Symposium articles

Early referral key to better outcomes in eating disorders

22 Jun 2017Registered users

Early recognition, referral and treatment are essential to achieve good outcomes for children and adolescents with eating disorders. Eating disorders have the highest mortality of all psychiatric conditions. However, provided there is access to early and evidence-based treatment, the majority of patients who are diagnosed with an eating disorder before the age of 18 will make a full recovery. Overall, outcomes in this age group are better than in adults. All children and adolescents with a possible eating disorder should be referred to their local specialist community-based eating disorder service for children and young people as soon as possible.

Diagnosing heart disease in children and adolescents

22 Jun 2017Registered users

Heart disease in children and adolescents can be congenital, in which structural defects of the heart and major blood vessels are present from birth, acquired, whereby disease develops during life, or genetic, including diseases affecting the heart muscle, electrical system or the aorta. The incidence of congenital heart disease has decreased over the past 30 years, with approximately 1 in 180 babies born with congenital heart disease in the UK each year. Several cardiac diseases are genetic and can manifest in childhood. Most are primary cardiomyopathies, ion channel diseases, coronary artery disease from familial hypercholesterolaemia or aortopathies.

Early intervention crucial in anxiety disorders in children

23 Jun 2016Paid-up subscribers

Anxiety disorders are among the most common mental health disorders of childhood. Three quarters of anxiety disorders have their origins in childhood, with presentation often chronic in nature. Where the child is experiencing significant distress or functional impairment (e.g. missing school, not taking part in age-appropriate activity), then specialist input is likely to be needed.

Optimising the management of wheeze in preschool children

23 Jun 2016Paid-up subscribers

One third of all preschool children will have an episode of wheeze and many of these present to primary care. Most will fall within a spectrum of diagnosis ranging from episodic viral wheeze to multiple trigger wheeze or early onset asthma. The child should be referred to hospital immediately if you suspect an inhaled foreign body or anaphylaxis (after administering IM adrenaline). NICE recommends immediate referral for children with wheeze and high-risk features and also those with intermediate-risk features failing to respond to bronchodilator therapy.

Managing the child with a fever

05 Aug 2015Registered users

Most illnesses associated with fever are self-limiting and children recover with no specific treatment. However, fever can also be the presenting feature of serious illness, which may be life threatening if not diagnosed and treated appropriately. If the diagnosis is unclear, potentially serious, and specific treatment may be needed to prevent deterioration, the child should be referred.

Optimising the management of bronchiolitis in infants

05 Aug 2015Registered users

Bronchiolitis shows a seasonal pattern with peak incidence occurring in the winter. Around 2-3% of children require admission to hospital. Admission rates are highest in infants less than three months old and those with underlying comorbidities. Infants will have a coryzal prodrome lasting one to three days before developing a persistent cough.


Mental health

Early intervention crucial in anxiety disorders in children

23 Jun 2016Paid-up subscribers

Anxiety disorders are among the most common mental health disorders of childhood. Three quarters of anxiety disorders have their origins in childhood, with presentation often chronic in nature. Where the child is experiencing significant distress or functional impairment (e.g. missing school, not taking part in age-appropriate activity), then specialist input is likely to be needed.

Managing disruptive behaviour disorders in children

23 May 2013Paid-up subscribers

The age at which individuals are most physically aggressive is 22 months. However, some children fail to inhibit this normal aggression and by the time they are three or four are showing signs of oppositional defiant disorder. In older children persistent antisocial behaviour is classified as conduct disorder. Epidemiological follow-up surveys show that the risk of poor outcomes in antisocial children is very high. The causes are multiple but two sets of factors stand out. First, genetic predisposition. Even children adopted away from violent or criminal parents have three or four times the rate of antisocial behaviour and second, poor parenting. [With external links to the evidence base]

Being bullied in childhood has long-term effects on mental health

26 Apr 2013Registered users

Children who are the victims of bullying are more likely to experience psychiatric problems as young adults, an American prospective population-based cohort study has found. A total of 1,420 children were recruited from 11 counties in Western Carolina. Participants were assessed annually between the ages of 9 and 16. Both the child and his/her parent were interviewed to identify bullying or bullying others, childhood psychiatric disorders and family hardships. Subsequent follow-up with a structured diagnostic interview took place at the ages of 19, 21 and 24-26.

