Paediatrics
Gwendoline Tan
Lydia Akinola
For Peer Teaching Society
21/9/15
What we will cover
• Viral/bacterial rashes in children
• Difficulty breathing
Measles
• Prodrome: cough, coryza, conjunctivitis, Koplik spots,
fever
• Maculopapular rash starts behind ears
• Complications
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encephalitis
giant cell pneumonia
subacute sclerosing panencephalitis
febrile convulsions
keratoconjunctivitis, corneal ulceration
• MMR within 72h of measles contact for nonimmunised child
Mumps
• Fever, malaise, parotitis
• Becomes bilateral in 70%
• Complications
– Pancreatitis
– Orchitis
– Meningitis/encephalitis
Rubella
• Pink macular rash which starts on face and
spreads to trunk
• Suboccipital and postauricular
lymphadenopathy
• In utero
– 1st to 4th week: eye anomaly
– 4th to 8th week: cardiac abnormality
– 8th to 12th week: deafness
Erythema infectiosum (fifth disease)
• Parvovirus B19
• Lethargy, fever, headache, ‘slapped-cheek'
rash on face and limbs
• Can cause marrow to stop producing RBCs 
aplastic crisis  transfusions
Roseola infantum (sixth disease)
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HHV6
High fever and MP rash when fever subsides
Febrile convulsions (10-15%)
Can cause aseptic meningitis, hepatitis
Hand foot mouth disease
• Coxsackie A16/enterovirus 71
• Sore throat, fever, oral ulcers then vesicles on
palms and soles
Chickenpox
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Varicella zoster virus (HHV3)
Can be caught from someone with shingles
Fever, rash often starting on back
Macule  papule  vesicle  ulcer  crust
Complications: purpura fulminans, necrotising
fasciitis, pneumonia, meningitis
• VZV Ig + aciclovir if immunosuppressed
Herpes simplex
• Gingivostomatitis: vesicles on lips, gums, tongue,
palate  high fever, painful eating and drinking
• Cold sores – usually HSV1
• Complications
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Eczema herpeticum
Herpetic whitlows
Blepharitis/conjunctivitis
Aseptic meningitis
HSV encephalitis
Molluscum contagiosum
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Umbilicated papules caused by Pox virus
Spread by direct contact
More extensive in those with eczema/HIV
Usually resolves w/o treatment in 18mths
Scarlet fever
• Group A strep (S. pyogenes) – seen poststrep/impetigo
• Fever, sore throat, strawberry tongue, rash
• Rash 12-48h after fever, feels like
sandpaper/goosebumps
• Peeling skin in armpits/groin/fingers and toes
• Complications: OM, post-strep GN, rheumatic
fever, septicaemia, pneumonia
• Penicillin V PO
Impetigo
• Contageous staph/strep skin infection
• Erythematous  vesicular  golden honeycoloured crusted lesions
• Topical mupirocin or fusidic acid if mild
• Flucloxacillin or erythromycin if extensive
Meningococcal septicaemia
• Non-blanching purpuric rash, fever, unwell
child, shock
• IM benzylpenicillin in community, IV
ceftriaxone
Age
Organism
Neonate – 3m
GBS, E. coli, Listeria monocytogenes
1m – 6y
N. meningitidis, S. pneumoniae, H. influenzae
>6y
N. meningitidis, S. pneumoniae
Nappy rash
• Ammoniac
– Crease-sparing
– Erythematous
– Irritant dermatitis – barrier cream e.g. Sudocrem
• Candida
– Creases involved
– Satellite lesions
– Treat with antifungal
Other rashes to revise
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Eczema
Dermatitis herpetiformis
Cellulitis/erysipelas
Henoch-Schonlein purpura
Tinea
Scabies
Don’t forget to consider NAI
Breathing difficulties
Airway Assessment
• Secretions or stridor
• Foreign body
• Unprotected airway
Breathing assessment
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Respiratory rate
Recession and use of accessory muscles
Oxygen saturations
Auscultation
Age
< 1 year
1-2
years
2-5
years
5-12
years
> 12
years
Resp.
