Paediatrics - Queensland Health - Queensland Government

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Gastrointestinal problems Fluid resuscitation regime for severe dehydration is based on 10% dehydration (person weighs 10% less than their usual weight) Initial treatment • 20 mL / kg • Reassess • Give second bolus of 20 mL / kg if still shocked • Ongoing fluids as discussed with MO • Re-hydrate / resuscitate severely dehydrated child with normal saline or IV Hartmann’s solution only [1] • Contact MO for ongoing fluid orders • Common IV fluids used in children for ongoing maintenance or replacement include normal saline or normal saline + 5% glucose [1] Arrangements should be made to transfer child to a paediatric centre. Ongoing fluid input should be managed in consultation with a Paediatrician 5. Follow up Evacuation / hospitalisation of children with moderate (if indicated) or severe dehydration Children with mild dehydration i.e. < 5% and no clinical signs review in 24 hours or earlier if parent / carer is concerned that child is worse Inform the carer that bowel actions may not return to normal for 2 weeks but a child with continuing watery diarrhoea should be reviewed by a MO Children with watery diarrhoea lasting longer than 2 - 3 days should have bloods taken for electrolytes, babies may require this earlier Reassurance, education and advice concerning hand washing, personal hygiene, avoiding food preparation, and public swimming pools until diarrhoea has settled Place child on care plan with individualised review and weighs according to severity and family situation If diarrhoea continues beyond 10 days. See Child with chronic diarrhoea flow chart Alert other parents of young children in the community of current gastrointestinal illness and the need to present early to clinic if their child displays any gastrointestinal symptoms Advise parent / carer(s) [1] • Use methods to help children drink e.g. cup, iceblock, bottle, syringe • Do not give medicines to reduce vomiting and diarrhoea. They do not work and may be harmful • Your baby or child is infectious so wash your hands well with soap and warm water, particularly before feeding and after changing nappies • Keep your child away from other children as much as possible until the diarrhoea has stopped • Return to clinic if: -- child is not drinking and still has vomiting and diarrhoea -- child is vomiting frequently and seems unable to keep any fluids down -- child is dehydrated e.g. not passing urine (< 3 wet nappies), is pale and has lost weight, sunken eyes, cold hands and feet, or is hard to wake up -- if your child has a bad stomach pain -- if there is any blood in the faeces -- if there is any green vomit, or you are worried for any other reason 608 Controlled copy V1.0 Primary Clinical Care Manual 2011
Gastrointestinal problems Nutrition during gastroenteritis • Poor appetite is normal during the acute phase of the illness - during this time, ensure fluid intake is sufficient as described above • Babies and young children who are breastfeeding will want to feed more often when they are sick - this is normal. Support mum to breastfeed more frequently • Acute gastroenteritis can result in transient lactose intolerance. Formula fed babies may need lactose free formulas until the baby’s gut recovers sufficiently to digest and absorb lactose • It is particularly important to ensure that formula fed babies get sufficient fluids • Breastfeeding should be maintained during the acute phase and through any subsequent lactose intolerance. Breastfed babies are fed more frequently than formula fed babies and are usually able to tolerate the lactose in the breast milk • If the child has an appetite, eating should be encouraged but avoid fatty food or high sugar foods and drinks Nutrition after gastroenteritis • Encourage continued breastfeeding with healthy food as well if the child is six months or older • If the child is under one year of age and not breastfed, he / she will need infant formula, not cows milk. The type of formula will depend on whether the child can tolerate lactose • An episode of acute gastroenteritis may result in weight loss • For children > 6 months of age, once the child’s appetite returns, encourage carer to provide healthy food with one extra meal each day until lost weight is regained • <strong>Health</strong>y food is important for replacing lean body tissue lost during the illness - encourage lean meat, fish, eggs, fruit and vegetables, peanut paste, baked beans, cheese and yoghurt, and wholegrain cereals like Weet-Bix ® • Children over one year of age can have cows milk provided there is no lactose intolerance • Monitor weekly to ensure healthy growth is resumed • Refer to MO if healthy growth is not resumed within four weeks - repeated or chronic infections can result in poor appetite and growth failure 6. Referral / consultation Consult MO immediately as above Children with chronic diarrhoea. See Child with chronic diarrhoea flow chart Children with weight loss or poor weight gain who are not acutely unwell - refer to Child <strong>Health</strong> Nurse or next MO clinic See Poor growth in children in the latest edition of the Chronic Disease Guidelines www.health.qld.gov.au/cdg/default.asp Primary Clinical Care Manual 2011 Controlled copy V 1.0 609
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Section 6 Paediatrics
Page 3 and 4:
Paediatric presentation History and
Page 5 and 6:
Paediatric presentation Presentatio
Page 7 and 8:
Paediatric presentation Standard cl
Page 9 and 10:
Paediatric presentation Physical ex
Page 11 and 12:
Child with fever Fever is usually a
Page 13 and 14:
Child with stridor Stridor is a har
Page 15 and 16: Any history of significant trauma?
Page 17 and 18: Meningitis Meningitis Recommend Co
Page 19 and 20: 6. Referral / consultation Consult
Page 21 and 22: Respiratory problems • For the ch
Page 23 and 24: Respiratory problems 1. May present
Page 25 and 26: Respiratory problems 4. Management
Page 27 and 28: Child < 3 months Contact MO immedia
Page 29 and 30: Immune complications Acute post st
Page 31 and 32: Immune complications Schedule 4 Ben
Page 33 and 34: Immune complications Acute rheumat
Page 35 and 36: Immune complications Australian gui
Page 37 and 38: presence of RHD Place person on Re
Page 39 and 40: Ear problems • Clean the ear usin
Page 41 and 42: Ear problems Acute otitis media (A
Page 43 and 44: Ear problems Schedule 4 Roxithromyc
Page 45 and 46: Ear problems 4. Management • Give
Page 47 and 48: See Simple analgesia back cover Ear
Page 49 and 50: Ear problems 6. Referral / consulta
Page 51 and 52: Ear problems 5. Follow up Children
Page 53 and 54: Ear problems Ear discharge in the p
Page 55 and 56: Ear problems 4. Management • Cons
Page 57 and 58: Ear problems Schedule 4 Flumethason
Page 59 and 60: Ear problems Foreign body / insect
Page 61 and 62: Gastrointestinal problems Acute gas
Page 63 and 64: Gastrointestinal problems 4. Manage
Page 65: Gastrointestinal problems • Bottl
Page 69 and 70: 5. Follow up Review 1 - 2 days aft
Page 71 and 72: Gastrointestinal problems Intestin
Page 73 and 74: Gastrointestinal problems Schedule
Page 75 and 76: Gastrointestinal problems 4. Manage
Page 77 and 78: Gastrointestinal problems Intussusc
Page 79 and 80: Gastrointestinal problems • Perfo
Page 81 and 82: Gastrointestinal problems Backgroun
Page 83 and 84: Schedule 2 Folic Acid Gastrointesti
Page 85 and 86: Urinary tract problems References 1
Page 87 and 88: Urinary tract problems ○ where no
Page 89 and 90: Bone and joint problems 3. Clinical
Page 91 and 92: Abuse and neglect 2. Immediate mana
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Paediatrics - Queensland Health - Queensland Government

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