Hypotonia in infancy is not caused by cystic fibrosis.

Understanding Hypotonia: Causes and Types

Hypotonia, also known as floppiness, is a condition characterized by decreased muscle tone and weakness. It can be caused by central nervous system disorders or nerve and muscle problems. In some cases, an acutely ill child may exhibit hypotonia during examination. Hypotonia associated with encephalopathy in newborns is often caused by hypoxic ischaemic encephalopathy.

Central causes of hypotonia include Down’s syndrome, Prader-Willi syndrome, hypothyroidism, and cerebral palsy. In some cases, hypotonia may precede the development of spasticity in cerebral palsy patients. On the other hand, neurological and muscular problems that can cause hypotonia include spinal muscular atrophy, spina bifida, Guillain-Barre syndrome, myasthenia gravis, muscular dystrophy, and myotonic dystrophy.

It is important to identify the underlying cause of hypotonia to determine the appropriate treatment plan. Early intervention and therapy can help improve muscle strength and function in individuals with hypotonia. Understanding the different types and causes of hypotonia can aid in early diagnosis and management of the condition.

The answer is mother’s brother, as X-linked recessive conditions are exclusive to males and do not transmit from male to male.

X-linked recessive inheritance affects only males, except in cases of Turner’s syndrome where females are affected due to having only one X chromosome. This type of inheritance is transmitted by carrier females, and male-to-male transmission is not observed. Affected males can only have unaffected sons and carrier daughters.

If a female carrier has children, each male child has a 50% chance of being affected, while each female child has a 50% chance of being a carrier. It is rare for an affected father to have children with a heterozygous female carrier, but in some Afro-Caribbean communities, G6PD deficiency is relatively common, and homozygous females with clinical manifestations of the enzyme defect can be seen.

Childhood Illnesses Caused by Adenovirus

Adenovirus is a common cause of childhood illnesses, including upper respiratory tract infections, otitis media, acute bronchiolitis, obliterative bronchiolitis, pneumonia, diarrhea, meningitis, encephalitis, hepatitis, urinary tract infections, and nonspecific febrile illnesses. It is important to note that adenovirus is not the cause of glandular fever, Kawasaki disease, roseola infantum, or scarlet fever. Glandular fever is caused by Epstein-Barr virus, the exact cause of Kawasaki disease is unknown, roseola infantum is caused by human herpesvirus 6, and scarlet fever is due to Streptococcus pyogenes infection. It is important for parents and caregivers to be aware of the symptoms of these illnesses and seek medical attention if necessary.

Febrile Convulsions: A Common Occurrence in Young Children

Febrile convulsions are a relatively common occurrence in young children, with a prevalence of 5% between the ages of 6 months and 5 years. Clinical experience has shown that most of these convulsions occur before the age of three. The convulsions are typically tonic-clonic in nature, and most children (75%) will only experience one seizure. A strong family history of febrile seizures is the most important factor in predicting whether a child will develop further seizures.

Fortunately, epilepsy develops in only approximately 2% of children who experience febrile convulsions. After the first seizure, no treatment is required other than symptomatic care. It is important for parents and caregivers to be aware of the signs and symptoms of febrile convulsions and to seek medical attention if they occur. With proper management and care, most children will recover fully from febrile convulsions without any long-term effects.

This family cannot foster another child because they are already fostering three children, which is the maximum allowed per family. However, if a group of more than three siblings needs to be fostered together, an exception can be made. Age over 50 is not a disqualifying factor for fostering, as the minimum age requirement is 18 (although most organizations prefer 21). While a diagnosis of epilepsy may be a concern if the condition is not well-controlled and the foster parent would be the sole caregiver for a young child, there is no indication in the question that this is the case. Finally, foster children are required to have medical examinations every six months, and failing to bring them to these appointments would be a cause for concern, but the consequences would depend on the outcome of an investigation into why the appointments were missed.

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.

It is recommended that children diagnosed with scarlet fever should not attend nursery or school until they have been on antibiotics for at least 24 hours.

