well as an increased incidence of autoimmune diseases such as autoimmune thyroiditis and Crohn’s disease.

In summary, Turner’s syndrome is a chromosomal disorder that affects females and is characterized by various physical features and health conditions. Early diagnosis and management can help individuals with Turner’s syndrome lead healthy and fulfilling lives.

If a child is diagnosed with measles, they should not attend school for at least four days after the rash appears.

Measles: A Highly Infectious Disease

Measles is a viral infection caused by an RNA paramyxovirus. It is one of the most infectious viruses known and is spread through aerosol transmission. The incubation period is 10-14 days, and the virus is infective from the prodromal phase until four days after the rash starts. Measles is now rare in developed countries due to immunization programs, but outbreaks can occur when vaccination rates drop.

The prodromal phase of measles is characterized by irritability, conjunctivitis, fever, and Koplik spots. These white spots on the buccal mucosa typically develop before the rash. The rash starts behind the ears and then spreads to the whole body, becoming a discrete maculopapular rash that may become blotchy and confluent. Desquamation may occur after a week, typically sparing the palms and soles. Diarrhea occurs in around 10% of patients.

Measles is mainly managed through supportive care, and admission may be considered for immunosuppressed or pregnant patients. It is a notifiable disease, and public health should be informed. Complications of measles include otitis media, pneumonia, encephalitis, subacute sclerosing panencephalitis, febrile convulsions, keratoconjunctivitis, corneal ulceration, diarrhea, increased incidence of appendicitis, and myocarditis.

If an unvaccinated child comes into contact with measles, MMR should be offered within 72 hours. Vaccine-induced measles antibody develops more rapidly than that following natural infection.

Torsion: A Serious Condition with Limited Treatment Window

A short history of severe pain without any other symptoms should be considered as torsion. It is crucial to note that even if other symptoms are present, torsion should not be overlooked as there is only a limited time frame for treatment. A horizontal-lying testis is a typical indication of torsion, although it may not always be visible. Early diagnosis and treatment are crucial in managing torsion and preventing any long-term damage.

Managing Asthma in Children: NICE Guidelines

The National Institute for Health and Care Excellence (NICE) released guidelines in 2017 for the management of asthma in children aged 5-16. These guidelines follow a stepwise approach, with treatment options based on the severity of the child’s symptoms. For newly-diagnosed asthma, short-acting beta agonists (SABA) are recommended. If symptoms persist or worsen, a combination of SABA and paediatric low-dose inhaled corticosteroids (ICS) may be used. Leukotriene receptor antagonists (LTRA) and long-acting beta agonists (LABA) may also be added to the treatment plan.

For children under 5 years old, clinical judgement plays a greater role in diagnosis and treatment. The stepwise approach for this age group includes an 8-week trial of paediatric moderate-dose ICS for newly-diagnosed asthma or uncontrolled symptoms. If symptoms persist, a combination of SABA and paediatric low-dose ICS with LTRA may be used. If symptoms still persist, referral to a paediatric asthma specialist is recommended.

It is important to note that NICE doesn’t recommend changing treatment for patients with well-controlled asthma simply to adhere to the latest guidelines. Additionally, maintenance and reliever therapy (MART) may be used for combined ICS and LABA treatment, but only for LABAs with a fast-acting component. The definitions for low, moderate, and high-dose ICS have also changed, with different definitions for children and adults.

Febrile Seizures: Risk Factors, Recurrence, Immunizations, and Management

Febrile seizures are common in young children and can be a cause of concern for parents. Here are some important points to keep in mind:

Risk Factors: The likelihood of epilepsy increases if the child has a complex febrile seizure (prolonged seizure, multiple seizures or seizure with focal features), if there is a neurological abnormality, if there is a family history of epilepsy and if the duration of fever was less than one hour before the seizure. Without these features, there is only a small increase in risk compared with the general population.

Recurrence: Recurrent febrile seizures occur in about 30% of cases. Risk factors for later recurrences of febrile seizures include onset before 18 months, a seizure with a lower temperature close to 38°C, a shorter duration of fever (less than one hour) before the seizure and a family history of febrile seizures.

Immunizations: Childhood immunizations should continue even if the febrile seizure followed an immunization. Immunization doesn’t increase the risk of further seizures.

Management: Antipyretic drugs may be given to reduce fever but there is no evidence they reduce the number of febrile seizures. Anticonvulsant drugs should not be routinely prescribed. There is no evidence that intellect is affected, even for children with complex febrile seizures.

Pierre-Robin syndrome is diagnosed in a baby who has micrognathia and a cleft palate. The baby is positioned in a prone position to alleviate upper airway obstruction. There is no familial history of similar conditions.

Childhood syndromes are a group of medical conditions that affect children and are characterized by a set of common features. Patau syndrome, also known as trisomy 13, is a syndrome that presents with microcephaly, small eyes, cleft lip/palate, polydactyly, and scalp lesions. Edward’s syndrome, or trisomy 18, is characterized by micrognathia, low-set ears, rocker bottom feet, and overlapping of fingers. Fragile X syndrome is a condition that causes learning difficulties, macrocephaly, a long face, large ears, and macro-orchidism. Noonan syndrome presents with a webbed neck, pectus excavatum, short stature, and pulmonary stenosis. Pierre-Robin syndrome is characterized by micrognathia, posterior displacement of the tongue, and cleft palate. Prader-Willi syndrome presents with hypotonia, hypogonadism, and obesity. William’s syndrome is characterized by short stature, learning difficulties, a friendly and extroverted personality, and transient neonatal hypercalcaemia. Finally, Cri du chat syndrome, also known as chromosome 5p deletion syndrome, presents with a characteristic cry due to larynx and neurological problems, feeding difficulties and poor weight gain, learning difficulties, microcephaly, micrognathism, and hypertelorism. It is important to note that Pierre-Robin syndrome has many similarities with Treacher-Collins syndrome, but the latter is autosomal dominant and usually has a family history of similar problems.

Calculation of Griseofulvin Dosage

When calculating the dosage of Griseofulvin for a patient, it is important to consider their weight and the recommended dose per kilogram. For example, if a patient weighs 15 kg and the recommended dose is 15 mg/kg OD, then the total dosage would be 225 mg.

