Intermittent squeaky inspiratory noise from collapsing larynx during respiration. Usually from birth.
Often worse when lying on back, or with colds, or with reflux (vomits). Worse if hypognathia eg Pierre-Robin sequence.
Clinical diagnosis usually. Settles in first few months of life.
Will need intervention if significantly increased work of breathing, cyanosis or apnoeas, or growth failure.
A technical term, not just a fever without obvious source! Essentially presence of confirmed fever for 8 days or more in a child in whom a careful thorough history and physical examination, and preliminary laboratory data fail to reveal a probable cause.
Long list of possible causes, long lists of possible tests – do thorough history and repeated examinations, then follow the clues!
In kids, infection is the commonest cause. But can be connective tissue disorder, or malignancy.
Beware factitious fever – admission sensible.
If possible, stop all drugs. Antipyretics may obscure the pattern of fever, and can occasionally be its cause (drug fever is one cause).
Unless the child is critically ill, try not to give antibiotics. If the diagnosis remains obscure, go back and take the history again, examine the child (fully) again, send the specimens again!
Could be reduced intake but usually excessive losses –
| Renal | Non-renal |
| Renal tubular acidosis (type 1 or 2) | Vomiting eg pyloric stenosis |
| Bartters or Gitelmans syndrome | Diarrhoea |
| Diuretics | Laxative overuse |
| Hyperaldosteronism (CAH, tumour) | Thyrotoxicosis |
| Salbutamol | |
| Familial periodic paralysis | |
| Pseudo-Bartter’s | |
| Trauma | |
| Diabetic ketoacidosis |
Symptoms depend on severity and how rapidly decrease has happened. Chronic low levels are better tolerated. Since potassium important for membrane potentials, effects are mostly neuromuscular.
ECG classically shows U waves, T wave flattening, and ST-segment changes. Can be tall wide P waves, can look like long QT if T and U waves merge.
Do urine and blood electrolytes to look at fractional excretion.
[Endocrine connections 2018][Current Treatment Options in Peds 2022]Common in newborns, presumably due to maternal hormones. Bud underneath the surface, plus swelling of areola/nipple area.
Another peak around puberty, can be unilateral, can be tender. Can progress to be cosmetically problematic.
Exclude a hormonal problem (including prolactinoma and other hormonal tumour):
Common, typically vesicular rather than bullous:
Rare:
For more dramatic blistering:
Not a great name, as it can persist for up to 6 months!
Large muscle groups, usually limbs but can be face. Can wax and wane with child remaining sleep. Usually bursts lasting seconds, up to a few minutes.
During sleep only, and stops when wakes.
Differential would be myoclonic epilepsy, startle (including hyperekplexia), jitters.
BRUE (Brief Resolved Unexplained Event) from AAP 2016, replacing ALTE (apparent life threatening event). “Life threatening” is unnecessarily anxiety provoking – and subjective for parents.
“Brief” is by definition less than 1 minute, but typically 20-30 seconds. Only intended for babies under 1yr.
Guidance for “low risk”:
If low risk criteria fulfilled, no investigations are required – consider gas and urinalysis if clinical concern.
Otherwise depends on history and examination. Consider:
Management could then be a period of observation, or discharge home with safety netting.
AAP advises against home cardiorespiratory monitoring given costs and false alarms vs uncertain benefit.
A US study looking at this guidance found that
But I’m disappointed there is no mention in the RHC guidance about SIDS prevention advice.
Tender, warm, poorly demarcated subcutaneous nodules. Acutally a panniculitis. Classically on the shins but can be widespread.
Mostly caused by Group A strep or drugs, but can be a clue to:
NSAIDs effective. Potassium iodide used in chronic/recurrent cases (can cause hyperthyroidism)!
Steroids should rarely be considered.
Belching, burping.
A functional GI disorder, due to excessive air swallowing.
Often associated with reflux and anxiety.
Patient, self aware eating?
Tanner stages – verbal descriptions but images helpful esp for self assessment.
Pubic Hair Scale (both males and females)
Female Breast Development Scale
For males you then have testicular volume, measured by orchidometer (between £26 and £208):
Cadbury’s Teasers and Truffles (from Celebrations box) are 8ml, equivalent to 50th centile at age 13.
If you only have a ruler, use maximum width in millimetres and the formula: (W-1.5)3 x 0.88, where ss is double scrotal skin thickness (for Tanner stages 1, 2, and 3).