Babies who are under 3 months old are usually the ones who experience infantile colic.

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.

Understanding Cystic Fibrosis

Cystic fibrosis is a genetic disorder that causes thickened secretions in the lungs and pancreas. It is an autosomal recessive condition that occurs due to a defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which regulates a chloride channel. In the UK, 80% of CF cases are caused by delta F508 on chromosome 7, and the carrier rate is approximately 1 in 25.

CF patients are at risk of colonization by certain organisms, including Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia (previously known as Pseudomonas cepacia), and Aspergillus. These organisms can cause infections and exacerbate symptoms in CF patients. It is important for healthcare providers to monitor and manage these infections to prevent further complications.

Overall, understanding cystic fibrosis and its associated risks can help healthcare providers provide better care for patients with this condition.

Understanding Precocious Puberty

Precocious puberty is a condition where secondary sexual characteristics develop earlier than expected, before the age of 8 in females and 9 in males. It is more common in females and can be classified into two types: gonadotrophin dependent and gonadotrophin independent. The former is caused by premature activation of the hypothalamic-pituitary-gonadal axis, while the latter is due to excess sex hormones. In males, precocious puberty is uncommon and usually has an organic cause, such as gonadotrophin release from an intracranial lesion, gonadal tumor, or adrenal cause. In females, it is usually idiopathic or familial and follows the normal sequence of puberty. Organic causes are rare and associated with rapid onset, neurological symptoms and signs, and dissonance, such as in McCune Albright syndrome. Understanding precocious puberty is important for early detection and management of the condition.

Children can use nasal triptans, but oral triptans are not approved for use and should not be the first choice. It is also important to avoid aspirin as it can increase the risk of Reye’s syndrome.

Headache in Children: Migraine and Tension-Type Headache

Headaches are a common complaint in children, with up to 50% of 7-year-olds and 80% of 15-year-olds experiencing at least one headache. Migraine without aura is the most common cause of primary headache in children, with a strong female preponderance after puberty. The International Headache Society has produced criteria for diagnosing paediatric migraine without aura, which includes headache lasting 4-72 hours, with at least two of four specific features and accompanied by nausea/vomiting and/or photophobia/phonophobia. Acute management of paediatric migraine involves ibuprofen, which is more effective than paracetamol, and triptans, which may be used in children over 12 years old but require follow-up. Prophylaxis for migraine is limited, with pizotifen and propranolol recommended as first-line preventatives, followed by valproate, topiramate, and amitriptyline as second-line options.

Tension-type headache is the second most common cause of headache in children. The IHS diagnostic criteria for TTH in children include headache lasting from 30 minutes to 7 days, with at least two of three specific pain characteristics and no nausea/vomiting but with photophobia/phonophobia present. Treatment for TTH involves identifying and addressing triggers, as well as using non-pharmacological interventions such as relaxation techniques and cognitive-behavioural therapy. Overall, headache in children requires careful diagnosis and management to improve quality of life and prevent long-term complications.

Breastfeeding and its Effects on Infant Health: A Comprehensive Overview

Breastfeeding has numerous benefits for infant health, including protection against sudden infant death syndrome (SIDS), many infections, childhood obesity, and future type 1 and 2 diabetes. While exclusive breastfeeding has the strongest protective effect against SIDS, any amount of breastfeeding can confer some protection. However, there is no evidence that exclusive breastfeeding protects against atopic eczema.

Breastfeeding may also affect neonatal jaundice. Breastfeeding jaundice, which occurs before the mother’s milk supply is fully developed, can make physiological jaundice appear worse. Breastmilk jaundice, on the other hand, is different and typically peaks between days 5 and 15 before becoming normal after week 3. It may persist up to age 3 months, and its cause is unclear.

Breastfeeding may also have implications for maternal bacterial infections, including tuberculosis. If the mother develops tuberculosis, temporarily stopping breastfeeding may be appropriate, but anti-tuberculosis drugs are safe for use with breastfeeding. Breastmilk is also low in vitamin D, so breastfed infants may need to receive vitamin D drops from 1 month of age if their mother has not taken supplements during pregnancy. This is particularly important for mothers at high risk of vitamin D deficiency.

Overall, breastfeeding has numerous benefits for infant health, but it is important to be aware of its potential implications for certain conditions.

In children under 12 months old, a heart rate of 140 is within the normal range of 110-160 bpm. However, pallor and not smiling are considered amber symptoms according to the NICE traffic light system for feverish children and should be monitored closely. A respiratory rate of 50 and a capillary refill time of 3 seconds or more are also abnormal and should be evaluated by a healthcare professional.

Paediatric vital signs refer to the normal range of heart rate and respiratory rate for children of different ages. These vital signs are important indicators of a child’s overall health and can help healthcare professionals identify any potential issues. The table below outlines the age-appropriate ranges for heart rate and respiratory rate. Children under the age of one typically have a higher heart rate and respiratory rate, while older children have lower rates. It is important for healthcare professionals to monitor these vital signs regularly to ensure that children are healthy and developing properly.

Age Heart rate Respiratory rate
< 1 110 - 160 30 - 40
1 – 2 100 – 150 25 – 35
2 – 5 90 – 140 25 – 30
5 – 12 80 – 120 20 – 25
> 12 60 – 100 15 – 20

If a child between the ages of 6 and 11 is experiencing an anaphylactic reaction, they should be given a dose of 300 micrograms (0.3ml) of adrenaline. This dose can be repeated every 5 minutes if necessary. Based on the patient’s age of 8 years old, it is recommended to administer the adrenaline at a dose of 300 micrograms IM immediately, as stated in the BNF. It is likely that the child is having an anaphylactic reaction to the nuts they were exposed to in the GP waiting room.