Griseofulvin is available in a concentration of 125 mg in 5 ml, which means there is 25 mg in 1 ml. To determine the correct dosage, divide the total dosage (225 mg) by the concentration (25 mg/ml), which equals 9 ml. Therefore, the correct dosage for this patient would be 9 ml OD. It is important to carefully calculate and administer the correct dosage to ensure the patient receives the appropriate treatment.

Understanding Rickets

Rickets is a condition that occurs when bones in developing and growing bodies are inadequately mineralized, resulting in soft and easily deformed bones. This condition is usually caused by a deficiency in vitamin D. In adults, a similar condition is called osteomalacia.

There are several factors that can predispose individuals to rickets, including a dietary deficiency of calcium, prolonged breastfeeding, unsupplemented cow’s milk formula, and a lack of sunlight.

Symptoms of rickets include aching bones and joints, lower limb abnormalities such as bow legs or knock knees, swelling at the costochondral junction (known as a rickety rosary), kyphoscoliosis, craniotabes (soft skull bones in early life), and Harrison’s sulcus.

To diagnose rickets, doctors may check for low vitamin D levels, reduced serum calcium, and raised alkaline phosphatase. Treatment typically involves oral vitamin D supplementation.

Overall, understanding rickets and its causes can help individuals take steps to prevent this condition and ensure proper bone development and growth.

Understanding Infant Bowel Movements: Breastfed Babies and Constipation

Breastfed infants tend to have more frequent bowel movements than formula-fed babies, but there is a wide range of normal variation. It is common for breastfed babies to have frequent bowel movements up to six weeks of age due to the gastro-colic reflex. However, it is also normal for breastfed babies to go several days without a bowel movement, sometimes up to 7-10 days. When a bowel movement does occur after a longer period of time, it may be a blow-out of normal consistency and should not cause concern as long as it appears painless.

It is important to note that simple straining to pass stool is also normal and doesn’t necessarily indicate constipation. However, if there are worrying signs such as difficulty with feeding, failure to gain weight, or signs of discomfort, medical attention should be sought.

It is not necessary to give a macrogol laxative unless a diagnosis of constipation is made. Additionally, introducing baby food containing fruit and vegetables is not appropriate for exclusively breastfed infants. Prune juice may help with constipation, but it is not recommended for infants until they are weaned at 4-6 months.

Overall, as long as the baby is well and examination is normal, there is no need for urgent referral to hospital. However, if constipation appears during the first few weeks of life, it may be a sign of a more serious condition such as Hirschsprung’s disease, which requires medical attention.

Management of Bilateral Undescended Testes

The management of bilateral undescended testes differs from that of unilateral undescended testes. If a child presents with bilateral undescended testes, urgent referral should be made to be seen within 2 weeks. This is because undescended testes, especially those presenting later in life, pose a risk of developing future malignancy. Boys and young men with a history of undescended testes should be advised to perform regular testicular self-examination during and after puberty to monitor for testicular cancer.

Furthermore, if there are bilateral undescended testicles at birth, it is important to consider whether there is a disorder of sexual development requiring further urgent genetic or endocrine investigation. In such cases, referral for specialist investigation should be made within 24 hours. It is crucial to recognize the significance of bilateral undescended testes and take appropriate action to ensure the best possible outcomes for the patient.

Immune-Mediated Thrombocytopenic Purpura in Children

This condition is the most common cause of low platelets in children and occurs due to immune-mediated platelet destruction. It typically affects children between 2 and 10 years of age, with onset occurring one to two weeks after a viral infection. Children with this condition develop purpura, bruising, nosebleeds, and mucosal bleeding. While intracranial hemorrhage is a rare complication, it is serious. However, in the vast majority of cases, ITP is an acute and self-limiting condition.

While acute lymphoblastic leukemia (ALL) can also present with abnormal bruising, the history and clinical features of this child are more suggestive of ITP. Other features of ALL include malaise, recurrent infections, pallor, hepatosplenomegaly, and lymphadenopathy, which are not present in this case.

Haemolytic-uraemic syndrome is a triad of acute renal failure, thrombocytopenia, and microangiopathic haemolytic anaemia. Patients are typically very unwell. Henoch-Schönlein purpura (HSP) typically presents with a palpable purpura that affects the buttocks and extensor surfaces, along with arthralgia, abdominal pain, and renal problems. Meningococcal septicaemia can also cause purpura, but affected patients are seriously unwell.

If alginates/thickened feeds fail to alleviate symptoms in infants with GORD and they exhibit feeding difficulties, distressed behavior, or faltering growth, a trial of PPI is recommended by NICE. However, metoclopramide should not be used without specialist advice due to the risk of side-effects like dystonia. Restarting breastfeeding is not practical once it has stopped, and there is no evidence to suggest that it would improve symptoms. While cow’s milk protein intolerance should be considered as a differential diagnosis, there is currently no indication of this diagnosis. Additionally, it is not advisable to stop milk feeds for such a young baby.

Gastro-oesophageal reflux is a common cause of vomiting in infants, with around 40% of babies experiencing some degree of regurgitation. However, certain risk factors such as preterm delivery and neurological disorders can increase the likelihood of developing this condition. Symptoms typically appear before 8 weeks of age and include vomiting or regurgitation, milky vomits after feeds, and excessive crying during feeding. Diagnosis is usually made based on clinical observation.

Management of gastro-oesophageal reflux in infants involves advising parents on proper feeding positions, ensuring the infant is not overfed, and considering a trial of thickened formula or alginate therapy. However, proton pump inhibitors (PPIs) are not recommended as a first-line treatment for isolated symptoms of regurgitation. PPIs may be considered if the infant experiences unexplained feeding difficulties, distressed behavior, or faltering growth. Metoclopramide, a prokinetic agent, should only be used with specialist advice.

Complications of gastro-oesophageal reflux can include distress, failure to thrive, aspiration, frequent otitis media, and dental erosion in older children. If medical treatment is ineffective and severe complications arise, fundoplication may be considered. It is important for healthcare professionals to be aware of the risk factors, symptoms, and management options for gastro-oesophageal reflux in infants.

Kawasaki disease is indicated by a high fever lasting more than 5 days, along with red palms that peel and a strawberry tongue. Symptoms of this condition also include conjunctivitis and cracked lips. It is important to note that Stevens-Johnson syndrome typically involves erythema multiforme with mucosal involvement, while the other conditions listed would not present in this manner.

