In case of suspected bacterial meningococcal septicaemia, benzylpenicillin should be administered to the patient without delaying their transfer to the hospital, unless there is a history of anaphylaxis. Ceftriaxone is the preferred treatment in secondary care, while cefotaxime can be used as an alternative if calcium-containing infusions are being given. Ampicillin can also be used in secondary care along with ceftriaxone. If the organism isolated is Listeria monocytogenes, gentamicin should be added to the treatment regimen.

Understanding Meningococcal Septicaemia

Meningococcal septicaemia is a serious condition that can cause high morbidity and mortality if not treated early. It is the leading infectious cause of death in early childhood, making it crucial to have a high index of suspicion. According to the 2010 NICE guidelines, meningococcal disease can present as meningitis, septicaemia, or a combination of both.

NICE divides the symptoms of meningococcal septicaemia into three categories: common nonspecific symptoms/signs, less common nonspecific symptoms/signs, and more specific symptoms/signs. Common nonspecific symptoms/signs include fever, vomiting, and lethargy, while less common nonspecific symptoms/signs include chills and shivering. More specific symptoms/signs include a non-blanching rash, altered mental state, capillary refill time more than 2 seconds, unusual skin colour, shock, hypotension, leg pain, and cold hands/feet.

If meningococcal septicaemia is suspected, it is important to give intramuscular or intravenous benzylpenicillin unless there is a history of anaphylaxis. However, if giving benzylpenicillin will delay hospital transfer, it should not be given. NICE recommends phoning 999 in case of suspected meningococcal septicaemia.

The National Institute for Health and Care Excellence (NICE) released guidelines in 2009 to help healthcare professionals identify when a child may be experiencing maltreatment. Child abuse can take many forms, including physical, emotional, and sexual abuse, neglect, and fabricated or induced illness. The guidelines provide a comprehensive list of features that may indicate abuse, but only selected features are highlighted here. Neglect may be suspected if a child has severe and persistent infestations, is not receiving essential prescribed treatment, has poor hygiene, or is not being dressed appropriately. Sexual abuse may be suspected if a child has persistent dysuria or anogenital discomfort, a gaping anus during examination, or is exhibiting sexualized behavior. Physical abuse may be suspected if a child has unexplained serious or unusual injuries, cold injuries, hypothermia, oral injuries, bruises, lacerations, burns, human bite marks, or fractures with unsuitable explanations.

Bartter’s syndrome is a genetic disorder that typically follows an autosomal recessive pattern of inheritance. It results in severe hypokalemia due to a malfunction in the absorption of chloride at the Na+ K+ 2Cl- cotransporter in the ascending loop of Henle. Unlike other endocrine causes of hypokalemia, such as Conn’s, Cushing’s, and Liddle’s syndrome, Bartter’s syndrome is associated with normotension.

The condition usually manifests in childhood and may present with symptoms such as failure to thrive, polyuria, polydipsia, weakness, and hypokalemia.

Hypertension, or high blood pressure, can also affect children. To measure blood pressure in children, it is important to use a cuff size that is approximately 2/3 the length of their upper arm. The 4th Korotkoff sound is used to measure diastolic blood pressure until adolescence, when the 5th Korotkoff sound can be used. Results should be compared to a graph of normal values for their age.

In younger children, secondary hypertension is the most common cause, with renal parenchymal disease accounting for up to 80% of cases. Other causes of hypertension in children include renal vascular disease, coarctation of the aorta, phaeochromocytoma, congenital adrenal hyperplasia, and essential or primary hypertension, which becomes more common as children get older. It is important to identify the underlying cause of hypertension in children in order to provide appropriate treatment and prevent complications.

Hand, foot, and mouth disease is a viral illness that causes mild systemic upset and oral ulcers, followed by vesicles on the palms and soles. It is typically caused by Coxsackie A16 virus, but other Coxsackie viruses and enterovirus 71 can also be responsible. Roseola, another viral infection, is caused by human herpesvirus 6 and is characterized by high fever followed by a distinctive rash. Croup, or laryngotracheobronchitis, is commonly caused by parainfluenza virus and produces a distinctive barking cough. Chickenpox, caused by varicella-zoster virus, is highly contagious and results in an itchy rash with small, fluid-filled blisters.

Hand, Foot and Mouth Disease: A Contagious Condition in Children

Hand, foot and mouth disease is a viral infection that commonly affects children. It is caused by intestinal viruses from the Picornaviridae family, particularly coxsackie A16 and enterovirus 71. This condition is highly contagious and often occurs in outbreaks in nurseries.

The clinical features of hand, foot and mouth disease include mild systemic upset such as sore throat and fever, followed by the appearance of oral ulcers and vesicles on the palms and soles of the feet.

Symptomatic treatment is the only management option available, which includes general advice on hydration and analgesia. It is important to note that there is no link between this disease and cattle, and children do not need to be excluded from school. However, the Health Protection Agency recommends that children who are unwell should stay home until they feel better. If there is a large outbreak, it is advisable to contact the agency for assistance.

If you come across a case of Female Genital Mutilation (FGM) in a female under the age of 18, it is important to report it to the police immediately. FGM is considered a form of child abuse and violence, and is illegal in England and Wales. This can be reported either by the child themselves or through physical examination.

It is crucial to take action as doing nothing is not an option when it comes to child abuse and the safety of other children. A safeguarding alert alone is not sufficient, as there is a mandatory reporting duty for healthcare professionals who encounter a confirmed case of FGM.