Rate
30-40
25-35
25-35
20-25
15-20
Wheeze
Common
Rare
Infection – bronchiolitis, viral induced
wheeze, whooping cough, pneumonia
Cystic fibrosis
Asthma (> 1 year of age)
Cow’s milk protein intolerance
Foreign body inhalation
External compression of airway
Gastro-oesophageal reflux
Heart failure
Recurrent aspiration
Persistent cough
Common
Uncommon
Post-infection
Pertussis
Recurrent URTIs
Foreign body
Post-nasal drip
Gastro-oesophageal reflux
Asthma (exercise, night)
Cystic fibrosis
Cigarette smoke
Tuberculosis
Habit
Immune deficiency
Respiratory distress
Symptom
Signs
Breathlessness
Tachypnoea
Difficulty talking
Tachycardia
Difficulty feeding
Dyspnoea
Wheeziness
Recession
Sweatiness
Cyanosis
Nasal flaring
Use of accessory muscles
Expiratory grunting
Crackles
Downward displacement of the lung
Case
A 14 month old girl is seen with a 2 day history
of a loud cough. She has a fever of 38.5°C, a
respiratory rate of 35, stridor and marked
intercostal and subcostal recession. She is
playful and is feeding well.
(taken from Paediatrics: Clinical Case Uncovered)
Asthma
Asthma
Features of episode that suggest asthma include:
• Nocturnal symptoms
• Recurrent cough, shortness of breathe, wheeze
• Worse following exposure to trigger
• Personal/family history of atopy
• Widespread wheeze on auscultation
• Improvement with treatment
Asthma
• What are the symptoms of life-threatening
asthma?
• What might you find on examination?
• What might you find on spirometry?
Asthma
What are the side effects of chronic treatment?
Cystic fibrosis
Cystic fibrosis
• Which other organs can be affected?
• Name 3 ways that CF may present?
• Name 5 people involved in CF MDT
Case
A 3 year old boy is in acute respiratory distress.
There is no past history of note except he has
not been immunised. He has a temperature of
40C, looks flushed and unwell, is drooling and
has an inspiratory stridor. His cough is muffled. A
colleague asks for help examining the boy’s
throat. Which is the single most appropriate
advice to give?
(taken from Oxford Assess & Progress)
A – do not disturb the child, and call for senior help
urgently
B – give neb budesonide and then examine the
throat
C – go ahead and examine the throat, but have a
laryngoscope and endotracheal tube to hand
D – go ahead and examine the throat straight away
to help make diagnosis
E – site an IV line and give a dose of cefotaxime
first, then examine the throat
Airway inflammation
Croup
Epiglottis
Time course
Days
Hours
Prodrome
Coryza
None
Cough
barking
Slight if any
Feeding
Can drink
No
Mouth
Closed
Drooling saliva
Toxic
No
Yes
Fever
< 38.5°C
> 38.5°C
Stridor
Rasping
Soft
Voice
Hoarse
Weak or silent
Croup
• Also known as acute laryngotracheobronchitis
• https://www.youtube.com/watch?v=XpPVYm
ALPoA
• Most commonly caused by parainfluenza virus
• What are the treatment options?
Pneumonia
Age
Pathogens
Neonates
Group B streptococcus
Escherichia coli (and other enterococci)
Chlamydia trachomatis
Infants
Respiratory virus (e.g. RSV, adenovirus)
Streptococcus pneumoniae
Haemophilus influenzae
Bordetella pertussis
Staphylococcus aureus (RARE)
Children
Streptococcus pneumoniae
Haemophilus influenzae
Group A streptococcus
Adolscents
As above
Mycoplasma pneumoniae
Chlamydia pnuemoniae
Whopping cough
• http://www.parents.com/videos/v/97819228/
what-does-whooping-cough-sound-like.htm
Case
A 6 week old is seen in the ‘failure to thrive’
clinic. For 3 weeks her feeding has been poor
with only 30-60 ml of milk taken each feed, in
several short bursts.
There is no cough. Her respiratory rate is 60/min
she has mild recession and inspiratory crackles.
(taken from Paediatrics: Clinical Case Uncovered)
Other conditions to revise
• Bronchiolitis
• URTIs include acute otitis media
• Chronic lung disease of prematurity