Understanding Kawasaki Disease

Kawasaki disease is a rare type of vasculitis that primarily affects children. It is important to identify this disease early on as it can lead to serious complications such as coronary artery aneurysms. The disease is characterized by a high-grade fever that lasts for more than five days, which is resistant to antipyretics. Other features include conjunctival injection, bright red, cracked lips, strawberry tongue, cervical lymphadenopathy, and red palms and soles that later peel.

Diagnosis of Kawasaki disease is based on clinical presentation as there is no specific diagnostic test available. Management of the disease involves high-dose aspirin, which is one of the few indications for aspirin use in children. Intravenous immunoglobulin is also used as a treatment option. Echocardiogram is the initial screening test for coronary artery aneurysms instead of angiography.

Complications of Kawasaki disease include coronary artery aneurysm, which can be life-threatening. Early recognition and treatment of Kawasaki disease can prevent serious complications and improve outcomes for affected children.

Newborns who are found to have bilateral undescended testes during their initial examination should be urgently reviewed by a senior paediatrician within 24 hours, as per the current guidelines from Public Health England. This is crucial as bilateral undescended testes may indicate underlying endocrine disorders or ambiguous genitalia, and early intervention can help prevent complications such as infertility, torsion, and testicular cancer.

It is not appropriate to monitor bilateral undescended testes in primary care, unlike unilateral undescended testes which may be monitored. Waiting for 4 months, 12 months, or 24 months is too long and can increase the risk of complications.

Arranging an ultrasound and waiting for the results is also not appropriate as it can take too much time. Urgent referral to a paediatrician is necessary to ensure timely diagnosis and management.

Undescended testis is a condition that affects approximately 2-3% of male infants born at term, but is more common in premature babies. Bilateral undescended testes occur in about 25% of cases. This condition can lead to complications such as infertility, torsion, testicular cancer, and psychological issues.

To manage unilateral undescended testis, it is recommended to consider referral from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age. Orchidopexy, a surgical procedure, is typically performed at around 1 year of age, although surgical practices may vary.

For bilateral undescended testes, it is important to have the child reviewed by a senior paediatrician within 24 hours as they may require urgent endocrine or genetic investigation.

Ankle Injuries in Children and the Ottawa Ankle Rules

The history of ankle injuries in children suggests a forced internal rotation at the ankle joint, which can cause a sprain of the lateral ligaments. This type of injury requires supportive strapping, analgesia, and graduated mobilization. However, ankle sprains are less common in children than adults because their ligaments are stronger than their growth plates. As a result, the growth plate tends to fracture before the ligament tears.

In some cases, Salter-Harris Type 1 fractures and ligament tears may not show up on radiographs. Therefore, it is important to consider the patient’s history, such as tenderness over the ligament rather than bone and whether the patient is weight-bearing.

The Ottawa ankle rules are helpful in assisting GPs in the management of ankle injuries in adults and determining the need for an x-ray. A recent study published in the BMJ showed that the Ottawa ankle rules are highly accurate at excluding ankle fractures after a sprain injury. By following these guidelines, healthcare professionals can provide appropriate care for ankle injuries in children and adults.

PCV in addition to the 6-1 vaccine (which includes protection against diphtheria, tetanus, whooping cough, polio, Hib, and hepatitis B).

The UK immunisation schedule recommends certain vaccines at different ages. At birth, the BCG vaccine is given if the baby is at risk of tuberculosis. At 2, 3, and 4 months, the ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B) and oral rotavirus vaccine are given, along with Men B and PCV at specific intervals. At 12-13 months, the Hib/Men C, MMR, PCV, and Men B vaccines are given. At 3-4 years, the ‘4-in-1 Preschool booster’ (diphtheria, tetanus, whooping cough and polio) and MMR vaccines are given. At 12-13 years, the HPV vaccination is given, and at 13-18 years, the ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio) and Men ACWY vaccines are given. Additionally, the flu vaccine is recommended annually for children aged 2-8 years.

It is important to note that the meningitis ACWY vaccine has replaced meningitis C for 13-18 year-olds due to an increased incidence of meningitis W disease in recent years. The ACWY vaccine is also offered to new students up to the age of 25 years at university. GP practices will automatically send letters inviting 17-and 18-year-olds in school year 13 to have the Men ACWY vaccine, while students going to university or college for the first time should contact their GP to have the vaccine before the start of the academic year.

The Men C vaccine used to be given at 3 months but has now been discontinued as there are almost no cases of Men C disease in babies or young children in the UK. All children will continue to be offered the Hib/Men C vaccine at one year of age, and the Men ACWY vaccine at 14 years of age to provide protection across all age groups.

Other Aspects of Immunisation

Consent is an important aspect of immunisation, and the Greenbook provides useful information on this topic. Written consent is not required, and a person with parental responsibility may give consent on behalf of a child who is not competent to give or withhold consent. Parental responsibility is defined by the Children Act 1989, and unmarried fathers can acquire it if they are named on the child’s birth certificate. If parents disagree, immunisation cannot go ahead without specific court approval. A person with parental responsibility doesn’t need to be present at the time of immunisation, but the healthcare provider must be satisfied that consent has been given in advance.

Vaccine storage is also crucial to ensure the effectiveness of immunisation. Vaccines should be stored in a fridge at +2ºC to +8ºC and kept in their original packaging to protect them from UV light. The temperature of the refrigerator should be monitored using a maximum-minimum thermometer and recorded daily. Ordinary domestic refrigerators should not be used, and surgeries should keep no more than 2 to 4 weeks’ supply of vaccines at any time. By following these guidelines, healthcare providers can ensure that vaccines are stored properly and administered safely to patients.

Teething is a natural process where baby teeth emerge through the gums, usually starting around 6 months of age. Symptoms are generally mild and include pain, increased biting, drooling, gum-rubbing/sucking, irritability, wakefulness, and possibly a slight increase in temperature. The recommended initial management is to provide reassurance and advise on self-care measures such as gentle gum rubbing and allowing the child to bite on a clean and cool object. Paracetamol or ibuprofen suspension can be given to infants 3 months or older. It is not recommended to use choline salicylate gels, topical anaesthetics, or complementary therapies like herbal teething powder. A further dental opinion is not necessary as teething is a normal process.