Diagnosing autism spectrum disorders in primary care

22 Nov 2011Paid-up subscribers

Autism, like most psychiatric disorders, covers a spectrum of severity from severely disabling classic autism to milder forms of Asperger’s syndrome which border on normality. The term autism spectrum disorder (ASD) includes autism, atypical autism and Asperger’s syndrome. Some parents consult their GP worried that their child might have autism. Others may attend with a range of concerns that might point to the condition such as problems with hearing, vision, hypersensitivity to sensory stimuli, behaviour management, language impairment or repetitive behaviour. Autism conditions often co-exist with neurological disorders (particularly those including epilepsy), and more than 300 syndromes which include autism have been described.The new NICE guidelines, launched in September 2011, cover children, from birth up to 19 years, on the autism spectrum and build on the guidance published by SIGN in 2007.ASD was once believed to be relatively rare but is now thought to occur in about 1% of children. There is certainly increasing demand for diagnostic services for children and young people. Whether the apparent increasing prevalence signifies an epidemic or an epidemic of discovery is debatable. [With external links to the evidence base]

Improving recognition and management of ADHD

03 May 2010Paid-up subscribers

Attention deficit hyperactivity disorder (ADHD) is the term most widely used to cover a group of common, chronic neurodevelopmental disorders characterised by developmentally abnormal and disabling levels of restlessness and overactivity (usually combined with impulsiveness) and/or inattention. ADHD is multifactorial in origin, with a strong genetic component and is four times more common in boys than girls. The prevalence of ADHD is at least 5% and that of the most severe form i.e. hyperkinetic disorder (HKD) 1-2%. However, a survey of services for ADHD in Scotland found that only 0.6% of children and adolescents were receiving treatment. [With external links to the evidence base]


Musculoskeletal disorders

Optimising the management of congenital talipes

23 Oct 2013Paid-up subscribers

Congenital talipes equinovarus (CTEV) is a condition of the lower limb in which there is fixed structural cavus, forefoot adductus, hindfoot varus and ankle equinus. It is important to differentiate CTEV from a non-structural or positional talipes which is fully correctable. This positional variant occurs about five times as commonly as CTEV. The latter condition does not require casting or surgical treatment. The majority of CTEV cases are picked up at the early baby check or on prenatal ultrasound, and referred to the paediatric orthopaedic service. However, some cases are mistaken early on as the positional variant, and may therefore present to the GP e.g. at the six week check. Urgent referral is warranted as the Ponseti treatment should be started  early. [With external links to the evidence base]

Diagnosing and managing hip problems in childhood

24 Jun 2013Paid-up subscribers

The hip and proximate tissues are implicated in a variety of childhood conditions, and in the differential diagnosis of many more. To a large extent the possible diagnoses are limited by the child’s age, an accurate history and thorough examination. [With external links to the evidence base]

Identifying heritable connective tissue disorders in childhood

20 Jun 2012Paid-up subscribers

Heritable connective tissue disease is rare, each disorder estimated at 1-10 per 100,000. However, as a group they are prevalent enough to constitute an important diagnostic challenge. Connective tissue disorders most significantly affect three systems: musculoskeletal, ocular and cardiovascular. Awareness of these conditions in children and early suspicion in primary care provides the opportunity to initiate early and appropriate specialist management and surveillance, which can dramatically improve the outcome for your patients. The conditions often run in families and thus a thorough family history is important. Making a diagnosis in the child can have a positive outcome for other family members, as yet undiagnosed, who may benefit from intervention themselves. In children these conditions seldom require emergency admission at the time of first presentation and therefore you have time to consider the symptoms and signs and read around them before initiating appropriate referrals. [With external links to the evidence base]

