Dr - PowerPoint Presentation

Document Sample
Dr - PowerPoint Presentation Powered By Docstoc
					              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
Inspiratory Stridor
• Foreign body
• Acute croup
  (largynocotracheobronchtis)
• Acute epiglottitis
• Acute retropharyngeal abscess
• Acute peritonsillar abscess
Expiratory Wheeze

• Foreign body
• Acute bronchiolitis
• Acute wheezy bronchitis
• Early Bronchial Asthma
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)
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
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
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
Learning Points
Preventive, Proactive Measures

Early Diagnosis and treatment

Continuous healthcare education

Risk assessment and management

Effective communications and team work
 Vaccination in children

 Dr. YUEN Kar Ngai Robert
  FRCP FRCPCH FRCPE
FRCPG FHKAM FHKCPaed
 1309 363 Nathan Road Jordan
        Tel: 23880078
       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
          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
          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
        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
         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)
      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
    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
      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
            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
       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
    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
                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
        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
    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
    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
         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.
Well Child Care and Health
       Supervision
               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
    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
    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
    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
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
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
    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
    Anticipatory Guidance : 6 months
•   Mixed feeding
•   Stranger anxiety
•   Sleep pattern
•   Injury prevention eg. Discourage the use
    of infant walkers

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

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

• immunization