Diagnosis: Coeliac disease

Causes of diarrhoea Diarrhoea is mainly caused by bacterial and viral infections and food poisoning. Diarrhoea can also be caused by bacteria or viruses that have been transmitted from person to person. Diarrhoea occurs when the micro-organisms irritate the mucous membrane of the small or large intestine resulting in an abnormally large quantity of water in the motions. Diarrhoea usually occurs when fluid cannot be absorbed from your bowel contents, or when extra fluid is secreted into the bowel, causing watery stools Acute diarrhoea Short-term diarrhoea is usually a symptom of gastroenteritis, which is an infection of the bowel. This is called acute infectious diarrhoea emotional upset or anxiety, drinking too much alcohol, drinking too much much coffee, or the side effect from some medicines. Chronic diarrhoea Chronic (persistent) diarrhoea can be caused by: a bacterial or viral infection, laxatives, poor diet (too much coffee, alcohol or sweets), and Long-term conditions such as ulcerative colitis, Crohn's disease, irritable bowel syndrome (IBS), lactose intolerance, coeliac disease, diabetes, and pancreatitis. Normal Height and Weight in Children http://www.who.int/childgrowth/en/ PCHR Child & family details Childs details Birth details Family history Local information Important health problems Screening / routine reviews Screening & routine reviews Can your baby see? Can your baby hear? 6-8 week review Other health reviews

Immunisation The routine immunisations Hep B infant vaccine programme Primary course of vaccines MMR Additional vaccinations Pre-school booster Growth charts & other information Your childs developmental firsts Growth Charts Articles Millennium cohort study Objectives: The personal child health record (PCHR) is a record of a childs growth, development, and uptake of preventive health services, designed to enhance communication between parents and health professionals. We examined its use throughout the United Kingdom with respect to recording childrens weight and measures of social disadvantage and infant health. Design: Cross sectional survey within a cohort study. Setting: UK. Participants: Mothers of 18 503 children born between 2000 and 2002, living in the UK at 9 months of age. Main outcome measures: Proportion of mothers able to produce their childs PCHR; proportion of PCHRs consulted containing record of childs last weight; effective use of the PCHR (defined as production, consultation, and childs last weight recorded). Results: In all, 16 917 (93%) mothers produced their childs PCHR and 15 138 (85%) mothers showed effective use of their childs PCHR. Last weight was recorded in 97% of PCHRs consulted. Effective use was less in children previously admitted to hospital, and, in association with factors reflecting social disadvantage, including residence in disadvantaged communities, young maternal age, large family size and lone parent status. Conclusions: Use of the PCHR is lower by women living in disadvantaged circumstances, but overall the record is retained and used by a high proportion of all mothers throughout the UK in their childs first year of life. PCHR use is endorsed in the National Service Framework for Children and has potential benefits which extend beyond the direct care of individual children. Community child health, public health, and epidemiology Height screening at school: ineffective without high standards and adequate resources Background: The Coventry Consensus in 1998 recommended a single height measurement of all children at school entry or around the age of 5 years and prompt referral of children with height <0.4th centile for further assessment, in order to identify undetected and treatable asymptomatic growth disorders.

Aim: To determine adherence and practicalities of following the Coventry Consensus recommendations in a community setting and the cost implications. Methods: Anthropometric data of all children born between September 1992 and August 1993 in the Rhondda and Taff Ely area and measured in school year September 1998 to August 1999 were obtained from the National Child Health System (NCHS) and analysed in July 2000. Results: Only 1592 (67.6%) of 2354 eligible children had their height measured. A conservative estimate of the cost to the health authority was 14 550 (US$23 300; 20 500) per annum. Conclusion: The study shows poor coverage and compliance together with a lack of parental awareness that short stature could be a potential health problem even in asymptomatic children. For a low yield programme to be successful and cost effective at the national level, a near 100% coverage is required. Further training of professionals in growth measurement and interpretation along with a campaign to raise both public and professional awareness is needed. Coeliac Disease An autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. Symptoms include chronic diarrhoea, failure to thrive (in children), and fatigue, but these may be absent, and symptoms in other organ systems have been described. Coeliac disease is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat. Upon exposure to gliadin, and certain other prolamins, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the smallbowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients, because the intestinal villi are responsible for absorption. The only known effective treatment is a lifelong gluten-free diet. Blood tests Serological blood tests are the first-line investigation required to make a diagnosis of coeliac disease. Serology for anti-tTG antibodies has superseded older serological tests and has a high sensitivity (99%) and specificity (>90%) for identifying coeliac disease. An equivocal result on tTG testing should be followed by antibodies to endomysium. Historically three other antibodies were measured: anti-reticulin (ARA), anti-gliadin (AGA) and anti-endomysium (EMA) antibodies. Serology may be unreliable in young children, with anti-gliadin performing somewhat better than other tests in children under five. Serology tests are based on indirect immunofluorescence (reticulin, gliadin and endomysium. Gliadin is a glycoprotein present in wheat Gliadins are known for their role, along with glutenin, in the formation of gluten. It is slightly soluble

The Sweat test The sweat test is usually done on the forearm, but may be done on the thigh of infants and children with small arms. First Step - Stimulating Sweat: The technician will place two electrodes containing a sweatinducing drug called pilocarpine on the skin. A small electric current is delivered through the electrodes to help the pilocarpine stimulate sweat. Second Step Collecting Sweat: After about 10 minutes, the technician stops the current and removes the electrodes. The skin is wiped dry and a piece of filter paper covered with plastic, sometimes called a sweat patch is placed on the site to collect the sweat. When a sufficient amount of sweat is collected, usually about 30 to 45 minutes, the sweat-drenched paper is removed and sent to the lab for testing. People with cystic fibrosis have high levels of salt, known as sodium chloride, in their sweat. The sweat test measures the amounts of sodium and chloride in the sweat, but the amount of chloride is the factor that determines the outcome of the test. Chloride Ranges in Infants: less than 30 = normal 30 59 = borderline 60 or greater = positive for CF