Scarlet fever is a condition caused by erythrogenic toxins produced by Group A haemolytic streptococci, usually Streptococcus pyogenes. It is more common in children aged 2-6 years, with the highest incidence at 4 years. The disease is spread through respiratory droplets or direct contact with nose and throat discharges. The incubation period is 2-4 days, and symptoms include fever, malaise, headache, sore throat, ‘strawberry’ tongue, and a rash that appears first on the torso and spares the palms and soles. Scarlet fever is usually a mild illness, but it may be complicated by otitis media, rheumatic fever, acute glomerulonephritis, or rare invasive complications.

To diagnose scarlet fever, a throat swab is usually taken, but antibiotic treatment should be started immediately, rather than waiting for the results. Management involves oral penicillin V for ten days, while patients with a penicillin allergy should be given azithromycin. Children can return to school 24 hours after starting antibiotics, and scarlet fever is a notifiable disease. Desquamation occurs later in the course of the illness, particularly around the fingers and toes. The rash is often described as having a rough ‘sandpaper’ texture, and children often have a flushed appearance with circumoral pallor. Invasive complications such as bacteraemia, meningitis, and necrotizing fasciitis are rare but may present acutely with life-threatening illness.

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.

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.

Management of a Child with Sore Throat

This child doesn’t exhibit any life-threatening symptoms or signs of bacterial tonsillitis. The presence of fever and tonsillar exudate suggests a viral sore throat, which doesn’t require antibiotics. It is important to explain to the parents that antibiotics are unlikely to help and may contribute to bacterial resistance. Instead, regular analgesia and fluids should be given, and safety-netting advice provided. Antibiotics may be prescribed immediately for certain groups, such as those with three or more Centor criteria, systemic illness, or pre-existing comorbidities. It is also important to inform parents about the average length of the illness. As a GP who helped develop the NICE guidelines, I recommend following these management strategies for children with sore throat.

Developmental Milestones for Infants

As infants grow and develop, they acquire new skills at different rates. However, there are certain milestones that most children will have achieved by a certain age. For instance, naming a simple picture in a book is a skill that is typically mastered by the age of 23 months. By 25-26 months, most children can name several body parts. Removing socks and shoes without assistance is a skill that is usually achieved by 27-28 months. By 31-32 months, throwing a ball overarm is a skill that most children will have mastered. Finally, using four or five words in a sentence is a milestone that is typically achieved by the age of 35-36 months. It’s important to remember that there is variation in the rate of development among infants, but these milestones can serve as a general guide for parents and caregivers.

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.

It is recommended to consider prescribing calcium supplements and vitamin D for breastfeeding mothers whose babies have or are suspected to have CMPI. This is to prevent deficiency while they exclude dairy from their diet, which puts them at risk of deficiency. Soya milk is not advised for infants due to its phyto-oestrogen content, and lactase enzyme products are not relevant as lactose intolerance is a different condition. Lactulose is also not indicated based on the given history.

Cow’s milk protein intolerance/allergy (CMPI/CMPA) is a condition that affects approximately 3-6% of children and typically presents in formula-fed infants within the first 3 months of life. However, it can also occur in exclusively breastfed infants, although this is rare. Both immediate (IgE mediated) and delayed (non-IgE mediated) reactions can occur, with CMPA usually used to describe immediate reactions and CMPI for mild-moderate delayed reactions. Symptoms of CMPI/CMPA include regurgitation and vomiting, diarrhea, urticaria, atopic eczema, colic symptoms such as irritability and crying, wheezing, chronic cough, and rarely, angioedema and anaphylaxis.

Diagnosis of CMPI/CMPA is often based on clinical presentation, such as improvement with cow’s milk protein elimination. However, investigations such as skin prick/patch testing and total IgE and specific IgE (RAST) for cow’s milk protein may also be performed. If symptoms are severe, such as failure to thrive, referral to a pediatrician is necessary.

