Day: April 9, 2024

Introduction Pyloric stenosis or infantile hypertrophic pyloric stenosis (IHPS) is a narrowing of the pylorus leading to intestinal obstruction in infants. it is caused by hypertrophy and hyperplasia of the pylorus (a muscular valve sitting between the stomach and duodenum). It classically presents with projectile non-bilious vomiting in infants 2-8 weeks old. Surgical management with a pyloromyotomy (Ramstedt’s or laparoscopic) normally results in full resolution and minimal morbidity. Epidemiology The incidence of IHPS is estimated to be 1 in 500 live births. Figures vary from study to study and there appears to be a gradual decrease in the incidence of IHPS. A review

Introduction Perthes’ disease affects the hip joint in children and is characterised by idiopathic avascular necrosis of the femoral epiphysis and resulting structural changes. Fully titled Legg–Calvé–Perthes disease after three physicians who independently and simultaneously described the condition, it most commonly presents in children aged 3-12 with features of atraumatic groin/hip pain, limp and stiffness. Though normally unilateral, up to 10-20% of cases are bilateral. The aetiology of Perthes’ disease is not yet understood. As described above it is characterised by idiopathic avascular necrosis of the femoral epiphysis. It is important to have a firm understanding of these terms: Idiopathic: means the

Overview Jaundice is one of the most common medical conditions affecting neonates. Jaundice refers to the yellow discolouration of skin and mucous membranes that occurs due to an increase in the level of bilirubin. Bilirubin is one of the main breakdown products of haemoglobin, which is the oxygen carrying molecule in our red blood cells. Neonatal jaundice refers to jaundice that occurs in preterm or term babies within the first month of life (the neonatal period). It may be a normal physiological response or due to a pathological disorder with serious consequences. Due to the potential short and long-term consequences of

Overview Mesenteric adenitis refers to acute or chronic inflammation of the mesenteric lymph nodes. Mesenteric adenitis (or lymphadenitis) is a common cause of abdominal pain in children. There is usually acute or chronic self-limiting inflammation of the mesenteric lymph nodes that leads to enlargement and associated pain. It is most commonly secondary to a viral infection. It can be difficult to differentiate mesenteric adenitis from acute appendicitis as the inflamed nodes are typically located in the right iliac fossa. In some cases, it may be necessary to proceed to an operation (e.g. laparoscopy) to be able to differentiate between the two.

Overview Measles is a highly contagious viral infection caused by the measles morbillivirus. Measles is a viral infection that was very common in childhood before the introduction of an effective immunisation programme. In countries where the measles vaccine is not part of a national immunisation programme it is still very prevalent. Measles causes a classic presentation of fever, coryzal symptoms, and conjunctivitis followed by an exanthem. An exanthem is a widespread rash that usually occurs with systemic symptoms (e.g. fever). When it occurs in association with a virus it is known as a ‘viral exanthem’ and other common causes include rubella,

Introduction Intussusception is the telescoping of intestine into a neighbouring segment, most frequently seen in infants and young children. It is a common abdominal emergency in infants and young children, typically occurring between the ages of 3 months and 3 years. Patients present with distress and severe abdominal pain often accompanied by vomiting and bloody stools. The mesentery of the telescoped segment of intestine is impaired leading to reduced venous and lymphatic outflow. Intestinal oedema, obstruction and ischaemia develop. Early diagnosis and appropriate management are essential to obtaining good outcomes. The majority of patients can be managed with non-operative reduction (with

Introduction Henoch-Schönlein purpura is an IgA vasculitis, which commonly presents in childhood. Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. Approximately, 90% of cases occur in children. The condition commonly presents in children aged 3-15 years old with an annual incidence of 20 per 100,000 in children aged < 17 years old. HSP is usually precipitated by a viral illness, leading to an immune-mediated reaction in blood vessels. The majority of cases are self-limiting without longterm sequelae. Similar to other vasculitidies, it is characterised by the presence of purpura. This refers to small haemorrhages within the skin approximately

Definition & classification Hand, foot and mouth disease (HFMD) is an acute viral illness, which is usually mild and self-limiting. The disease is characterised by papulovesicular lesions on the distal limbs and vesicular eruptions in the mouth. HFMD occurs worldwide. In temperate climates (including the UK) it is most common in late summer and early autumn. It presents either in outbreaks or as sporadic cases. Outbreaks occur frequently in schools and nurseries, and it often spreads within families. It occurs most typically in children under 10 years of age, and most commonly in those under 4 years of age. Hand, foot & mouth

