Chest pain this month – which is very rarely cardiac in the paediatric population, early recognition of various childhood cancers, links to some drug and alcohol support groups, paediatric drooling. Do leave comments.
Tag Archives: child development
February 2015 (just)
Have just uploaded February 2015 newsletter – with 4.5 hours of February to go….
NICE on gastro-oesophageal reflux disease, how to recognise speech delay, more viral exanthems, resus cards and information on forthcoming allergy courses. Do leave comments below:
October 2014 published
October 2014 holds quite a few topics: scalp ringworm, sleep and behaviour, support for victims of sexual abuse, immunotherapy for peanut allergy, link to parental asthma booklet and what to do with babies with chicken pox. Do leave comments below…
How to help your child get a good night’s sleep
New leaflet available for downloading to give to parents struggling with getting their child to sleep. Written by a paediatric registrar, Dr Sophie Niall, with input from the Redbridge child development and Early Years team. I find it a useful summary of some of what I say in a general paediatric consultation when the conversation turns to the parents’ sleepless nights.
June newsletter
June’s newsletter has been uploaded. Migraine presentation in adults and children v. tension headaches, baby slings and a bit on acne. Do leave comments below.
February 2014 uploaded
Scabies this month with a beautiful picture of plantar lesions in a child. Updated NICE head injuries, antipyretics (or not) for febrile convulsions, child trafficking and the last in the sleep series. Do leave comments below.
Dermatology for the New Year!
Eczema this month, a reminder of treatment of infections and links to some useful audit tools from NICE. Next month, scabies. Another excellent website on food and nutrition in toddlers with a bit on do’s and don’ts of faddy eating and a paper on whether treating ADHD reduces crime. Do leave comments.
Obesity – assessment in secondary care and associated dysmorphisms
Article by Dr Hajera Sheikh, paediatric registrar
Assessment in Secondary Care
History:
• Lifestyle Assessment
• Menstrual History
• Obstructive Sleep Apnoea: Snoring, difficulty breathing during sleep, morning headaches or fatigue
• Symptoms of co-morbidity including psychological
• Drug use (particularly glucocorticoids and atypical antipsychotics)
• Family history, particularly diabetes <40 yrs, early heart disease <60 yrs
Examination:
• Height, weight, BMI
• Obesity pattern: generalised, central (greater risk of adverse cardiovascular outcomes), buffalo hump and neck (may be suggestive of Cushing syndrome)
• Blood pressure
• Pubertal assessment
• Acanthosis nigricans (indicative of insulin resistance, first seen round neck and axillae)
• Signs of endocrinopathy
• Dysmorphisms: (Look out for early onset obesity, learning difficulties, deafness, epilepsy, retinitis, dysmorphic features, hypogonadism)
Investigations (directed)
• Urinalysis
• Thyroid function
• Fasting lipids (total and HDL cholesterol), triglycerides
• Liver function, including ALT
• Fasting glucose and insulin not usually done first line
Refer to Paediatric Obesity/Endocrinology or other specialist service if further investigation is required
Aetiology
• Genetic studies
• Thyroid studies: T3, thyroid antibodies, calcium, phosphate
• Cushing syndrome investigations
For co-morbidities
• Oral glucose test
• PCOS studies (LH, FSH, adrenal androgens, Sex Hormone Binding Globulin, prolactin, pelvic ultrasound)
• Sleep Study
Dysmorphic and monogenic syndromes associated with obesity:
Main clinical obesity associated syndromes:
• Chromosomal
Prader-Willi syndrome
Trisomy 21
• Autosomal dominant
Biemond syndrome (some cases)
• Autosomal recessive
Aistrom syndrome
Bardet-Biedl syndrome
Biemond Syndrome(some cases)
Carpenter syndrome
Cohen syndrome
• X-linked inheritance
Borjeson-Forssman-Lehmann syndrome
• Single gene lesions affecting leptin metaboilsm
Congenital leptin deficiency
Leptin receptor mutation
Prohormone convertase 1 mutation
Melanocortin 4 mutation
Clinical features suggesting obesity may be secondary to another condition or syndrome
• Severe unremitting obesity
• Disorders of the eyes
Colobomata
Retinal problems, especially retinitis pigmentosa
Narrow palpebral fissures
Abnormally positioned palpebral fissures
Severe squint (eg Prader-Willi)
• Skeletal abnormalities
Polydactyly
Syndactyly
Kyphoscoliosis
• Sensorineural deafness (eg Alstrom syndrome: sensorineural deafness, diabetes mellitus, retinal dystrophy, obesity)
• Microcephaly and/or abnormally shaped skull
• Mental retardation
• Hypotonia
• Hypogonadism
Crptorchidism
Micropenis
Delayed puberty
• Renal abnormalities
• Cardiac abnormalities
July 2013 PDF
Neglect and emotional abuse is the safeguarding topic this month. ED advice on the management of minor head injuries, a report from BPSU in hypocalcaemic fits secondary to vitamin D deficiency, the new UK immunisation poster and a bit on crying babies. Hope you find it all helpful. Comments welcome below
Parasomnias
Parasomnias – with thanks to Dr Sophia Datsopoulos
A group of sleep disorders that are paroxysmal, predictable in timing in the sleep cycle and characterized by retrograde amnesia. Polysomnography (type of sleep study in which various parameters are measured in order to rule in or out various sleep disorders), if performed, is abnormal. Diagnosis is based on a thorough history; extensive work-up seldom necessary.
Focus on: ‘Pavor Nocturnus’ or Night Terrors
Children aged three to eight years, M>F. Often family history of night terrors or sleepwalking. Occur approximately 90 minutes into sleep,
during non-REM sleep.
Presentation: Child suddenly sits bolt upright, screams, and is inconsolable for up to 15 minutes, before relaxing and falling back to sleep
with no memory of the event the next morning. Tachycardia, tachypnoea and other signs of autonomic arousal are apparent.
Management:
– Reassure families that they have a benign course and are self-limiting
– Advise them not to attempt to wake the child during an episode and that comforting during the episode may delay its recovery
– Explore and alleviate any stress in the child’s environment. Encourage a relaxing bedtime routine
– If frequent and occurring at a specific times every night, behavioural interventions such as scheduled awakenings (see http://www.epic.edu.au/sites/default/files/Sleep/PDFed/Night%20terrors.pdf) may be beneficial
– More severe forms may benefit from treatment with benzodiazepines (e.g., clonazepam) under direction of specialist services.
Main differential: nightmares – these can occur at any age, during the lighter stage of sleep when dreaming, and so tend to be later in the night. Seizures due to temporal lobe epilepsy can appear similar to night terrors but the seizures are usually brief (30 seconds to a few minutes) and are more common in older children and adults.
Comparison: Night Terrors and Nightmares
| Factor | Sleep Terrors | Nightmares |
| Age | 3 – 8 years | Any age |
| Gender | M>F | Either |
| Occurrence in sleep cycle | NREM | REM |
| Arousable? | No | Yes |
| Memory for event | No | Yes |
| Exacerbated by stress | Yes | Yes |
REM = rapid eye movement; NREM = non-rapid eye movement.
Next month: Focus on: Somnambulism (sleep waking) and Somniloquy (sleep talking)