Early intervention is key in juvenile idiopathic arthritis

27 Aug 2009Paid-up subscribers

Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases of childhood. The annual incidence in the UK is 1 in 10,000 children and the prevalence is 1 in 1,000. JIA occurs in all races and geographical areas and is more common in girls. The age of onset peaks between three and six and then again around adolescence. As most children with JIA will first present to primary care, GPs have an important role in diagnosis and management.[With external links to the evidence base]


A hundred years ago

A children’s casualty department - Evelina Hospital, London 1914

20 Mar 2014Registered users

'There was one type of scald, a grievous type, caused by the parents (with that modicum of wisdom which is infinitely worse than ignorance)  enveloping their children’s nether extremities in boiling rags, not wrung out dry, the very travesty of a fomentation. I saw many more or less severe cases of this kind; one poor child, a little girl aged about four, was brought up with her thigh literally cooked, and died some few days after admission.'

Breast milk: vomiting and diarrhoea

25 May 2011Paid-up subscribers

A HUNDRED YEARS AGO: A Gilbertian school of physicians has arisen who place breast-feeding in the same category as original sin and other evils of human heritage; and who stridently proclaim the superhuman virtues of unsterilized cow's milk.

A hundred years ago: Infantile paralysis

01 Feb 2008Paid-up subscribers

By Guthrie Rankin, M.D., F.R.C.P. (Edin.), M.R.C.P. (lond.), Physician to the Seamen’s Hospital, Greenwich; Physician to the Royal Waterloo Hospital for Children and Women, London Extracted from the February 1908 issue of The Practitioner

A hundred years ago: Convulsions in infancy and childhood

01 Oct 2007Paid-up subscribers

By George F. Still, M.A., M.D., F.R.C.P., Professor of Diseases of Children, King’s College, London; Physician for Diseases of Children, King’s College Hospital; Physician to Outpatients, Hospital for Sick Children, Great Ormond Street.<


Conditions in children

23 Sep 2014Paid-up subscribers

  • Juvenile plantar dermatosis
  • Molluscum contagiosum
  • Verrucas
  • Impetigo
  • Breast buds
  • Slapped cheek disease

Infant problems

09 Aug 2011Registered users



Diagnosing and managing peanut allergy in children

23 Jun 2014Registered users

The prevalence of peanut allergy is thought to be rising with 1 in 70 children affected in the UK. Accidental exposures are frequent and nut allergies are the leading cause of fatal food allergic reactions. Peanut allergy most commonly presents in the first five years of life. More than 90% of nut allergic children will have a history of eczema, asthma, rhinitis or another food allergy. The clinical diagnosis of peanut allergy is made from a typical history in combination with clinical evidence of sensitisation i.e. the presence of peanut-specific IgE or positive skin prick tests. [With external links to the evidence base]

Optimising treatment of allergic rhinitis in children

24 Jun 2013Paid-up subscribers

Acute and chronic symptoms of allergic rhinitis can disrupt school and leisure activities, significantly reducing quality of life. Temporal patterns of exacerbation give clues as to the most important aeroallergens implicated.  Where continuing deterioration presents a challenge and allergic symptoms remain uncontrolled, patients should be referred to a specialist allergy service to be considered for immunotherapy. [With external links to the evidence base]

Diagnosing and managing food allergy in children

22 Jun 2011Paid-up subscribers

Studies suggest that the prevalence of food allergy in children in the UK is now around 5%.The number of children put on restricted diets by their parents because of presumed allergy is likely to be much higher. A recent study in the Isle of Wight found that 33% of mothers thought their child had had an allergic reaction to food by the age of three. Careful documentation using a targeted and thorough history usually makes it possible to distinguish suspected IgE-mediated allergy from non IgE-mediated. Once diagnosed, management requires allergen avoidance guided by a dietician together with education in recognising and treating reactions appropriate to the underlying mechanism. Food allergy is commonly outgrown so regular reassessment is essential both to monitor for tolerance and also to look for development of allergic comorbidities. [With external links to the evidence base]


Online only

SI - Children and young people 3: 2012

15 Apr 2013Paid-up subscribers

This document can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer.