Management of CMPI/CMPA depends on whether the child is formula-fed or breastfed. For formula-fed infants with mild-moderate symptoms, extensive hydrolyzed formula (eHF) milk is the first-line replacement formula, while amino acid-based formula (AAF) is used for infants with severe CMPA or if there is no response to eHF. Around 10% of infants with CMPI/CMPA are also intolerant to soy milk. For breastfed infants, mothers should continue breastfeeding while eliminating cow’s milk protein from their diet. Calcium supplements may be prescribed to prevent deficiency while excluding dairy from the diet. When breastfeeding stops, eHF milk should be used until the child is at least 12 months old and for at least 6 months.

The prognosis for CMPI/CMPA is generally good, with most children eventually becoming milk tolerant. In children with IgE-mediated intolerance, around 55% will be milk tolerant by the age of 5 years, while in children with non-IgE mediated intolerance, most will be milk tolerant by the age of 3 years. However, a challenge is often performed in a hospital setting as anaphylaxis can occur.

Possible Causes of Recurrent Respiratory Tract Infection

In the presence of a positive history of whooping cough, the most likely diagnosis is bronchiectasis with possible pseudomonas colonisation. This could be a result of untreated or poorly treated whooping cough infection. However, IgA deficiency, cystic fibrosis, and ciliary dysmotility are also possible causes of recurrent respiratory tract infection, but less likely to be the cause here.

It is recommended that the patient be referred to a paediatric respiratory specialist for further advice. A sweat test to exclude cystic fibrosis will certainly be part of the workup. It is important to identify the underlying cause of recurrent respiratory tract infection to provide appropriate treatment and prevent further complications.

Children with hand, foot and mouth disease do not need to be excluded from childcare or school.

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.

Further assessment should be sought if a child is unable to walk without support by the age of 18 months.

Gross Motor Developmental Milestones

Gross motor developmental milestones refer to the physical abilities that a child acquires as they grow and develop. These milestones are important indicators of a child’s overall development and can help parents and healthcare professionals identify any potential delays or concerns. The table below summarizes the major gross motor developmental milestones from 3 months to 4 years of age.

At 3 months, a baby should have little or no head lag when pulled to sit and should have good head control when lying on their abdomen. By 6 months, they should be able to pull themselves to a sitting position and roll from front to back. At 9 months, they should be able to crawl and pull themselves to a standing position. By 12 months, they should be able to cruise and walk with one hand held. At 18 months, they should be able to walk unsupported and squat to pick up a toy. By 2 years, they should be able to run and walk up and down stairs holding onto a rail. At 3 years, they should be able to ride a tricycle using pedals and walk up stairs without holding onto a rail. Finally, at 4 years, they should be able to hop on one leg.

It is important to note that while the majority of children crawl on all fours before walking, some children may bottom-shuffle, which is a normal variant that runs in families. By monitoring a child’s gross motor developmental milestones, parents and healthcare professionals can ensure that they are meeting their developmental goals and identify any potential concerns early on.

The automated otoacoustic emission test is utilized for screening hearing problems in newborns. This test involves inserting a small soft-tipped earpiece in the outer part of a baby’s ear to send clicking sounds down the ear. A healthy cochlea is indicated by the presence of a soft echo.

The auditory brainstem response test is an incorrect answer. It may be conducted by an audiologist if a baby is not found to have satisfactory hearing during newborn screening with the automated otoacoustic emission test. This test involves placing small sensors on the baby, playing sounds of different frequencies into their ears, and recording the response using a computer.

Play audiometry is also an incorrect answer. It is suitable for children between two and five years old and not for newborns as the child is required to perform a simple task when they hear a sound.

Pure tone audiometry is another incorrect answer. It is used in older children (school age) and adults and is not suitable for use in newborns as the patient must respond when they hear a noise by pressing a button.

Hearing Tests for Children

Hearing tests are important for children to ensure that they are developing normally. There are several tests that may be performed on children of different ages. For newborns, an otoacoustic emission test is typically done as part of the Newborn Hearing Screening Programme. This test involves playing a computer-generated click through a small earpiece and checking for the presence of a soft echo, which indicates a healthy cochlea. If the results of this test are abnormal, an Auditory Brainstem Response test may be done.

