PAEDIATRICS FOR GPS
Dr Laura Weidner
MBChB MRCGP PGCMDE
GP partner / new trainer at Southmead Surgery
Introduction
• Who am I & who are you?
• Plan for the afternoon: Quiz, Cases, Rashes
• Please share you own cases / experience
• Resources
How are GPs unique?
• Gatekeepers to hospital – know when to refer
• Deal with all the minor childhood illnesses
• Supporting parents in caring for their children
day-to-day
Practicalities of life as a GP – top things I think
you need to know 
WHAT DOES A GP HAVE TO
KNOW ABOUT PAEDIATRICS?
Team quiz…
Common GP Problems
Case stories…
My child is constipated…
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Red flags – blood, faltering growth, meconium
Think coeliac / hypothyroidism
NICE - Movicol 1st line +/- stimulant
Movicol –licensed >5 faecal impaction and >2
chronic constipation
• Maintenance = half dis-impaction dose
• Ask diet / fluids / behavioural rewards / regular
toileting
NICE guidelines [CG99] Published date: May 2010
My son’s foreskin doesn’t retract….
• By 3y 90% have retractile foreskins
• Of those that are not, 90% improve by age 15y
• Diprosone od 4-6w 70% success
My babies eyes are always sticky…
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Imperforate valve of Muller
90% clear spontaneously
Try lacrimal massage tds 20 squeezes for 3m
Refer 12m for probing (success greatest <2y)
Sooner if >3 conjunctivitis
My daughter has sore bits…
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Worms?
Thrush?
Contact dermatitis - Bubble baths? Tights?
Think child protection
My baby cries a lot…
• Physical exam to exclude organic cause
• Growth chart
• Screen for maternal depression
• Colic? =
Paroxysmal uncontrollable crying in an
otherwise healthy baby <3m age with >3h
crying / day in >3d / wk for >3w
My baby vomits a lot…
• Think about organic causes
e.g. pyloric stenosis, volvulus
• Behavioural measures – feed propped up, feed
volumes, winding
• Trial gaviscon / ranitidine
• Refer if failing to thrive despite simple
measures
• Reassure and review
I think my baby has a food allergy…
• Top food allergens – milk (CMP 2-7% children), eggs, nuts, wheat
• Consider if multi-system sx or dose dependent sx or failure
to respond to rx for eczema / GORD / constipation
• IgE within 20m – urticaria / angiooedema
• Non IgE – eczema / GORD / diarrhoea
• Rx – elimination (4-6w), dietician
• Refer if – IgE mediated, severe, failure to thrive, atopic,
multiple food allergies, diagnostic uncertainty, nonresolution
• Most outgrow – 3y for non IgE and 5y for IgE
• 1° lactose intolerance rare (except after gastroenteritis)
NICE guidelines [CG116] Published date: February 2011
My child ‘just isn’t right’ doc…
E.g. headache, tummy aches
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Try to pin them down
Acute or chronic
Ask about red flags eg sweats, failure to thrive
Examine – glands, organomegaly
Height / Weight
Document
Review
SPOT DIAGNOSIS
My picture quiz…
Anyone share any
stories…
What’s the oddest thing you’ve ever
been asked?
Survival tips…
• How do you deal with all the odd questions
you are asked – paeds, colleagues, personal
experience, friends, super nanny!
• Be aware of local funding priorities
e.g. tonsillectomy
Resources
• NICE: febrile child, UTI in children, food allergy
in children
• Local hospital or CCG guidelines
• Local support:
– Colleagues
– GPwSI?
– Paeds line Mon-Fri 1-2pm 07919-175643
References
• Google images
• Dr Martin Kittel (Forest End Medical Centre –
Bracknell)