There is no need to contact the parents for further information as physical evidence has already been observed. It is also not appropriate to advise the child to call the police, as they are vulnerable and it is the duty of healthcare professionals to provide assistance.

Understanding Female Genital Mutilation

Female genital mutilation (FGM) is a practice that involves the partial or total removal of the external female genitalia or other forms of injury to the female genital organs for non-medical reasons. This practice is classified into four types by the World Health Organization (WHO). Type 1 involves the partial or total removal of the clitoris and/or the prepuce, while Type 2 involves the partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. Type 3 involves the narrowing of the vaginal orifice with the creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris. Type 4 includes all other harmful procedures to the female genitalia for non-medical purposes, such as pricking, piercing, incising, scraping, and cauterization. It is important to understand the different types of FGM to raise awareness and prevent this harmful practice.

Oral lesions typically manifest before palm and sole lesions in cases of hand, foot and mouth disease.

Hand, Foot and Mouth Disease: A Contagious Condition in Children

Hand, foot and mouth disease is a viral infection that commonly affects children. It is caused by intestinal viruses from the Picornaviridae family, particularly coxsackie A16 and enterovirus 71. This condition is highly contagious and often occurs in outbreaks in nurseries.

The clinical features of hand, foot and mouth disease include mild systemic upset such as sore throat and fever, followed by the appearance of oral ulcers and vesicles on the palms and soles of the feet.

Symptomatic treatment is the only management option available, which includes general advice on hydration and analgesia. It is important to note that there is no link between this disease and cattle, and children do not need to be excluded from school. However, the Health Protection Agency recommends that children who are unwell should stay home until they feel better. If there is a large outbreak, it is advisable to contact the agency for assistance.

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 primary screening test for infant hearing is now the Newborn Hearing Screening Programme, which is replacing distraction testing. Midwives rarely conduct visits beyond 4 weeks in their daily routine.

Child Health Surveillance in the UK

Child health surveillance in the UK involves a series of checks and tests to ensure the well-being of children from before birth to Preschool age. During the antenatal period, healthcare professionals ensure that the baby is growing properly and check for any maternal infections that may affect the baby. After birth, a clinical examination is conducted, and the newborn hearing screening programme is carried out to detect any hearing problems. The mother is also given a Personal Child Health Record.

Within the first month, a heel-prick test is conducted to check for hypothyroidism, PKU, metabolic diseases, cystic fibrosis, and medium-chain acyl Co-A dehydrogenase deficiency (MCADD). A midwife visit may also be conducted within the first four weeks. In the following months, health visitor input is provided, and a GP examination is conducted at 6-8 weeks. Routine immunisations are also given during this time.

Preschool children are screened for vision problems through a national orthoptist-led programme. Ongoing monitoring of growth, vision, and hearing is conducted, and health professionals provide advice on immunisations, diet, and accident prevention. Although midwife visits are supposed to occur up to four weeks after birth, in practice, health visitors usually take over at two weeks. Overall, child health surveillance in the UK aims to ensure that children receive the necessary care and support for their physical and developmental well-being.

Identifying Red Flags in Febrile Children

Febrile illness in children can be a cause of concern for parents and healthcare providers. While most cases are self-limiting and resolve without complications, some may require urgent medical attention. It is important to identify red flags that indicate a potentially serious underlying condition.

Factors that may increase family anxiety include a history of serious illness or death due to feverish illness, other illnesses affecting the child or family members, and parental instinct. Parents should not ignore their intuition and seek medical advice if they are concerned.

While there are no set rules about how long a fever should last, parents should seek further advice if their child has been febrile for five days without resolution. In infants aged 0-3 months, a temperature of >38°C is a red flag, while a temperature of >39°C in infants aged 3-6 months is an amber flag. After six months of age, the temperature alone is no longer an indicator of intermediate or high risk.

Reduced fluid intake, dry mucous membranes, reduced urine output, and reduced skin turgor are amber warning signs that require medical attention. A blanching erythematous rash is likely to indicate a viral infection and is not a cause for concern. However, non-blanching petechiae and patches in a sick child suggest meningococcal disease and require urgent medical attention.

In conclusion, identifying red flags in febrile children is crucial for timely diagnosis and management of potentially serious conditions. Parents should seek medical advice if they are concerned about their child’s health.

Differentiating between types of muscular dystrophy

Muscular dystrophies are a group of inherited disorders that cause progressive muscle wasting and weakness. There are several types of muscular dystrophy, each with its own unique characteristics. It is important to differentiate between these types in order to provide appropriate treatment and management.

Becker muscular dystrophy is a less severe form of the disorder, with a later onset and longer life expectancy. It mainly affects the proximal muscles of the limbs and is inherited in an X-linked-recessive pattern.

Duchenne muscular dystrophy, on the other hand, is a more severe form that presents in early childhood and leads to wheelchair dependence and early death. It is also inherited in an X-linked-recessive pattern and affects the proximal muscles of the limbs, as well as the heart and intellect.

Facioscapulohumeral dystrophy is an autosomal dominant or recessive disorder that affects the face and shoulder muscles in early adulthood, but doesn’t affect life expectancy.

Limb-girdle muscular dystrophy is an autosomal dominant or recessive disorder that presents in the teenage years with weakness in the pelvic girdle and shoulders, but doesn’t affect life expectancy or intellect.

Myasthenia gravis is an acquired, autoimmune disorder that causes fluctuating muscle weakness, particularly in the extraocular, bulbar, or proximal limb muscles. It typically occurs in adulthood.

Understanding the differences between these types of muscular dystrophy can aid in diagnosis and management of the disorder.