For infants between 6-9 months, a Distraction test may be performed by a health visitor with the help of two trained staff members. For children between 18 months to 2.5 years, a Recognition of familiar objects test may be used, which involves using familiar objects like a teddy or cup and asking the child simple questions like where is the teddy? For children over 2.5 years, Performance testing and Speech discrimination tests using similar-sounding objects like the Kendall Toy test or McCormick Toy Test may be used. Pure tone audiometry is typically done at school entry in most areas of the UK for children over 3 years old.

In addition to these tests, there is also a questionnaire for parents in the Personal Child Health Records called Can your baby hear you? This questionnaire can help identify any potential hearing issues in children. Overall, hearing tests are an important part of ensuring that children are developing normally and can help identify any issues early on.

Causes of Acute Stridor

A sudden onset of stridor without any warning signs such as cough and runny nose may indicate epiglottitis. Symptoms to look out for include respiratory distress, cyanosis, agitation, and drooling. However, there are other causes of acute stridor such as croup, bacterial tracheitis, subglottic stenosis, foreign body inhalation, and retropharyngeal abscess. Smoke inhalation, diphtheria, and angioneurotic edema can also lead to stridor. In all cases, it is important to administer oxygen to maintain adequate saturation. Severe cases may require ventilation. Enlarged adenoids and tonsils can also cause snoring.

A reflex anoxic seizure, also known as white reflex asystolic attacks, is not an epileptic seizure but is often misdiagnosed as one. It occurs due to increased vagal tone, resulting in transient reflex asystole. These seizures can occur from birth but are common between six months to two years of age and are triggered by shock, anxiety, or minor injury. Symptoms include pallor, loss of consciousness, stiffening, eye deviation, and vagal asystole, which may progress to a seizure. However, there is a rapid spontaneous recovery, and no treatment is required. Unlike epileptic seizures, patients having a reflex anoxic seizure do not usually bite their tongue.

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.

Understanding the Timing of Men ACWY Immunisation

When reading the introduction, it is important to pay attention to the specific type of immunisation being discussed. This question pertains to Men ACWY, not Men B. Misreading the question could lead to confusion about the correct timing of the immunisation. For Men ACWY in an otherwise healthy individual, the vaccine is administered at 14 years of age.

It is important to note that patients with certain medical conditions should also receive the Men ACWY vaccine. These conditions include asplenia or splenic dysfunction (including Coeliac disease and sickle cell disease) and complement disorders (including those receiving complement inhibitor therapy). By understanding the timing and circumstances in which Men ACWY immunisation is necessary, we can ensure the best possible protection against meningococcal disease.

A non-IgE mediated food allergy is indicated by the presence of atopic eczema.

Food allergies in children and young people can be categorized as either IgE-mediated or non-IgE-mediated. It is important to note that food intolerance is not caused by immune system dysfunction and is not covered by the 2011 NICE guidelines. Symptoms of IgE-mediated allergies include skin reactions such as pruritus, erythema, urticaria, and angioedema, as well as gastrointestinal and respiratory symptoms. Non-IgE-mediated allergies may present with symptoms such as gastro-oesophageal reflux disease, loose or frequent stools, and abdominal pain. If the history suggests an IgE-mediated allergy, skin prick tests or blood tests for specific IgE antibodies to suspected foods and co-allergens should be offered. If the history suggests a non-IgE-mediated allergy, the suspected allergen should be eliminated for 2-6 weeks and then reintroduced, with consultation from a dietitian for nutritional adequacies, timings, and follow-up.

Undescended testicles are more common in premature infants, such as the patient in this case. According to new guidelines, it is recommended to review the patient at 3 months and refer them for consideration of orchidopexy before they reach 6 months of age if the condition persists.

While a referral to a pediatrician is not necessary at this stage, it can be arranged if the parents are concerned. However, if the patient has bilateral undescended testes, an urgent referral is required to rule out any genetic abnormalities.

Similarly, a referral to a pediatric urologist is not needed yet. A review at 3 months may show that the testes have descended normally, and parents should be reassured that observation is useful in preventing unnecessary surgeries.

