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 Kawasakis 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, videoconsultation 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 carers 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