Introduction Down syndrome (DS) is a genetic condition caused by trisomy 21. Trisomy 21 is a genetic condition that refers to an additional copy of the 21st chromosome. This condition is commonly known as Down syndrome and it is the most common chromosomal abnormality amongst liveborn children. The additional genetic material leads to characteristic physical features of the head, neck, and extremities. Some of these features are universal, whereas others are more variable among people with Down syndrome. Though intellectual disability is almost universal, the degree is highly variable. Educational, speech, and language support should be offered and tailored to each individual’s

Overview A developmental milestone refers to a specific set of abilities a child should reach by a certain age. Childhood development refers to a continuous and largely predictable process that involves biological, psychological, and emotional changes that occur from birth to the end of adolescence. The sequence of events can be described in ‘milestones’. Milestones refer to a specific set of abilities a child should reach by a certain age. These milestones start off simple and then as the child gets older they become more complex. Milestones are divided into key domains, which include: Gross motor: using large muscle groups to

Overview Developmental delay broadly refers to children < 5 years old who fail to meet expected milestones. Developmental delay is the failure to achieve developmental milestones in comparison to peers of the same age range. This is generally defined as being more than two standard deviations below the mean. The core developmental milestone domains include: Gross motor Fine motor/vision Speech/language Social/emotional Cognitive Developmental delay is not a diagnosis. Instead, it is a descriptive term that requires further investigation into the possible cause of the delay. A delay may be isolated occurring in a single domain. When a significant delay occurs in

Overview Chickenpox is a highly contagious viral illness that causes a classic vesicular rash. Chickenpox is predominantly an illness of childhood that is caused by the varicella-zoster virus (VZV). It causes a highly contagious vesicular rash that is managed symptomatically in the majority of cases. In children, chickenpox is most commonly a benign self-limiting illness. However, in adults or those immunosuppressed, it can cause a severe illness with severe complications (e.g. varicella pneumonia). Varicella-zoster virus VZV is one of the human herpes viruses that is the cause of both chickenpox and shingles. The human herpes viruses are a large family of DNA viruses that

Overview Cerebral palsy is a broad term for a group of permanent motor disorders that affect muscle tone, posture, and/or movement. Cerebral palsy (CP) describes any non-progressive disorder of motor function that results from malformation or damage to the early developing brain. Therefore, it is an umbrella term for a heterogeneous group of conditions that cause permanent motor dysfunction due to injury in the prenatal, perinatal or early postnatal period. CP may occur alongside other major disorders of sensation, perception, cognition, communication, and behaviour. CP is commonly multifactorial due to an acquired pathology (although some hereditary factors can increase the risk

Introduction Acute bronchiolitis is the most common cause of lower respiratory tract infection in children under the age of 2. Children typically present with a coryzal prodrome followed by cough, reduced oral intake and possible dehydration, increased work of breathing and on auscultation, crepitations and wheeze. Infection follows a seasonal pattern peaking during the winter months, and is most commonly caused by the respiratory synctial virus (RSV). Symptoms are usually mild lasting only a few days, but in some cases hospital admission may be required. Management of bronchiolitis consists of supportive measures such as ensuring adequate hydration and temperature control. In a

Overview Biliary atresia refers to progressive destruction of the extrahepatic biliary system. Biliary atresia presents exclusively in the neonatal period with biliary obstruction. It is due to progressive destruction of the extrahepatic biliary system. The cause is idiopathic and may be associated with other congenital malformations. It is the most common reason for surgical intervention in neonatal jaundice and the most common cause of liver transplantation in children. The incidence is around 1 in 10,000-20,000 live births. Without surgical intervention to fix the obstruction, the condition is invariably fatal. Aetiology and pathophysiology The cause of biliary atresia is idiopathic. Biliary atresia is

Overview Acute epiglottitis refers to inflammation of the epiglottis and surrounding supraglottic mucosa. It can be a life-threatening condition due to airway obstruction. Thankfully, acute epiglottitis is now rare in children due to the introduction of the Haemophilus influenzae type B (Hib) vaccination as part of the routine immunisation programme. In adults, the incidence is estimated at 1-4 per 100,000 people. In children, the median age at presentation has increased to 6-12 years (traditionally affected children 2-5 years old). Children who have not been vaccinated are at particular risk. Basic anatomy The epiglottis is a thin layer of elastic cartilage that sits at the base of the