According to NICE guidelines, if a child under 6 months old has a UTI that responds well to antibiotics within 48 hours, an ultrasound scan should be done within 6 weeks. However, if the UTI is atypical or recurrent, additional tests such as ultrasound during the acute infection, DMSA 4-6 months after the acute infection, and MCUG are recommended.

An atypical UTI may present with symptoms such as being seriously ill, poor urine flow, an abdominal or bladder mass, elevated creatinine, failure to respond to antibiotics within 48 hours, or non-E. coli organisms. Recurrent UTI is defined as having two or more episodes of UTI with acute pyelonephritis/upper urinary tract infection, one episode of UTI with acute pyelonephritis/upper urinary tract infection plus one or more episodes of UTI with cystitis/lower urinary tract infection, or three or more episodes of UTI with cystitis/lower urinary tract infection.

Urinary tract infections (UTIs) in children require investigation to identify any underlying causes and potential kidney damage. Unlike in adults, the development of a UTI in childhood may indicate renal scarring. The National Institute for Health and Care Excellence (NICE) recommends imaging the urinary tract for infants under six months who present with their first UTI and respond to treatment, within six weeks. Children over six months who respond to treatment do not require imaging unless there are features suggestive of an atypical infection, such as being seriously ill, having poor urine flow, an abdominal or bladder mass, raised creatinine, septicaemia, failure to respond to antibiotics within 48 hours, or infection with non-E. coli organisms.

Further investigations may include a urine microscopy and culture, as only 50% of children with a UTI have pyuria, making microscopy or dipstick of the urine inadequate for diagnosis. A static radioisotope scan, such as DMSA, can identify renal scars and should be done 4-6 months after the initial infection. Micturating cystourethrography (MCUG) can identify vesicoureteric reflux and is only recommended for infants under six months who present with atypical or recurrent infections.

Treatment options for idiopathic constipation with faecal impaction and overflow incontinence

Idiopathic constipation with faecal impaction and overflow incontinence requires prompt and appropriate treatment. The National Institute of Health and Care Excellence (NICE) recommends the use of macrogols (polyethylene glycol ‘3350’ + electrolytes; Movicol©) with an escalating dose regimen, adjusting the dose according to the response. Adequate fluid and fibre are necessary but should not be used alone as the only treatment. Rectal suppositories and sodium citrate enemas are suggested as options only if oral treatment fails. If this fails, phosphate enemas in hospital are recommended. A stimulant laxative such as senna can be added to the macrogols if the latter do not lead to disimpaction after two weeks. A stimulant laxative singly or in combination with an osmotic laxative or a stool softener should be used if macrogols are not tolerated. It is important to choose the appropriate treatment option based on the patient’s condition and response to treatment.

While positional management of gastro-oesophageal reflux may seem logical, it is important to note that infants should always sleep on their backs to minimize the risk of cot death. Although there are no concerning symptoms, it is advisable to provide treatment for the child’s distress. It is not recommended to increase the volume of feeds as this may exacerbate reflux. Instead, smaller and more frequent feeds could be considered. Diluting the feeds will not improve symptoms and may actually increase the volume in the stomach.

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.

MMR Vaccine Administration Guidelines

The MMR vaccine can be administered at any age, but it is recommended to consult with your local Health Protection Team if the child is under 1 year of age. In case of exposure to measles, mumps, or rubella, most individuals can receive post-exposure prophylaxis with the MMR vaccine within three days, provided that the vaccine is not contraindicated. However, the response to MMR vaccine in infants under 6 months of age is not optimal, and it is not recommended as post-exposure prophylaxis in this age group.

For children under 6 months of age, pregnant women, and immunocompromised individuals, human normal immunoglobulin should be considered if the MMR vaccine cannot be given. It is important to follow the recommended guidelines for MMR vaccine administration to ensure the best protection against these diseases.

