Gianotti Crosti this month, updated “Working Together” safeguarding document, epistaxis and malaria. Also links to a few other useful documents recently uploaded to the Primary Care Guidelines part of the website, with thanks to Redbridge and West Suffolk. All comments welcome.
Tag Archives: safeguarding
April and May!
I seem to have forgotten to put a blog post up when I published April’s newsletter which contains information on: tonsillectomy for parents, erythema infectiosum (which I think my son had this week), a safety alert about bath seats, tranexamic acid in paediatric trauma and how to make a nasal douche for rhinitis sufferers.
May is now also published and features dangerous dogs, knee pain, dental caries and continuations of both the dermatology and ENT features. Do leave comments below.
March 2015 published
March 2015: the first post of the new ENT feature this month – glue ear, more help with viral exanthems, important safeguarding information on the UK government’s Prevent Strategy, breastfeeding for mums and research in the paediatric ED.
December 2014 – in time for Christmas
December 2014 : ‘flu vaccination for children, calprotectin, paintballing bruises, eczema and some useful links to atopy downloads. Do leave comments:
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…
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.
May 2014 newsletter
Pityriasis rosea this month, plus domestic violence, constipation, domperidone, next instalment of headache and a link to a site for parents on immunisations. Do leave comments below…
March 2014 newsletter
March brings urticaria, headaches, rugby injuries, Severs disease and bruising. 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.
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