Anaphylaxis is a severe and potentially life-threatening allergic reaction that affects the entire body. It can be caused by various triggers, including food, drugs, and insect venom. The symptoms of anaphylaxis typically develop suddenly and progress rapidly, affecting the airway, breathing, and circulation. Swelling of the throat and tongue, hoarse voice, and stridor are common airway problems, while respiratory wheeze and dyspnea are common breathing problems. Hypotension and tachycardia are common circulation problems. Skin and mucosal changes, such as generalized pruritus and widespread erythematous or urticarial rash, are also present in around 80-90% of patients.

The most important drug in the management of anaphylaxis is intramuscular adrenaline, which should be administered as soon as possible. The recommended doses of adrenaline vary depending on the patient’s age, with the highest dose being 500 micrograms for adults and children over 12 years old. Adrenaline can be repeated every 5 minutes if necessary. If the patient’s respiratory and/or cardiovascular problems persist despite two doses of IM adrenaline, IV fluids should be given for shock, and expert help should be sought for consideration of an IV adrenaline infusion.

Following stabilisation, non-sedating oral antihistamines may be given to patients with persisting skin symptoms. Patients with a new diagnosis of anaphylaxis should be referred to a specialist allergy clinic, and an adrenaline injector should be given as an interim measure before the specialist allergy assessment. Patients should be prescribed two adrenaline auto-injectors, and training should be provided on how to use them. A risk-stratified approach to discharge should be taken, as biphasic reactions can occur in up to 20% of patients. The Resus Council UK recommends a fast-track discharge for patients who have had a good response to a single dose of adrenaline and have been given an adrenaline auto-injector and trained how to use it. Patients who require two doses of IM adrenaline or have had a previous biphasic reaction should be observed for a minimum of 6 hours after symptom resolution, while those who have had a severe reaction requiring more than two doses of IM adrenaline or have severe asthma should be observed for a minimum of 12 hours after symptom resolution. Patients who present late at night or in areas where access to emergency care may be difficult should also be observed for a minimum of 12

The use of aspirin as a pain reliever is not recommended for children because it can increase the risk of Reye’s syndrome. This condition is characterized by symptoms such as fever, rash, and vomiting, which can quickly progress to encephalopathy and even lead to death.

However, aspirin is approved for use in treating Kawasaki disease and as an antiplatelet medication to prevent blood clots after surgery.

Reye’s syndrome is a serious condition that affects children and causes progressive brain damage. It is often accompanied by the accumulation of fat in the liver, kidneys, and pancreas. The exact cause of Reye’s syndrome is not fully understood, but it is believed to be associated with the use of aspirin and viral infections. The condition is most common in children around 2 years of age and is characterized by confusion, seizures, and coma. Treatment for Reye’s syndrome is primarily supportive, and while the prognosis has improved in recent years, there is still a mortality rate of 15-25%.

Contraindications and Considerations for MMR Vaccine

Anaphylaxis to the MMR vaccine is rare, with less than 15 cases per million. The few contraindications to the vaccine include pregnancy, immunosuppression, gelatin or neomycin allergy with previous known anaphylaxis, and anaphylaxis to a previous dose of MMR. Egg allergy is not a contraindication, but some regions suggest immunizing in the secondary care setting. Breastfeeding and milk allergy are also not contraindications. Patients with pre-existing neurological conditions can receive the vaccine, but it is advised to postpone immunization if the condition is poorly controlled or progressive.

According to the Green Book, minor illnesses without fever or systemic upset are not valid reasons to postpone immunization. However, if an individual is acutely unwell, immunization should be postponed until they have fully recovered to avoid confusing the differential diagnosis of any acute illness by wrongly attributing any signs or symptoms to the adverse effects of the vaccine. It is important to note that patients who have received the MMR vaccine in the past can receive another dose, and the risk of allergy reduces with each successive immunization. At least two doses should provide satisfactory cover, but further immunization may not be required.

Patellofemoral pain syndrome is a common knee condition that affects a large number of individuals. It typically develops slowly and starts off as mild and sporadic, but can eventually become severe and persistent. The pain is alleviated by taking a break and exacerbated by activities like kneeling, running, or jumping.

Knee Problems in Children and Young Adults

Knee problems are common in children and young adults, and can be caused by a variety of conditions. Chondromalacia patellae is a condition that affects teenage girls and is characterized by softening of the cartilage of the patella. This can cause anterior knee pain when walking up and down stairs or rising from prolonged sitting. However, it usually responds well to physiotherapy.

Osgood-Schlatter disease, also known as tibial apophysitis, is often seen in sporty teenagers. It causes pain, tenderness, and swelling over the tibial tubercle. Osteochondritis dissecans can cause pain after exercise, as well as intermittent swelling and locking. Patellar subluxation can cause medial knee pain due to lateral subluxation of the patella, and the knee may give way. Patellar tendonitis is more common in athletic teenage boys and causes chronic anterior knee pain that worsens after running. It is tender below the patella on examination.

It is important to note that referred pain may come from hip problems such as slipped upper femoral epiphysis. Understanding the key features of these common knee problems can help with early diagnosis and appropriate treatment.