Teething: Symptoms, Diagnosis, and Treatment Options

Teething is the process of primary tooth eruption in infants, which typically begins around 6 months of age and is usually complete by 30 months of age. It is characterized by a subacute onset of symptoms, including gingival irritation, parent-reported irritability, and excessive drooling. These symptoms occur in approximately 70% of all children and are equally prevalent in boys and girls, although girls tend to develop their teeth sooner than boys.

During examination, teeth can typically be felt below the surface of the gums prior to breaking through, and gingival erythema will be noted around the site of early tooth eruption. Treatment options include chewable teething rings and simple analgesia with paracetamol or ibuprofen. However, topical analgesics or numbing agents are not recommended, and oral choline salicylate gels should not be prescribed due to the risk of Reye’s syndrome.

It is important to note that teething doesn’t cause systemic symptoms such as fevers or diarrhea, and these symptoms should be treated as warning signs of other systemic illness. Additionally, teething necklaces made from amber beads on a cord are a common naturopathic treatment for teething symptoms but represent a significant strangulation and choking hazard. Therefore, it is crucial to avoid their use.

In conclusion, teething is a clinical diagnosis that can be managed with simple interventions. However, it is essential to be aware of potential hazards and to seek medical attention if systemic symptoms are present.

MMR Vaccination Contraindications

There are only a few individuals who cannot receive the MMR vaccination. The vaccine should not be given to those who are immunosuppressed, have had a confirmed anaphylactic reaction to a previous dose of a measles, mumps, or rubella-containing vaccination, or have a previous confirmed anaphylactic reaction to neomycin or gelatin. Pregnant women should also avoid the vaccine due to a theoretical risk of fetal infection. However, true anaphylaxis following the MMR vaccination is rare, occurring at a rate of 3.5 to 14.4 per million doses. If a minor allergic reaction occurs, it is not a contraindication to future vaccination. Inactivated vaccines are safe for pregnant women, but should only be used if protection is needed without delay. It is recommended to consult with a specialist or local immunisation coordinator for further advice if there is any doubt.

Treatment Ladder for Asthma in Children

Here we have a 7-year-old child who is currently on a regular inhaled very low dose corticosteroid and salbutamol PRN for asthma. However, despite the regular inhaled steroid, the child still requires salbutamol most days, indicating suboptimal control and the need for treatment escalation.

To guide treatment titration, the British Thoracic Society treatment ladder is the most well-recognized guideline in the UK. Based on this, the next step should be to add in an inhaled long-acting beta2 agonist or an LTRA (Leukotriene receptor antagonist) if over 5 years old. If the child was under 5 years old, then an LTRA alone would be added.

It is important to note that higher inhaled corticosteroid doses are treatment options further up the ladder, and theophylline would not normally feature in the primary care setting. Continuing the same treatment with review in 12 months is not appropriate as the child’s current disease control is suboptimal.

Differential Diagnosis of Abdominal Pain in Children: Intussusception as the Most Likely Diagnosis

Intussusception is a common cause of intestinal obstruction in young children. It occurs when a section of bowel invaginates into the section next to it, leading to the sloughing off of ischaemic bowel mucosa and the characteristic redcurrant jelly stool. In most cases, the cause of intussusception is unclear, but in some cases, a pathological lead-point may be present. Meckel’s diverticulum is the most common lead-point, but an enlarged Peyer patch caused by a viral infection may also be a factor.

Other potential causes of abdominal pain in children include intestinal duplication, appendicitis, and Henoch-Schönlein purpura (HSP). Intestinal duplication is a rare congenital malformation that may present as a solid or cystic tumor, intussusception, perforation, or bleeding. Appendicitis is most common in older children and typically presents with central abdominal pain that localizes to the right iliac fossa. HSP may cause abdominal pain, nausea, vomiting, and bloody diarrhea, but it is typically accompanied by a purpuric rash, which is absent in this scenario.

Overall, given the age of the patient and the presence of a tender mass in the upper abdomen and emptiness in the right lower quadrant, intussusception is the most likely diagnosis. A lead-point may be present, making non-operative reduction unlikely.

Rickets and its Risk Factors in Dark-Skinned Populations

Rickets is a condition that affects bone development in children, and dark skin is a risk factor for this condition in certain populations. In the United Kingdom, South Asian, African Caribbean, and Middle Eastern descent populations are particularly at risk. A study conducted in Bristol found that most cases of rickets were among Somali patients. The study identified 31 children with vitamin D deficiency, seven of whom had bone or limb pain, seven had bow legs or swollen joints, one had convulsions, and one had respiratory difficulty. Twelve children were asymptomatic and diagnosed through screening after a family member was found to have vitamin D deficiency. Fibromyalgia, infantile tibia vara, juvenile chronic arthritis, and physiological bow leg deformity are not related to rickets. It is important to identify and address risk factors for rickets in order to prevent and treat this condition.

If a child develops measles, they should not attend school for four days after the rash appears. Measles is a highly contagious viral disease that can be severe, especially for those with weakened immune systems, young infants, and pregnant women. The best way to prevent measles is through vaccination, but there have been recent outbreaks in unvaccinated individuals in London. While the UK has achieved elimination of measles, there are still small clusters of cases. Symptoms of measles include a runny nose, cough, fever, and rash. Cases are infectious for four days before and after the rash appears, so it’s important to keep them out of school during this time. Public health officials should be notified if there is a suspected case of measles to control outbreaks through testing, contact tracing, and immunization.

The Health Protection Agency has provided guidance on when children should be excluded from school due to infectious conditions. Some conditions, such as conjunctivitis, fifth disease, roseola, infectious mononucleosis, head lice, threadworms, and hand, foot and mouth, do not require exclusion. Scarlet fever requires exclusion for 24 hours after commencing antibiotics, while whooping cough requires exclusion for 2 days after commencing antibiotics or 21 days from onset of symptoms if no antibiotics are taken. Measles requires exclusion for 4 days from onset of rash, rubella for 5 days from onset of rash, and Chickenpox until all lesions are crusted over. Mumps requires exclusion for 5 days from onset of swollen glands, while diarrhoea and vomiting require exclusion until symptoms have settled for 48 hours. Impetigo requires exclusion until lesions are crusted and healed, or for 48 hours after commencing antibiotic treatment, and scabies requires exclusion until treated. influenza requires exclusion until the child has recovered for 48 hours.

