• Neonatal Hypotonia → neonatal sepsis, spinal muscular atrophy, hypothyroidism, spinal muscular atrophy.
• Hypernatraemic Dehydration → jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness/coma.
• ‘Heel Prick Test’ → performed between 5th-9th day of life, typically by a visiting midwife. Only tests done before newborn leaves hospital is NIPE and hearing test (otoacoustic emission test).
• Spina Bifida Occulta → failure of fusion of vertebral arch, causing tethered spinal cord, Insidious onset in childhood. Lower back pain, gait disturbance, neurological dysfunction (reduced power), bladder/bowel dysfunction, sacral dimple.
• General Rule of Thumb → structural protein disorders: autosomal dominant, metabolic pathway disorders: autosomal recessive.
• Life-Threatening Asthma Exacerbation → spO2 <92%, PEFR <33%, silent chest, poor respiratory effort, altered consciousness (reduced GCS), cyanosis.
• Head Lice → treat with malathion (anti-microbial) and wet-combing. Household contacts don’t need to be treated unless also affected. School exclusion not advised.
• Rheumatic Fever → group A strep, children 5-15yo, long term damage leads to mitral stenosis. 2-6 weeks after pharyngeal infection: polyarthritis, pericarditis, erythema marginatum. Sydenham’s chorea (involuntary movements) 2-6 months later. Diagnosis via jone’s criteria. Manage with high-dose aspirin, antibiotics (amoxicillin) and corticosteorids. Monthly injections of benzathine penicllin as prophylaxis (until 10 years after last episode or until age of 21).
• Chest Infection in Young Children → bronchiolitis causes wheeze and no changes on CXR. Bacterial pneumonia will cause CXR changes (focal consolidation). PCP is fungal chest infection, may cause subtle ground-glass changes on CXR.
• Coeliac Disease → may present with normal growth until age of weaning (6 months), when gluten is introduced into diet.
• Eczema Distribution → infants: face and trunk, young children: extensor surfaces, older children: flexure surfaces and creases.
• Labial Fusion → benign condition in female children <7yo, may present with partial fusion of labia minora. Develops at 1-2yo and resolves by puberty. If asymptomatic, reassure and follow-up. If symptomatic (pain, difficulty urinating, dribbling of urine), 4-6w course of topical oestrogen may be prescribed.
• Psoriasis → ‘scaly’ rash. Guttate psoriasis occurs post-strep infection.
• Tuberous Sclerosis → ‘ash leaf’ patch (woods lamp), angiofibromata (butterfly facial distribution), infantile spasms, intellectual disability, angiomyolypoma.
• UTI → USS during acute infection: all children with atypical UTI or <6m with recurrent UTI, USS within 6 weeks: <6m with first UTI or >6m with recurrent UTI.
• Tinea (Ringworm) → scaly, annular (ring appearance) lesions. Treat with topical terbinafine (give orally if tinea capitis).
• Irritable Bowel Syndrome → symptoms may be precipitated by GI infection (post-infectious IBS). Coeliac must be ruled out.
• Strabismus → common up to 3m of age, most commonly due to refractive error. If present >3m, refer for specialist ophthalmological opinion.
• Osteomyelitis → more chronic in onset and less severe than septic arthritis (ie. over a week rather than a day).
• ASD → closure at 3-5 years old with device closure in catheter laboratory.