Symposium articles
Identifying heritable connective tissue disorders in childhood
Prompt treatment of acne improves quality of life

Special reports
Improving the management of atopic eczema in primary care

Special Interest - Children and young people 2: 2011

14 Apr 2013Paid-up subscribers

This document can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer.

Symposium articles
Diagnosing and managing food allergy in children
Treating nocturnal enuresis in children in primary care

Special reports
Diagnosing autism spectrum disorders in primary care
Improving outcomes in patients with cystic fibrosis



Prompt treatment of acne improves quality of life

20 Jun 2012Paid-up subscribers

Acne vulgaris is an inflammatory disorder of the pilosebaceous (hair follicle) units. It is very common, affecting 90% of teenagers, albeit often mildly. However, its onset may be delayed until the late twenties or early thirties, and very occasionally even later. In the majority of cases, acne settles by the mid-twenties, but for some patients it may still be problematic in their forties and beyond. Patients should be referred to a dermatologist if they have: a very severe variant; severe social or psychological problems; risk of scarring; failed to respond to treatment or are suspected of having an underlying endocrinological cause. [With external links to the evidence base]

Improving the management of atopic eczema in primary care

25 Apr 2012Paid-up subscribers

Although generally considered a childhood ailment, 38% of patients with atopic eczema in the UK are adults. The condition often has a significant detrimental effect on the quality of life of affected individuals and their families. Despite national evidence-based guidelines in the UK, standards of care in the community setting can vary. Patients or carers should receive a full explanation of how to use topical treatments and a demonstration of how to apply dressings, if applicable. [With external links to the evidence base]


Selected special reports

Improving outcomes in patients with cystic fibrosis

08 Aug 2011Paid-up subscribers

Cystic fibrosis (CF) is the most common fatal inherited disease in Caucasian people. Recent data indicate that there are more than 9,000 patients with CF in the UK. This would equate to around one or two patients for an average GP practice. Recognising the symptoms and signs that may point to a diagnosis of CF is important so that appropriate referral and investigations can be organised. Symptoms suggestive of CF in the first two years of life include failure to thrive, steatorrhoea, recurrent chest infections, meconium ileus, rectal prolapse and prolonged neonatal jaundice. In older children, additional suggestive symptoms include ‘asthma'-like symptoms, clubbing and idiopathic bronchiectasis, nasal polyps and sinusitis, and heat exhaustion with hyponatraemia. Suggestive symptoms in patients who present in adulthood, who are more likely to have atypical CF, include azoospermia, bronchiectasis, chronic sinusitis, acute or chronic pancreatitis, allergic bronchopulmonary aspergillosis, focal biliary cirrhosis, abnormal glucose tolerance, portal hypertension and cholestasis/gallstones. [With external links to the evidence base]

Tracking down chlamydia infection in primary care

21 Sep 2010Paid-up subscribers

Infection is usually asymptomatic. Sexually active people aged under 20 in the UK are the group most likely to have a positive result if tested. This is probably because this group changes partners more frequently. However, there also appear to be immunological factors which make infection more persistent in the young. Transmission occurs through vaginal, rectal or oral sex. It can also be vertically transmitted. Untreated chlamydia infection can result in complications including pelvic inflammatory disease (potentially leading to infertility or ectopic pregnancy), sexually acquired reactive arthritis and epididymo-orchitis. There is controversy over important questions such as the likelihood of complications developing and, hence, what sort of control measures are appropriate. Some countries, for example England, have set up screening programmes while others, such as Scotland, have elected not to. [With external links to the evidence base]

Passive smoking damages children’s health

29 May 2010Paid-up subscribers

The simplest way to prevent passive exposure of children to tobacco smoke is to encourage and support their parents to quit smoking. For parents and other family members who will not or cannot quit smoking, the next best course of action is to make the home environment in which children live completely smoke-free. Primary care health professionals, in common with all health professionals, therefore need to engage with smoking prevention and cessation initiatives at all levels, but particularly in all contacts with individual patients who smoke, or family members who smoke. As educators, GPs and practice nurses can explore with GP and nursing trainees the importance of smoking cessation in preventing disease and improving health, an element that is barely covered in the traditional organ-based medical school curricula. [With external links to the evidence base]