Regarding Chickenpox, Public Health England recommends that children should be excluded until all lesions are crusted over, while Clinical Knowledge Summaries suggest that infectivity continues until all lesions are dry and have crusted over, usually about 5 days after the onset of the rash. It is important to follow official guidance and consult with healthcare professionals if unsure about exclusion periods for infectious conditions.

Slipped Upper Epiphysis: Diagnosis and Treatment

Slipped upper epiphyses are more common in overweight boys aged 10-15 and are associated with obesity and hypothyroidism. Patients often present with pain, which may be referred to the knee, and it is important to examine the hips thoroughly. On examination, abduction and internal rotation may both be reduced, and the affected leg may be shortened. The key findings supporting the diagnosis are the presence of risk factors and gait abnormalities.

Slipped epiphyses can be classified as acute, chronic, or acute on chronic, and as unstable or stable. In the case of unstable slipped epiphysis, urgent surgical repair is necessary to prevent avascular necrosis. Stable slipped epiphysis is usually treated with in situ screw fixation, and prophylactic fixation of the contralateral hip may also be considered.

In the primary care setting, emergency admission under orthopaedics is necessary for patients with acute and unstable slipped epiphysis. For chronic and stable cases, x-ray is the first line investigation, and U&Es, serum TFTs, and serum growth hormone may also be considered.

In summary, early diagnosis and appropriate treatment are crucial in managing slipped upper epiphysis.

Possible causes of microcytic anaemia in a 9-month-old child

Microcytic anaemia is a condition characterized by a low level of haemoglobin (Hb) in red blood cells, along with small cell size. In a 9-month-old child, this can be caused by various factors. One possible cause is overconsumption of cow’s milk, which is low in iron but high in calories. This can lead to a lack of appetite and subsequent deficiencies in vitamins and minerals, especially iron. Another possible cause is folic acid deficiency, which typically results in megaloblastic anaemia rather than microcytic anaemia. Calorie deficit is unlikely in a child with a high weight percentile. Inflammatory bowel disease is rare in infancy and not supported by the given information. Finally, it is worth noting that a normal physiological fall in Hb occurs after birth, but by 6 months of age, the Hb level should be within the range of 110-140 g/l. Treatment for microcytic anaemia may involve dietary education and oral iron supplementation.

Developmental dysplasia of the hip (DDH) is a condition that affects 1-3% of newborns and is more common in females, firstborn children, and those with a positive family history or breech presentation. It used to be called congenital dislocation of the hip (CDH). DDH is more often found in the left hip and can be screened for using ultrasound in infants with certain risk factors or through clinical examination using the Barlow and Ortolani tests. Other factors to consider include leg length symmetry, knee level when hips and knees are flexed, and restricted hip abduction in flexion. Ultrasound is typically used to confirm the diagnosis, but x-rays may be necessary for infants over 4.5 months old. Management options include the Pavlik harness for younger children and surgery for older ones. Most unstable hips will stabilize on their own within 3-6 weeks.

All children who are in long-term foster care must undergo a medical examination every six months. This is a legal requirement. It is important to note that once a child reaches the age of five, a yearly examination is sufficient. The Fostering Services 2002 Regulation 6 and Review of Children’s Cases Regulations 1991 state that the responsible authority must arrange for the child to receive a health assessment by a registered medical practitioner or registered nurse under the supervision of a registered medical practitioner. The assessment must be carried out at least once every six months before the child’s fifth birthday and at least once every twelve months after the child’s fifth birthday, unless the child refuses the assessment and is of sufficient understanding. It is important to follow these regulations to ensure the health and well-being of children in foster care.

Foster care is a system in which children who cannot live with their birth families are placed with foster families who provide them with a safe and nurturing environment. According to Schedule 7 of the Children Act 1989, there is a limit of three foster children per family. Additionally, all children in long-term foster care require a medical examination every six months to ensure their physical and emotional well-being. This system aims to provide children with stability and support while their birth families work towards resolving any issues that led to their placement in foster care.

Understanding Cystic Fibrosis and Other Possible Causes of Recurrent Infections in Children

Cystic fibrosis (CF) is a genetic disorder that affects the secretion and absorption of sodium and chloride, leading to problems in the respiratory, gastrointestinal, pancreatic, and reproductive systems. While CF is the most common lethal genetic disorder affecting Caucasian children, it can present at any age and is now often detected through newborn screening. Frequent antibiotic use can lead to the development of resistant bacterial strains, but it is unlikely to be the sole cause of recurrent symptoms in a child. Other possible causes include Crohn’s disease, immunodeficiency, and, rarely, sarcoidosis. It is important to maintain a high index of suspicion and seek medical attention for children with frequent infections and other concerning symptoms.

Referral and Support for Children with Developmental Delays

Children who present with delays in their development require a thorough assessment to identify the underlying cause. In cases where delays are observed in one area, such as fine motor development, a full developmental assessment with a Paediatrician is recommended. The Paediatrician can then refer the child to other services, such as Physiotherapy, Audiology, and Speech and Language Therapy, as needed.

Concerns regarding hearing, speech, and language development should prompt a referral to Audiology. While congenital hearing problems are usually detected via newborn screening tests, it is important to consider hearing loss in children presenting with developmental concerns.

Offering reassurance is not always sufficient, especially if a child is unable to reach out for objects by six months. In such cases, further assessment is necessary.

Health Visitors play a crucial role in monitoring children with developmental concerns and offering support to parents. Parents can contact the Health Visiting service directly without a referral from primary care.

Physiotherapy can be helpful in children presenting with delays in gross motor development. However, for children with concerns regarding fine motor development, a review by a Paediatrician is necessary before considering a referral to Physiotherapy.

Gastro-oesophageal reflux (GOR) is a common condition in infants that usually resolves by the age of one. If the infant is not bothered by the GOR and doesn’t experience any complications, observation is sufficient. However, parents should monitor for worsening symptoms, weight loss, or complications. If the infant is distressed or has complications, they may have gastro-oesophageal reflux disease (GORD) and require treatment. Alginate therapy, such as Gaviscon® Infant, is the first-line treatment for breastfed infants with GORD.

