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Dr. Robert Yuen Common Childhood Diseases and Initial Management

Dr. Robert Yuen Common Childhood Diseases and Initial Management. Common Symptoms of Diseases in Early Childhood and its Initial Management. Respiratory Distress. Ddx: Inspiratory Stridor Expiratory Wheeze Tachypnoea (ie. Increased respiratory rate) Increased Respiratory Effort.

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Dr. Robert Yuen Common Childhood Diseases and Initial Management

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  1. Dr. Robert YuenCommon Childhood Diseases and Initial Management

  2. Common Symptoms of Diseases in Early Childhood and its Initial Management

  3. Respiratory Distress • Ddx: • Inspiratory Stridor • Expiratory Wheeze • Tachypnoea (ie. Increased respiratory rate) • Increased Respiratory Effort

  4. Inspiratory Stridor • Foreign body • Acute croup (largynocotracheobronchtis) • Acute epiglottitis • Acute retropharyngeal abscess • Acute peritonsillar abscess

  5. Expiratory Wheeze • Foreign body • Acute bronchiolitis • Acute wheezy bronchitis • Early Bronchial Asthma

  6. Other Causes of Resp Distress • Viral and bacterial pneumonia • Metabolic acidosis secondary to dehydration and diarrhoea • Drug overdose including Chinese medicine • Inborn errors of metabolism (IEM)/ Inherited metabolic disease (IHD)

  7. Fever in Children • Infection – viral, bacterial, TB, fungus • eg. URTI (pharyngitis), pneumonia, meningitis, otits media.urinary tract infection, speticaemia, osteitis • Reactive –dehydration fever due to poor feeding and vomiting • Malignancy eg. leukaemia, lymphoma • Kawasaki’s disease, autoimmune disease

  8. Loose stool • Distinguish bloody stool and melaena • Diarrhoea – viral eg. Rotavirus, bacteria eg. Salmonella, Campylobactor, typhoid, malabsorption eg. Lactose intolerance • Bloody – intussuception, anal fissure, Shigella • Melaena (ie. Tarry stool) – massive gastrointestinal bleeding, volvulus

  9. Initial Management • 1. treat emergency –basic life support, airway position, posture, suction and oxygen, gentle restraint during convulsion, advanced life support (PALS) • 2. shout for help, telephone advice, video-consultation and call ambulance, • 3. identify treatable causes • 4. good and timely communications with parents, supervisory officers and medical personnels

  10. Learning Points Preventive, Proactive Measures Early Diagnosis and treatment Continuous healthcare education Risk assessment and management Effective communications and team work

  11. Vaccination in children Dr. YUEN Kar Ngai Robert FRCP FRCPCH FRCPE FRCPG FHKAM FHKCPaed 1309 363 Nathan Road Jordan Tel: 23880078

  12. Immunization Program in Hong Kong (1) • Newborn: - B.C.G. Vaccine • - Polio Type I • - Hepatitis B Vaccine – • First dose • 1 month: - Hepatitis B Vaccine – • Second dose

  13. Immunization Program in Hong Kong (2) • 2-4 months: • - DPT Vaccine (Diphtheria, Pertussis & Tetanus) – • First Dose • - Polio Trivalent - First Dose • 3-5 months: - DPT Vaccine (Diphtheria, Pertussis & Tetanus) - Second Dose • 4-6 months: - DPT Vaccine (Diphtheria, Pertussis & Tetanus) - Third Dose • - Polio Trivalent - Second Dose

  14. Immunization Program in Hong Kong (3) • 6 months: - Hepatitis B Vaccine - Third Dose • 1 year: MMR Vaccine (Measles, Mumps & Rubella) - First Dose • 1 1/2 year: DPT Vaccine (Diphtheria, Pertussis & Tetanus) - Booster Dose • Polio Trivalent - Booster Dose

  15. Immunization program in Hong Kong (4) • Primary 1: DT Vaccine (Diphtheria & Tetanus) - Booster Dose • Polio Trivalent - Booster Dose • MMR Vaccine (Measles, Mumps & Rubella) - Second Dose • Primary 6 DT Vaccine (Diphtheria & Tetanus) - Booster Dose • Polio Trivalent - Booster Dose

  16. Hepatitis B vaccine • All newborns should receive monovalent recombinant Hep B vaccine within 12 hours after birth (AAP) • Babies born to mothers with HBsAg-positive should receive Hep B vaccine and Hepatitis B immune globulin (HBIG) within 12 hours of birth • Hepatitis B vaccine program should be completed with either monovalent Hep B vaccine or combination vaccine at 1-2 months old and final third dose at age of >24 weeks (AAP)

  17. Infanrix-IPV + Hib (GSK) • 5 in 1 • Diphtheria toxoid, tetanus toxoid • three pertussis antigens (pertussis toxoid, filamentous haemagglutinin and pertactin) • Three inactivated polio virus (type 1, type 2 and type 3) • Purified capsular polysaccharide of Haemophilus influenzae b covalently bound to tetanus toxoid

  18. Primary vaccination of 5 in 1 • Three doses in the first 6 months of life and can start from age of 2 months. • An interval of at least one month should be maintained between subsequent doses • A booster dose is recommended in the second year of life • Deep intramuscular injection in the anterolateral thigh

  19. Infanrix-hexa (GSK) • 6 in 1 • Diphtheria toxoid, tetanus toxoid • Three pertussis antigens • Three inactivated polio virus (type 1, • Type 2 and type 3) • Purified capsular polysaccharide of H. • Influenzae b • Recombinant HBsAg protein