By 6 months of age, the testis should have descended, and if it hasn’t, it is definitely abnormal. Delaying referral until 12 months of age is not ideal, as surgical procedures are typically planned for this age group, and undescended testes can lead to complications such as infertility, torsion, and testicular cancer. Therefore, earlier review and referral are crucial.

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.

Fraser Guidelines and Young People’s Competence to Consent to Contraceptive Advice or Treatment

The Fraser guidelines provide a framework for assessing young people’s competence to consent to contraceptive advice or treatment. According to these guidelines, a young person is considered competent if they understand the doctor’s advice, cannot be persuaded to inform their parents, are likely to start or continue having sexual intercourse with or without contraceptive treatment, are at risk of physical or mental harm without treatment, and require advice or treatment in their best interests without parental consent.

However, there can be considerable differences in the maturity of teenagers seeking contraception, and it is important to consider whether the failure of the consultation is due to the doctor’s communication skills or the young person’s anxiety. For instance, a young person who is not sexually active may not understand the importance of contraception and may need education or counselling to help them make informed decisions about their sexual health.

In such cases, a specialist young people’s service may be able to provide the necessary support, such as counselling, education, or youth work interventions, to help the young person understand the risks and benefits of contraception and make an informed decision about their sexual health. By providing young people with the information and support they need, healthcare professionals can help them make responsible choices about their sexual health and reduce the risk of physical and mental harm.

At the age of 2, a child is expected to have the ability to use a spoon proficiently and drink from a cup without spilling. This is based on both the MRCPCH development guidelines and commonly accepted developmental milestones. As such, it appears that the child in question is progressing normally, and the mother can be given reassurance.

Developmental Milestones in Social Behaviour, Feeding, Dressing, and Play

Developmental milestones are important markers in a child’s growth and development. In terms of social behaviour and play, there are several milestones that parents and caregivers can look out for. At six weeks, a baby may start to smile, which develops into laughter by three months. At six months, they become less shy, but by nine months, they may exhibit shyness. Additionally, babies at this age tend to put everything in their mouths.

In terms of feeding, a six-month-old may start to put their hand on the bottle while being fed. By 12-15 months, they can drink from a cup and use a spoon, which develops over a three-month period. At two years, they become competent with a spoon and don’t spill with a cup, and by three years, they can use a spoon and fork. Finally, at five years, they can use a knife and fork.

When it comes to dressing, a child may start to help with getting dressed and undressed at 12-15 months. By 18 months, they can take off shoes and hats but may not be able to replace them. At two years, they can put on hats and shoes, and by four years, they can dress and undress independently, except for laces and buttons.

Lastly, in terms of play, a nine-month-old may start to play peek-a-boo and wave bye-bye. By 12 months, they may play pat-a-cake, and at 18 months, they can play contentedly alone. At two years, they may play near others but not necessarily with them, and by four years, they can play with other children. These milestones can help parents and caregivers track a child’s development and ensure they are meeting age-appropriate goals.

If a child under the age of 3 months has a fever exceeding 38ºC, they should be considered at high risk for serious illness according to the NICE traffic light system. This is classified as a red alert. NICE CKS provides additional information, stating that research from six studies indicates that the risk of serious illness is more than 10 times greater in this age group compared to older children.

The NICE Feverish illness in children guidelines were introduced in 2007 and updated in 2013 to provide a ‘traffic light’ system for assessing the risk of febrile illness in children under 5 years old. The guidelines recommend recording the child’s temperature, heart rate, respiratory rate, and capillary refill time, as well as looking for signs of dehydration. Measuring temperature should be done with an electronic thermometer in the axilla for children under 4 weeks or with an electronic/chemical dot thermometer in the axilla or an infra-red tympanic thermometer. The risk stratification table categorizes children as green (low risk), amber (intermediate risk), or red (high risk) based on their symptoms. Management recommendations vary depending on the risk level, with green children managed at home, amber children provided with a safety net or referred to a specialist, and red children urgently referred to a specialist. The guidelines also advise against prescribing oral antibiotics without an apparent source of fever and note that a chest x-ray is not necessary if a child with suspected pneumonia is not being referred to the hospital.

