PAEDIATRICS FOR GPS Dr Laura Weidner

1. PAEDIATRICS FOR GPSDr Laura Weidner MBChB MRCGP PGCMDE GP partner / new trainer at Southmead Surgery

2. Introduction • Who am I & who are you? • Plan for the afternoon: Quiz, Cases, Rashes • Please share you own cases / experience • Resources

3. 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 

4. WHAT DOES A GP HAVE TO KNOW ABOUT PAEDIATRICS? Team quiz…

5. Common GP Problems Case stories…

6. My child is constipated… • 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

7. 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

8. My babies eyes are always sticky… • 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

9. My daughter has sore bits… • Worms? • Thrush? • Contact dermatitis - Bubble baths? Tights? • Think child protection

10. 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

11. 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

12. 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, non-resolution • Most outgrow – 3y for non IgE and 5y for IgE • 1° lactose intolerance rare (except after gastroenteritis) NICE guidelines [CG116] Published date: February 2011

13. My child ‘just isn’t right’ doc… E.g. headache, tummy aches • Try to pin them down • Acute or chronic • Ask about red flags eg sweats, failure to thrive • Examine – glands, organomegaly • Height / Weight • Document • Review

14. SPOT DIAGNOSIS My picture quiz…

29. Anyone share any stories… What’s the oddest thing you’ve ever been asked?

30. 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

31. 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

32. References • Google images • Dr Martin Kittel (Forest End Medical Centre – Bracknell)