  20. Infanrix-hexa (GSK) • Indicated for primary immunization against • Diphtheria, tetanus, poliomyelitis, pertussis, hepatitis B and Haemophilus influenzae type b in infants from age of 6 weeks and may be given to infants who received a first dose of hepatitis B vaccine at birth • Primary vaccination of three doses with at least one month in between doses • No recommendations for booster dose in the second year of life because of limited data • Deep intramuscular injection • History of febrile convulsion and family history of convulsion do not constitute contra-indications

  21. Pneumococcal conjugate Vaccine ( Prevenar) • Polysaccharide from seven common capsular antigen of Strept pneumoniae serotypes 4, 5B, 9V, 14,18C, 19F and 23F individually conjugated to diphtheria carrier protein • Indicated for active immunization of infants and children from 6 weeks to 9 years of age against invasive disease, pneumonia and otitis media caused by Streptococcus pneumoniae. • 2 months old : 2,4,6,12-15 months • 7-11 months old: two doses one month apart and third dose in second year • 12-23 months old: two doses 2 months apart • Over 24 months old: one dose

  22. 23-valent Pneumococcal Polysaccharide Vaccine • Used for children over 2 years old and adult • Contains part of the polysaccharide coat that surrounds the 23 types of pneumococcal bacterium • These 23 types of bacteria cause about 96% of all pneumococcal diseases cases in UK • Infants who received pneumococcal 7-valent conjugate vaccine could also have the 23-valent polysaccharide vaccine from 2 years old to cover them against the wider range of serotypes

  23. Varilrix (GSK) • Live attentuated varicella-zoster virus • Indicated for active immunization of healthy patients as from 12 months old and susceptible high-risk patients and their susceptible healthy close contacts eg. acute leukaemia, chronic disease • Subcutaneous route only • 12 months – 12 years: one dose • 13 years and above : two doses with interval of 6 – 10 weeks

  24. Hepatitis A vaccine • Inactivated hepatitis A virus • Indicated for active immunization of subjects at risk of exposure to Hep A virus • Used for children over one years old • Booster dose at 6 to 12 months later to ensure long term protection • Intramuscular injection

  25. Fluarix- inactivated influenza vaccine (GSK) • Recommended for prophylaxis against influenza in adults and children older than 6 months • Especially recommended for adults over 60 years old, patients with chronic lung disease, chronic heart disease, uraemia, diabetes, congenital and acquired immune deficiency, healthcare personnels. • A second dose should be given for children who have not previously been vaccinated after an interval of at least 4 weeks • Vaccinated before the beginning of the influenza season and repeated every year with vaccine of updated antigen composition

  26. Meningococcal C conjugate (MenC) • Primary vaccination program in UK at 2, 3 and 4 months old (Australia MenCCV: 12 months old) • Protects against septicaemia and meningitis caused by Meningococcal Group C • Also available to adults under 25 years old: greater risk for people aged between 20 and 24 years old

  27. MPSV4 and MCV4 • Meningococcal polysaccharide vaccine (MPSV4) and meningococcal conjugate vaccine (MCV4) against 4 types of meningococcal disease licenced in USA. • MCV4 preferred for people 11-55 years and all children at routine visit at 11 years old • MPSV4 should be used for children 2-10 years old and over 55 years at risk.

  28. Well Child Care and Health Supervision

  29. Newborn • History of maternal illness etc. • Blood test for Blood group, G6PD and TSH screening • Physical examination • Measure OFC, BW and length • Parent-child interaction • Immunization schedule

  30. Anticipatory Guidance - newborn • Feeding method • Sleep position and environment • Care of skin, cord • Breast engorgement and vaginal discharge • Neonatal jaundice • Postpartum adjustment of mother, siblings and family

  31. Health Supervision at one month • Review birth history and family history • Physical examination including growth percentile • Check for heart murmur, hip dislocation • Developmental progress: • Head to one side while supine with occasional opening of hand • Turn head to light and startle by sudden noise • Follow movement of bright, dangling toy • Immunization schedule

  32. Anticipatory Guidance at 1 month • Nutrition: breast feeding/ bottle feeding • Sleep pattern • Social interaction with family • Injury prevention eg. Car safety seats, hot water temperature

  33. Health Supervision at 3 months • History of ill health • Physical examination and growth percentiles • Developmental milestones: Head central on supine position Support with forearm when prone Good head control and kick well Clasp and unclasp both hands Smile in response to speech Fixate on carer’s face during feeding

  34. Anticipatory Guidance : 3 month • Feeding • Sleep pattern • Social/family relationships eg. Play, cuddle baby, sibling rivalry and free time for parents • Injury prevention eg. Car safety restraints, safe toys • Immunization program

  35. Health Supervision 6 months • History and physical examination • Growth percentiles • Developmental milestones: • Reach out with both hands and transfer • Roll over and support with hand in prone position • Bear weight on standing • Sit with support and straight back • Babbling and imitate sounds • Visually very alert

  36. Anticipatory Guidance : 6 months • Mixed feeding • Stranger anxiety • Sleep pattern • Injury prevention eg. Discourage the use of infant walkers • immunization

  37. Health Supervision : 9 months • History and physical examination Growth percentiles Developmental milestone sit alone with a straight back unsupported stand holding onto furniture crawl or shuffle on the bottoms pincer grip say single word

  38. Anticipatory Guidance : 9 month • Feeding and regular mealtime • Regular bedtime routines • Injury prevention eg. Childproof the home, avoid aspiratable food eg. Peanuts • Immunization program

  39. Health Supervision : 1 year old • History and physical examination • Growth percentile • Developmental milestone: • Cruise along furniture and stand alone for a while • Walk with one hand held • Fine pincer grip and point with index finger • Speak 2 – 6 recognisable words

  40. Anticipatory Guidance : 1 year • Nutrition: do not force feed • Sleep pattern and structured bedtime routine • Injury prevention eg. Never leave baby alone • immunization

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