Group A Streptococccal Infections in Children - What Has Changed?
Paediatrics for Primary Care (and anyone else)
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1y ago
At the time of publication, the UK is experienced the effects of an increase in cases of group A streptococcal (GAS) infections in children.  Scarlet Fever cases are more prevalent and there are more cases of invasive infection than in an average year.  Most importantly the number of deaths in children related to GAS infection is high and the associated news coverage has been significant. When our clinical landscape changes, the question should always be: What has changed and what should I be doing differently?  Let's look at each element of practice around GAS infections and se ..read more
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Understanding Traffic Lights - The Unwell Child and What to Do Next
Paediatrics for Primary Care (and anyone else)
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1y ago
When I am driving and see a traffic light ahead the first thought is, "Am I supposed to stop or go?" My next thought is, "what might it change to and what do I do then?"  Assessing the unwell child is like that.  It's not just about the snapshot.  Guidelines look a moment in time but the unwell child is in constant flux making that approach problematic. The traffic light system for unwell children has been around for a very long time.  It is used across Primary and Secondary care to aid clinicians in their attempts to risk assess febrile and unwell children with all of the ..read more
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Where is Your Focus? Let's Play Spot the Ball.
Paediatrics for Primary Care (and anyone else)
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2y ago
I think that the hunt for a focus of infection in a child is a lot like a game called “Spot the Ball” in which people looked at a picture from a football game with the ball removed and tried to guess where the ball was. Finding a focus of infection is a very interesting topic at the moment.  More than ever, primary care clinical assessments are occurring remotely rather than face to face. Febrile children are being assessed without laryngoscopy or auscultation.  This seemingly contradicts the tradition of the need to find a focus of infection.  So what is the deal?  I've be ..read more
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With every crisis an opportunity - How to use blood count in children
Paediatrics for Primary Care (and anyone else)
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2y ago
Another week, another crisis - This time, in the UK we have a major shortage of blood bottles. Primary care have been advised to suspend non-urgent blood tests for the next few weeks during a major shortage in sample bottles. Personally, I blame the 5G mast they put up near the hospital. When we are faced with limited resources, we have to get even better than ususal at decision making.  We have an opportunity to look with fresh eyes and recognise those areas of practice which may have become facile and revisit how we use available resources.  In this post, I'll be looking at the use ..read more
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Trial by Inhaler - Bronchiolitis vs Viral Wheeze
Paediatrics for Primary Care (and anyone else)
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2y ago
With wheeze in children becoming a major presentation again, it feels like a good time to explore the issue of deciding whether a child has bronchiolitis or viral induced wheeze.  There are various way that people do this in practice.  Many stick to a strict 12 month cut off.  This method works reasonably well and is rarely problematic.  Bronchospasm is rare below this age and if it is going to be problematic under the age of 12 months, in my experience the infant is severely distressed and gets bronchodilators out of desperation rather than a diagnostic trial. I have alr ..read more
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Joining The Dots - How to recognise the seriously unwell child
Paediatrics for Primary Care (and anyone else)
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3y ago
In the previous post, I outlined how to tell the difference between abnormal signs that are part of a functional and fully compensated response and those that are part of an illness that is having a more significant clinical effect. The child who is completely well and the child who is visibly seriously unwell and decompensating are both fairly straightforward scenarios.  The child who is very well causes no clinical concern.  The child who is decompensating causes unambiguous and immediate clinical concern.  If only decision making was always this easy. The child who is febrile ..read more
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You are Entitled to Compensation - When does "abnormal" physiology mean that I should worry about an unwell child?
Paediatrics for Primary Care (and anyone else)
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3y ago
 Assessing the severity of a respiratory problem in children is not entirely straightforward.  Guidelines attempt to categorise according to specific parameters however it is not uncommon for the category given to contradict our gut feel.  Sometimes the answer suggested by the guideline seems to be contradicted by the appearance of the child in frontof us.  Why is that?  What weight can we put on our gut feel?  When should we be worried? To understand any severity system and to explore the nuances, I would ask the question, “What is the correlation between the wo ..read more
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Newborn Presentations
Paediatrics for Primary Care (and anyone else)
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3y ago
People get worried about newborn babies.  When presented with a baby problem, there are a few basic rules to apply: Most things that newborns present with are unlikely to have a significant cause.  Some presentations are more concerning that others and while there are no absolutes, it is good to know which things to be more suspicious of. In many cases, it is possible to significantly change the index of suspicion by knowing the red flags to look out for. Let's look at a few examples: Imperfectly shaped head Since the discovery that putting a baby to sleep on their back dramati ..read more
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Everything has changed - Non-blanching rash in children
Paediatrics for Primary Care (and anyone else)
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3y ago
If you told me that nothing has changed for you this past twelve months, I'd be quite surprised.  This year has been a rollercoaster both in and out of work for every healthcare professional I know.  As a finishing touch to the year that has changed everything, I have one more bit of news for you that will change your practice.  Strap in.  This one is huge. So how did we get there from where we used to be? - "Fever with non-blanching rash is meningococcal sepsis until proved otherwise." It has long been recognised that this outdated adage has become obsolete in a populati ..read more
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Labels in child and adolescent mental health presentations - A Christmas stocking stuffer
Paediatrics for Primary Care (and anyone else)
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3y ago
 Here's another stocking stuffer.  In the same way as last time, it's just a mini-FOAMed post. So next time you see a child or young person with a mental health presentation, I would suggest the following: Don't think of behaviour as behavioral.  Assume it is a symptom of something more complex. Don't feel pressured to give a label.  Many young people don't ever get a formal diagnosis. See each contact as an opportunity to discover more about what is going on and why.  While this may not always be something massive, sometimes it takes a lot of feeling safe for a you ..read more
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