Gastro-oesophageal reflux is a common cause of vomiting in infants, with around 40% of babies experiencing some degree of regurgitation. However, certain risk factors such as preterm delivery and neurological disorders can increase the likelihood of developing this condition. Symptoms typically appear before 8 weeks of age and include vomiting or regurgitation, milky vomits after feeds, and excessive crying during feeding. Diagnosis is usually made based on clinical observation.

Management of gastro-oesophageal reflux in infants involves advising parents on proper feeding positions, ensuring the infant is not overfed, and considering a trial of thickened formula or alginate therapy. However, proton pump inhibitors (PPIs) are not recommended as a first-line treatment for isolated symptoms of regurgitation. PPIs may be considered if the infant experiences unexplained feeding difficulties, distressed behavior, or faltering growth. Metoclopramide, a prokinetic agent, should only be used with specialist advice.

Complications of gastro-oesophageal reflux can include distress, failure to thrive, aspiration, frequent otitis media, and dental erosion in older children. If medical treatment is ineffective and severe complications arise, fundoplication may be considered. It is important for healthcare professionals to be aware of the risk factors, symptoms, and management options for gastro-oesophageal reflux in infants.

Differences in Presentation of Hodgkin’s and Non-Hodgkin’s Lymphoma

Hodgkin’s lymphoma is characterized by the presence of painless cervical and/or supraclavicular lymphadenopathy, although it can also occur in other areas. The progression of the disease is usually slow, taking several months. Most patients do not experience systemic symptoms such as fever, night sweats, or itching.

On the other hand, non-Hodgkin’s lymphoma tends to progress more rapidly and may present with a variety of symptoms, including lymphadenopathy, shortness of breath, SVC obstruction, and abdominal distension.

To summarize, while both types of lymphoma can present with lymphadenopathy, the rate of progression and accompanying symptoms can differ significantly. It is important to consult with a healthcare professional if any concerning symptoms arise.

Approach to Constipation in Children: Consider Systemic Disease and Avoid Stimulant Laxatives and Enemas

Constipation in children can have various organic causes, such as anorectal malformations, but when a systemic disease is the underlying issue, other symptoms of that disease are likely to be present. Therefore, it is important to check for related symptoms of systemic disease. For instance, hypothyroidism may cause constipation along with a goitre, slow growth, weight gain, and intolerance to cold. Diabetes mellitus or diabetes insipidus may cause constipation due to associated polyuria.

Stimulant laxatives may be necessary in some cases, but macrogols should be the first-line treatment for constipation in children. Hirschsprung’s disease is a possible cause of chronic constipation, but it usually presents early in life, and functional constipation is more common. Reassuring parents that their child will grow out of constipation is not advisable, as prompt treatment can help resolve symptoms sooner.

Enemas should be avoided if possible, as they can cause emotional and physical trauma. If necessary, the child should be admitted to the hospital for this procedure. Overall, a thorough evaluation of the child’s symptoms and medical history is necessary to determine the best approach to managing constipation.

Measles: Key Points to Remember

– Prophylactic antibiotics are not effective in treating measles.
– Koplik spots are a unique symptom of measles.
– Erythromycin doesn’t reduce the duration of measles.
– The MMR vaccine is typically given to children between 12-15 months of age.
– The rash associated with measles is widespread and different from the vesicular rash of Chickenpox.

Measles is a highly contagious viral infection that can cause serious complications, particularly in young children. It is important to remember that prophylactic antibiotics are not effective in treating measles, and erythromycin doesn’t shorten the duration of the illness. One unique symptom of measles is the presence of Koplik spots, which are small white spots that appear on the inside of the mouth. The MMR vaccine is the most effective way to prevent measles and is typically given to children between 12-15 months of age. Finally, it is important to note that the rash associated with measles is widespread and different from the vesicular rash of Chickenpox.

Understanding Gillick and Fraser Competence

When it comes to prescribing contraception to minors, healthcare professionals may refer to the terms Gillick competence and Fraser competence. These terms are often used interchangeably, but some authorities use Fraser competency specifically when discussing contraception.

Gillick competence refers to a minor’s ability to make decisions about their own healthcare without parental consent. This includes decisions about contraception, but also extends to other areas of consent. Fraser competence, on the other hand, specifically relates to a minor’s ability to understand the risks and benefits of contraception and make an informed decision about using it.

In either case, healthcare professionals must assess the minor’s level of understanding and maturity before prescribing contraception without parental consent. If the minor is deemed competent, they have the right to make their own decisions about their healthcare, including the use of contraception.

Childhood Development Milestones

At around 16 months, a child should be able to walk without assistance, with the average age for achieving this milestone being 12 months. Additionally, they should be able to assist with dressing themselves at this age. However, building a tower of four cubes and scribbling with a pencil are not expected until around two years old. By this age, the child should also understand the meaning of no and be able to appropriately state mama and dada. These are important developmental milestones to keep in mind as a child grows and develops.

A teacher who specializes in coordinating special educational needs is known as a SENCO.

Special educational needs (SEN) refer to children who have a greater difficulty in learning compared to their peers or have a disability that hinders their access to educational facilities. When a child is struggling, a review called ‘School Action’ is conducted by the school and parents to determine what can be done. If outside help is required, such as from an educational psychologist or speech therapist, the review is called ‘School Action Plus’. However, if these actions are not sufficient, a formal statement of educational needs may be necessary.

To assess children who may require help, a special educational needs coordinator (SENCO) is a teacher who specializes in this area. The statement of SEN should be made and reviewed annually to ensure that the child’s needs are being met. The Education Act 1993 aimed to provide early intervention to children with SEN.

Understanding Coeliac Disease Testing: Differentiating Between IgA tTGAs, IgA Gliadin Antibodies, IgA EMAs, HLA Genetic Testing, and IgG tTGAs

Coeliac disease is a condition that affects the small intestine and is caused by an intolerance to gluten. While small-bowel biopsy is the most reliable way to diagnose coeliac disease, IgA tissue transglutaminase antibodies (tTGAs) are the preferred initial investigation. This test is highly specific and sensitive for untreated coeliac disease, but should not be performed on children younger than two years as it may give a false negative result.

It is important to note that around 0.4% of the population has selective IgA deficiency, which can lead to a false-negative result. In such cases, the laboratory should measure IgA levels. Some laboratories may do this routinely when measuring tTGAs.