Gynaecological Problems in Children: Vulvovaginitis

In children, gynaecological problems are not uncommon, and vulvovaginitis is the most prevalent disorder. This condition is often caused by poor hygiene, tight clothing, lack of labial fat pads protecting the vaginal orifice, and lack of protective acid secretion found in the reproductive years. Bacterial or fungal organisms may be responsible for the infection, and in rare cases, sexual abuse may present as vulvovaginitis. If there is a bloody discharge, it is essential to consider a foreign body.

It is not recommended to perform vaginal examinations or vaginal swabs on children. Instead, referral to a paediatric gynaecologist is appropriate for persistent problems. Most newborn girls have some mucoid white vaginal discharge, which usually disappears by three months of age.

The management of vulvovaginitis includes advising the child about hygiene, using soothing creams, and applying topical antibiotics or antifungals. In resistant cases, oestrogen cream may be necessary. It is crucial to seek medical attention if the symptoms persist or worsen.

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.

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.

Monitoring and Side Effects of Methylphenidate Therapy for ADHD

Height and growth should be regularly monitored and plotted on a growth chart for children receiving methylphenidate therapy for attention deficit hyperactivity disorder (ADHD). Growth retardation is a serious potential side effect, and weight loss may also occur. In addition, heart rate and blood pressure should be monitored and recorded on a centile chart before and after each dose change, as well as routinely every three months. Methylphenidate is a central nervous system stimulant that is used as part of a comprehensive treatment program for children with severe ADHD. However, patients who experience sustained resting tachycardia, arrhythmia, or systolic blood pressure greater than the 95th percentile (or a clinically significant increase) measured on two occasions should have their dose reduced and be referred to a pediatrician. Routine blood tests and ECGs are not recommended unless there is a clinical indication. It is important to record pulse, blood pressure, psychiatric symptoms, appetite, weight, and height at initiation of therapy, following each dose adjustment, and at least every six months thereafter.

Differentiating between Acute EBV, CMV, and Toxoplasmosis

Acute EBV typically presents with symptoms such as fatigue, malaise, fever, pharyngitis, and bilateral lymphadenopathy. Heterophil antibody tests are usually positive. On the other hand, CMV mononucleosis has a lower incidence of pharyngitis and cervical adenopathy. The clinical presentation of CMV infectious mononucleosis may be similar to EBV, but it is usually not accompanied by posterior cervical adenopathy, and non-exudative pharyngitis is minimal or absent.

Primary toxoplasmosis is acquired through the ingestion of undercooked meat containing toxoplasma cysts or fresh food contaminated by toxoplasma excreted in cats’ faeces. The infection is asymptomatic in 80-90% of immunocompetent patients. Highly characteristic of toxoplasmosis is asymmetrical lymphadenopathy limited to an isolated lymph node group. Patients with toxoplasmosis have little or no fever, fatigue, or pharyngitis.

Mild transient thrombocytopenia is not uncommon in EBV infectious mononucleosis. In contrast, patients with toxoplasmosis have little or no fever, fatigue, or pharyngitis. The diagnosis of ALL and HD is made by a combination of blood film examination, bone marrow aspiration and biopsy, and lymph node biopsy.

In summary, while EBV and CMV mononucleosis may have similar clinical presentations, the absence of posterior cervical adenopathy and minimal or absent non-exudative pharyngitis may indicate CMV. Asymmetrical lymphadenopathy limited to an isolated lymph node group is highly characteristic of toxoplasmosis.

Understanding Measles

Measles is a highly contagious disease that is characterized by a rash with maculopapular lesions. The onset of the disease is marked by a prodromal phase, which includes symptoms such as fever, malaise, loss of appetite, cough, rhinorrhea, and conjunctivitis. This phase typically lasts for one to four days before the rash appears.

The rash usually starts on the head and then spreads to the trunk and extremities over a few days. The fever usually subsides once the rash appears. The rash itself lasts for at least three days and then fades in the order of appearance. In some cases, it can leave behind a brownish discoloration and may become confluent over the buttocks.

It is important to note that measles is a serious disease that can lead to complications such as pneumonia, encephalitis, and even death. Vaccination is the best way to prevent measles and its complications.