Common Paediatric illnesses in Primary Care – when to refer.pptVIP

Common Paediatric illnesses in Primary Care – when to refer? Southend University Hospital NHS Foundation Trust Paediatric referrals Increased by 38% over the previous year Total Outpatient referrals per year: 15,480 Choose and Book 750 New referrals 3,850 Rapid access 2400 follow ups 8440 Inpatient admissions: 1300 Length of stay 1.1 days Urgent Referrals The acutely unwell infant Uncertain diagnosis and you are worried! Extreme parental anxiety Worries about child safety or non-accidental injury; also contact social services Low threshold for admission in: Children with co-morbidity eg diabetes, cystic fibrosis, on immuno-suppressives/steroids Past history of intensive care treatment eg diabetic ketoacidosis, life-threatening asthma Young infants below 3 months Recognition of the sick infantImportant considerations Completely undress the infant (remember it is easy to miss petechiae or bruising or a hernia) Infants are difficult to assess objectively Illness can result in rapid deterioration over a few hours. It is therefore helpful to re-assess the child after a suitable interval Younger the baby lower the threshold of admission With exception of dehydration, an infant that is feeding well is unlikely to have a serious illness Recognition of the Sick Infant significant symptoms Reduced feeding (50% of normal in previous 24 hours) Persistent vomiting (50% of the previous 3 feeds) Any bile-stained vomiting Frank blood in stools Less than 4 wet nappies in 24 hours Rapid breathing – particularly if noisy and of sudden onset Inappropriate drowsiness or irritability Convulsions Persistently unusual cry History suggestive of apnoeic episodes Recognition of the Sick Infant significant signs Activity: Floppy Reduced response to verbal or painful stimuli Dehydration: tachycardia 120/min reduced skin turgor of ≥2secs Reduced capillary refill ≥3secs dry mouth, sunken fontanelle Respiration: