Emergency medicine clinical excellence series: PEM #3 – Assessment of the child less than one year old

I was lucky enough to be given study leave to attend the Royal Society of Medicine Paediatric Emergency Medicine study day. I learnt a lot from the day, and wrote some notes as we went along. The speakers were all excellent, and any errors in my note taking will be my errors in interpretation, rather than theirs.

Here is a summary of the third talk:

Assessment of the child less than one year old – pitfalls and how to avoid them

Dr Ffion Davies, Consultant in EM

The over-riding message from this presentation was to listen to your gut feeling, and listen to mum. The younger the child, the more likely you should be to refer to paediatricians, especially if there are any “worrying” features:

• A young mum (<20 years) – they are more likely to have a child death but we’re not sure why.
• Previous medical history – ex-prem/cardiac history/structural or developmental delay

Information snippets and pearls:

• The average 1 year old has 8 viral illnesses per year!
• Rubbing ears ≠ otitis media
• Wet nappies – remember to check how wet wet is!
• <1 yr old, the stethoscope is unreliable – unlikely to pick up focal signs
• Quantify behaviour – if they’re playing, how long are they playing for
• Give dioralyte if 3- 6 months, or >24hr duration
• Bottle fed babies are more likely to get gastroenteritis
• Breast fed babies are more likely to be dehydrated

Neonates:

Be very careful with neonates. Remember that in neonates they normally have a higher temperature so A LOW temperature is as worrying as a fever.

When treating a neonatal collapse consider sepsis, duct dependent heart disease, inborn error of metabolism or NAI + bleed. Examine carefully for the liver (in heart failure the liver gets bigger) and make sure you practice so you know what abnormal is.

Neonatal jaundice:

• <24 hours admit
• 1-7 days likely to be physiological, but needs admission anyway.
• The longer the jaundice lasts for, the more likely there is to be a structural cause.

Ophthalmia neonatorum:

Always refer to paeds as an emergency (not as an outpatient) as you can get very sick, and they can ensure adequate follow up, and make sure the results of any swabs are chased up.

Corneal abrasions can occur in less than 48 hours, so time really matters.

References:

Spotting the Sick Child