Babies with cow’s milk protein allergy may also have an intolerance to soya milk. The primary milk alternatives used for such babies are extensively hydrolysed formula and alpha amino acid formula. Oat and almond milk are not advised for babies with this allergy, although there is no evidence of any adverse reactions to them.

Cow’s milk protein intolerance/allergy (CMPI/CMPA) is a condition that affects approximately 3-6% of children and typically presents in formula-fed infants within the first 3 months of life. However, it can also occur in exclusively breastfed infants, although this is rare. Both immediate (IgE mediated) and delayed (non-IgE mediated) reactions can occur, with CMPA usually used to describe immediate reactions and CMPI for mild-moderate delayed reactions. Symptoms of CMPI/CMPA include regurgitation and vomiting, diarrhea, urticaria, atopic eczema, colic symptoms such as irritability and crying, wheezing, chronic cough, and rarely, angioedema and anaphylaxis.

Diagnosis of CMPI/CMPA is often based on clinical presentation, such as improvement with cow’s milk protein elimination. However, investigations such as skin prick/patch testing and total IgE and specific IgE (RAST) for cow’s milk protein may also be performed. If symptoms are severe, such as failure to thrive, referral to a pediatrician is necessary.

Management of CMPI/CMPA depends on whether the child is formula-fed or breastfed. For formula-fed infants with mild-moderate symptoms, extensively hydrolyzed formula (eHF) milk is the first-line replacement formula, while amino acid-based formula (AAF) is used for infants with severe CMPA or if there is no response to eHF. Around 10% of infants with CMPI/CMPA are also intolerant to soy milk. For breastfed infants, mothers should continue breastfeeding while eliminating cow’s milk protein from their diet. Calcium supplements may be prescribed to prevent deficiency while excluding dairy from the diet. When breastfeeding stops, eHF milk should be used until the child is at least 12 months old and for at least 6 months.

The prognosis for CMPI/CMPA is generally good, with most children eventually becoming milk tolerant. In children with IgE-mediated intolerance, around 55% will be milk tolerant by the age of 5 years, while in children with non-IgE mediated intolerance, most will be milk tolerant by the age of 3 years. However, a challenge is often performed in a hospital setting as anaphylaxis can occur.

Medications for Croup: Understanding Their Uses and Limitations

Croup is a common respiratory illness in children, characterized by a barking cough and inspiratory stridor. While it is usually caused by a viral infection, treatment with medications can help alleviate symptoms and prevent complications. Here is a breakdown of some commonly used medications for croup and their uses:

Dexamethasone: This steroid medication is recommended for all children with mild to moderate croup. It helps reduce inflammation in the airways and can improve symptoms within hours.

Amoxicillin: While croup is usually caused by a virus, bacterial infections can sometimes complicate the illness. Amoxicillin is an antibiotic that can be used to treat bacterial infections in children with croup.

Cetirizine: This antihistamine medication is not recommended for children with croup, as it is used to relieve allergy symptoms and has no effect on the underlying cause of croup.

Salbutamol: This medication is used to treat asthma and other respiratory conditions, but is not typically used for croup.

Simple linctus: This cough syrup contains citric acid and is sometimes used as a demulcent to soothe the throat. However, its effectiveness in reducing cough frequency is limited.

It is important to note that medications should only be used under the guidance of a healthcare professional, and that treatment for croup may vary depending on the severity of the illness and the individual needs of the child.

If the testicle remains undescended after 3 months, it is recommended to consider referral for orchidopexy. For further information, please refer to the CKS guidelines.

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.

Fluoxetine as the Only Effective Medication for Treating Depression in Children and Adolescents

According to the British National Formulary (BNF), fluoxetine is the only medication that has been proven effective in clinical trials for treating depressive illness in children and adolescents. It is important to note that medication is not typically prescribed by non-specialists in this age group. However, as a healthcare provider, it is important to have a general understanding of any specialist-initiated treatments and investigations to be able to discuss them with patients.

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.