IgA gliadin antibodies are not commonly used to diagnose coeliac disease. Instead, IgA EMAs are autoantibodies against tissue transglutaminase type 2 (tTGA2) and are highly specific and sensitive for untreated coeliac disease. However, IgA EMAs should be measured if IgA tTG is only weakly positive.

HLA genetic testing is not recommended for diagnosing coeliac disease in primary care. Coeliac disease is strongly associated with the genes HLA-DQ2 and HLA-DQ8, but testing for these genes is not necessary for diagnosis.

Finally, IgG tTGAs should only be considered in people who are IgA deficient to avoid the risk of a false-negative IgA tTGA result.

In summary, understanding the differences between these tests is crucial in accurately diagnosing coeliac disease and providing appropriate treatment.

Sepsis in Newborns: Apnoeic Episodes and Potential Consequences

Sepsis is a common issue in newborns, often presenting as apnoeic episodes. In the initial stages, the fontanelle may appear normal. The most frequent cause of sepsis in newborns is group B Streptococcus, which can be acquired during or after delivery. Unfortunately, the mortality rate for infants with sepsis is between 5-15%. Even those who survive may experience long-term consequences such as learning difficulties, speech problems, visual impairment, or neural deafness. Additionally, meningomyelocele is a risk factor for the introduction of meningeal infection.

Unilateral Discharge in Children: A Possible Sign of Foreign Body

The occurrence of unilateral discharge in an otherwise healthy child may indicate the presence of a foreign body, especially in this age group. It is important to consider the child’s history to determine the possible cause of the discharge. If a foreign body is suspected, prompt removal is necessary to prevent further complications. Fortunately, removal of the foreign body is usually curative and can alleviate the symptoms.

Childhood disintegration disorder

Children with hand foot and mouth infection can attend school or nursery as long as they are well enough to do so, and do not need to be excluded. This is because the infection is typically mild and self-limiting. However, if the child has a fever, they should be kept at home. It is important to note that exclusion periods for other illnesses, such as Chickenpox, rubella, measles, scarlet fever, and impetigo, differ from those for hand foot and mouth. For more information on exclusion periods, refer to the Public Health Agency website.

The Health Protection Agency has provided guidance on when children should be excluded from school due to infectious conditions. Some conditions, such as conjunctivitis, fifth disease, roseola, infectious mononucleosis, head lice, threadworms, and hand, foot and mouth, do not require exclusion. Scarlet fever requires exclusion for 24 hours after commencing antibiotics, while whooping cough requires exclusion for 2 days after commencing antibiotics or 21 days from onset of symptoms if no antibiotics are taken. Measles requires exclusion for 4 days from onset of rash, rubella for 5 days from onset of rash, and Chickenpox until all lesions are crusted over. Mumps requires exclusion for 5 days from onset of swollen glands, while diarrhoea and vomiting require exclusion until symptoms have settled for 48 hours. Impetigo requires exclusion until lesions are crusted and healed, or for 48 hours after commencing antibiotic treatment, and scabies requires exclusion until treated. influenza requires exclusion until the child has recovered for 48 hours.

Regarding Chickenpox, Public Health England recommends that children should be excluded until all lesions are crusted over, while Clinical Knowledge Summaries suggest that infectivity continues until all lesions are dry and have crusted over, usually about 5 days after the onset of the rash. It is important to follow official guidance and consult with healthcare professionals if unsure about exclusion periods for infectious conditions.

Understanding Laryngomalacia: A Common Condition in Young Babies

Laryngomalacia, also known as congenital laryngeal stridor, is a condition that affects many young babies. It is caused by delayed maturation of the cartilage in the larynx, which leads to collapse of the supraglottic larynx during inspiration. This results in a noisy respiration and an inspiratory stridor, which is typically more noticeable when the baby is in a supine position, feeding, crying, sleeping, or during intercurrent illness.

While there may be gastro-oesophageal reflux, the child is otherwise well and there is no associated upper respiratory discharge. However, infants with laryngomalacia may have difficulty coordinating the ‘suck-swallow-breathe’ sequence needed for feeding due to their airway obstruction.

It is important to note that respiratory distress is uncommon, and if there is tachypnoea, it is only mild and there is no reduction in oxygen saturation. Additionally, a barking cough is not a typical symptom of laryngomalacia. The classic symptom is inspiratory stridor, which may be increased when the child has an upper respiratory infection.

While symptoms may initially worsen, they typically resolve by 18-24 months without the need for treatment. However, if the stridor is worsening, other diagnoses should be considered. Overall, understanding laryngomalacia can help parents and caregivers better recognize and manage this common condition in young babies.

Understanding Recurrent Abdominal Pain in Children

Recurrent abdominal pain is a common issue among children that can disrupt their daily activities. It is often not accompanied by any organic pathology and tends to occur frequently, with at least three episodes in three months. The pain is usually located in the central abdomen and can be severe enough to affect the child’s activities.

While there are many possible organic causes for recurrent abdominal pain, diagnostic investigations are only recommended for children with alarm symptoms or signs. These include involuntary weight loss, slowing of linear growth, gastrointestinal blood loss, significant vomiting, chronic severe diarrhea or constipation, unexplained fever, pain localized away from the central abdomen, or a family history of inflammatory bowel disease.

It is important to note that persistent right-upper or right-lower-quadrant pain should raise more concern. Headache is more likely to occur in children with non-organic recurrent abdominal pain, and pain relieved by defecation is usually a feature of irritable bowel syndrome and doesn’t match the features in this scenario.

Recurrent abdominal pain can lead to increased functional impairment in everyday life, such as school absences. Therefore, it is crucial to understand the distinction between organic disease, functional disorders, and emotional factors to provide appropriate care for children experiencing this issue.

Wilms’ Tumour: A Common Childhood Malignancy

Wilms’ tumour, also known as nephroblastoma, is a prevalent type of cancer in children, with a median age of diagnosis at 3 years old. It is often associated with Beckwith-Wiedemann syndrome, hemihypertrophy, and a loss-of-function mutation in the WT1 gene on chromosome 11. The most common presenting feature is an abdominal mass, which is usually painless, but other symptoms such as haematuria, flank pain, anorexia, and fever may also occur. In 95% of cases, the tumour is unilateral, and metastases are found in 20% of patients, most commonly in the lungs.

