Child Protection and Sexual Offences

The Sexual Offences Act 2003 states that children under the age of 13 are not capable of giving consent to sexual activity. Any sexual offence involving a child under 13 should be treated with utmost seriousness. Health professionals should consider referring such cases to social services under the Child Protection Procedures. It is advisable to seek advice from designated child protection professionals in the first instance.

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.

The baby is displaying signs that suggest infantile colic, which typically begins in the first few weeks of life and resolves by 3-4 months of age. The crying usually occurs in the late afternoon or evening, and the baby may arch their back or draw their knees up to their abdomen while crying. The symptoms appear to be ongoing but occasional, as the baby is happy during the day.

Although antimuscarinics have been shown to be effective, they come with serious adverse effects and are not recommended. Simeticone (Infacol) is commonly used, but there is no evidence to support its use and it is not recommended by CKS. Gaviscon is not necessary as there is no indication of gastro-oesophageal reflux. Low-lactose formula and paracetamol are also not recommended.

Since the baby is happy during the day, it is unlikely that they have cow’s milk protein allergy, which is rare in breastfed infants. Therefore, there is no need for the mother to exclude dairy from her diet.

Understanding Infantile Colic

Infantile colic is a common condition that affects infants under three months old. It is characterized by excessive crying and pulling up of the legs, usually worse in the evening. This condition affects up to 20% of infants, and its cause is unknown.

Despite its prevalence, the use of simeticone and lactase drops is not recommended by NICE Clinical Knowledge Summaries. These drops are commonly used to alleviate the symptoms of infantile colic, but their effectiveness is not supported by evidence. Therefore, it is important to seek medical advice before using any medication to treat infantile colic.

Management of Otitis Media with Effusion (Glue Ear)

Eighty percent of children under 10-years-old will have experienced at least one episode of otitis media with effusion (OME), commonly known as glue ear. This condition is characterized by relapsing and remitting episodes that can last for 6-10 weeks, with bimodal peaks at 2 and 5 years of age. The main concern with glue ear is the associated conductive hearing impairment, which can have significant repercussions for a child’s education and speech and language development.

In cases where symptoms persist, specialist referral to audiometry or ENT for hearing assessment is indicated, probably leading to the need for ENT intervention (grommet insertion) based on the clinical picture (developmental issues are present and the problems are persistent). It is worth noting that antibiotics, topical and systemic steroids, decongestants, mucolytics, and antihistamines are not recommended in the routine management of OME.

The National Institute for Health and Care Excellence (NICE) guidelines recommend a period of watchful waiting for three months, with two pure-tone audiograms three months apart, to confirm and quantify the hearing loss. Audiometry is important to ensure there is not a more significant hearing deficit. Ultimately, surgical treatment in the form of ventilation tube (grommet) insertion is effective in managing OME.

The Barlow manoeuvre involves an attempt to dislocate the femoral head of a newborn.

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.

Common Myths and Facts about Safe Sleeping for Babies

There are many misconceptions about safe sleeping for babies that can put them at risk of Sudden Infant Death Syndrome (SIDS). Here are some common myths and facts to help parents ensure their baby is sleeping safely.

Myth: It’s okay to smoke around the baby.
Fact: Smoking during and after pregnancy increases the risk of SIDS. Passive smoking also significantly increases the risk of SIDS, and the risk increases further when both parents smoke.

Myth: The ideal room temperature for a baby is 20-24°C.
Fact: This temperature might be uncomfortably warm; the ideal room temperature is 16–20 °C.

Myth: Babies should sleep in the same room as their parents for the first year of life.
Fact: Infants should share the same room, but not the same bed, as their parents for the first six months to decrease the risk of SIDS.

Myth: Place the baby on their front to sleep.
Fact: Babies should be placed on their backs to sleep, with feet touching the end of the cot, so that they cannot slip under the covers. The use of pillows is not recommended.

Myth: The use of pacifiers is not recommended.
Fact: The use of pacifiers while settling the baby to sleep reduces the risk of cot death.

Measles Treatment and Complications

If a person has been exposed to measles within the past 72 hours, the measles vaccine is the preferred treatment option. This vaccine can provide lifelong immunity, although it is not 100% effective in preventing the disease. If the vaccine is not an option, immune globulin can be given within six days of exposure.

Complications from measles are common, with one-third of those infected experiencing issues such as pneumonia, otitis media, and diarrhea. However, the most serious complication is the development of subacute sclerosing pan-encephalitis.

Measles typically begins with coryzal symptoms, followed by the appearance of a rash several days later.

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.

Vaccination for Children with Congenital Heart Diseases

Children with congenital heart diseases should be vaccinated in most situations. There is no contraindication to vaccination unless the child is actively febrile, and vaccination should not be deferred. Even if a child is born prematurely and not adjusted to the predicted date of birth, they should still be vaccinated per the normal schedule. Live vaccines, such as the measles, mumps, rubella vaccine (MMR), are given together and do not seem to reduce the immune response. However, single component vaccines for the MMR are not available through the NHS. It is important to prioritize vaccination for children with congenital heart diseases to protect them from preventable diseases.

Infant Weight Loss and Monitoring

It is normal for infants to experience weight loss during the early days of life. However, if an infant loses more than 10% of their birth weight, it is important to assess for dehydration, underlying illness, and feeding problems. Monitoring the infant closely is also recommended, but weighing should not be done more frequently than daily according to NICE guidelines. If there is evidence of illness or failure to respond to feeding support, referral to paediatric services should be considered.

Supplementation with infant formula may result in the cessation of breastfeeding, so it is advised to support the mother to continue breastfeeding. The RCGP recommends testing for normality and sometimes, monitoring or reassurance may be the answer to questions related to infant weight loss. By closely monitoring and addressing any concerns, infants can return to their birth weight by 3 weeks of age.