If a child presents with an unexplained enlarged abdominal mass, it is crucial to arrange a paediatric review within 48 hours to rule out Wilms’ tumour. The management of this cancer typically involves nephrectomy, chemotherapy, and radiotherapy if the disease is advanced. Fortunately, the prognosis for Wilms’ tumour is good, with an 80% cure rate.

Histologically, Wilms’ tumour is characterized by epithelial tubules, areas of necrosis, immature glomerular structures, stroma with spindle cells, and small cell blastomatous tissues resembling the metanephric blastema. Overall, early detection and prompt treatment are essential for a successful outcome in children with Wilms’ tumour.

When to Worry About Lymph Node Enlargement in Children

Lymphadenopathy, or lymph node enlargement, is a common occurrence in children. In most cases, it is benign and resolves on its own. However, there are certain characteristics that warrant urgent referral to a healthcare provider. These include non-tender, firm or hard lymph nodes, nodes larger than 2 cm, progressively enlarging nodes, general ill-health, fever or weight loss, involvement of axillary nodes (in the absence of local infection or dermatitis), or involvement of supraclavicular nodes.

It is important to note that these characteristics are particularly concerning if there is no evidence of local infection.

The milestones of development are categorized into gross motor skills, fine motor skills, vision, speech and hearing, and social behavior and play. For children who are -years old, they should be able to run, climb stairs, construct a tower using 6 cubes, replicate a vertical line, use 2-word phrases, eat with a spoon, dress themselves with a hat and shoes, and engage in play activities with other children.

Fine Motor and Vision Developmental Milestones

Fine motor and vision developmental milestones are important indicators of a child’s growth and development. At three months, a baby can reach for objects and hold a rattle briefly if given to their hand. They are visually alert, particularly to human faces, and can fix and follow to 180 degrees. By six months, they can hold objects in a palmar grasp and pass them from one hand to another. They become visually insatiable, looking around in every direction. At nine months, they can point with their finger and develop an early pincer grip. By 12 months, they have a good pincer grip and can bang toys together.

In terms of bricks, a 15-month-old can build a tower of two, while an 18-month-old can build a tower of three. A two-year-old can build a tower of six, and a three-year-old can build a tower of nine. When it comes to drawing, an 18-month-old can make circular scribbles, while a two-year-old can copy a vertical line. A three-year-old can copy a circle, a four-year-old can copy a cross, and a five-year-old can copy a square and triangle.

It’s important to note that hand preference before 12 months is abnormal and may indicate cerebral palsy. These milestones serve as a guide for parents and caregivers to monitor a child’s development and ensure they are meeting their milestones appropriately.

If an infant with GORD is experiencing troublesome symptoms even after a 1-2 week trial of alginate therapy, the recommended course of action is to prescribe a 4-week trial of a proton pump inhibitor. This is in line with NICE guidelines.

Opting for a 2-week trial of omeprazole is not advisable as it may not be sufficient to alleviate the symptoms.

Continuing with alginate suspension alone is not appropriate as the symptoms have worsened since starting the treatment.

Ranitidine is no longer recommended due to the presence of small amounts of the carcinogen N-nitrosodimethylamine (NMDA) in formulations from multiple manufacturers. Nitrosamines, which are carcinogens commonly found in smoked fish, are linked to high rates of oesophageal and gastric cancer in East Asian countries.

If metoclopramide, a prokinetic agent, is used, it should be done so with caution and under the supervision of a specialist.

Gastro-oesophageal reflux is a common cause of vomiting in infants, with around 40% of babies experiencing some degree of regurgitation. However, certain risk factors such as preterm delivery and neurological disorders can increase the likelihood of developing this condition. Symptoms typically appear before 8 weeks of age and include vomiting or regurgitation, milky vomits after feeds, and excessive crying during feeding. Diagnosis is usually made based on clinical observation.

Management of gastro-oesophageal reflux in infants involves advising parents on proper feeding positions, ensuring the infant is not overfed, and considering a trial of thickened formula or alginate therapy. However, proton pump inhibitors (PPIs) are not recommended as a first-line treatment for isolated symptoms of regurgitation. PPIs may be considered if the infant experiences unexplained feeding difficulties, distressed behavior, or faltering growth. Metoclopramide, a prokinetic agent, should only be used with specialist advice.

Complications of gastro-oesophageal reflux can include distress, failure to thrive, aspiration, frequent otitis media, and dental erosion in older children. If medical treatment is ineffective and severe complications arise, fundoplication may be considered. It is important for healthcare professionals to be aware of the risk factors, symptoms, and management options for gastro-oesophageal reflux in infants.

New advice on vitamin D supplements

The latest advice from Public Health England (PHE) recommends that adults and children over the age of one should consider taking a daily supplement containing 10mcg of vitamin D, especially during autumn and winter. Those who are at a higher risk of vitamin D deficiency, such as people who have little or no exposure to the sun, those who cover their skin when outside, and people with dark skin from African, African-Caribbean, and South Asian backgrounds, are advised to take a supplement all year round. This advice is based on a review by the Scientific Advisory Committee on Nutrition (SACN), which identified these groups as being at risk of vitamin D deficiency.

Speech Delay in Children: Possible Causes and Exclusions

Speech delay is a common issue that affects 3-10% of all children, with boys being 3-4 times more likely to experience it than girls. One possible cause of speech delay in older children is elective mutism, which can be assessed through proper diagnosis. However, before progressing to other investigations, it is important to exclude deafness as a possible cause. Other factors that should be excluded include social and environmental deprivation, disorders of metabolism, and degenerative nervous diseases, which are rare possibilities. By identifying and addressing the underlying cause of speech delay, children can receive the necessary support and intervention to improve their communication skills.

Mumps Orchitis: Symptoms and Complications

Mumps orchitis is a common complication affecting around 25% of adult males who develop mumps. The condition is treated symptomatically with analgesia and scrotal support. Although up to 50% of those affected may experience some testicular shrinkage, it doesn’t necessarily lead to infertility. Other complications include pancreatitis (4%) and oophoritis (5% of post-pubertal women). Deafness, either unilateral or bilateral, is also a well-recognized complication, but it is less common.