Fontanelle paediatric education – Details, episodes & analysis

Many of us see children with joint pain, some of whom are incredibly bendy. But have they "got hypermobility" or even EDS? Join Dr Alice Leahy and Marisa McMillan in their wide ranging discussion about EDS, hypermobility syndrome, arthritis, factors affecting how people perceive pain, and possible reasons why EDS has become more prominent on social media recently. ------------------------------------------------------------------------------------------------------------------------------------- Pearls include: The Beighton Score: not very useful in the local paediatric population and is not validated. ---- Ehlers Danlos Syndrome (EDS) is a collection of collagen disorders 13 subtyes of EDS, 12 of which have known genetic mutations and histopathological changes, the 13th - neither genetic nor histopathological changes, otherwise known as hypermobility EDS. ----The 3 types worth remembering are: ☆Vascular type EDS - very rare - usually present to genetics depts rather than to rheumatology department - FH vascular rupture, Distinctive facial characteristics. ☆☆Classical type EDS. Also rare. Extremely hypermobile. Excessively stretchy skin. Can pull skin out from forearm 6cm (upper range of normal 2cm) Autosomal dominant. Often very bruised with plentiful scarring on body. ☆☆☆Hypermobility type EDS: Beighton score of >6 pre-pubescent children; >4 in pubescent children ------ Joint pain is not a good indicator of inflammatory arthritis. ♡♡♡JIA usually presents with very little pain. Arthritis will present with joint swelling. If arthritis is suspected, request an ultrasound. A normal USS will exclude inflammatory disease. Blood tests are not helpful in diagnosing arthritis - neither are X-rays. ------------------------------------------------------------------------------------------------------------------------------------------------------------- Useful Resources: •••The 2017 international classification of the Ehlers–Danlos syndromes (Malfait et al) https://doi.org/10.1002/ajmg.c.31552 ••••The RCPCH position statement on establishing a correct diagnosis of Ehlers Danlos Syndrome hypermobility type (hEDS) in children and adolescents  https://www.rcpch.ac.uk/resources/establishing-correct-diagnosis-ehlers-danlos-syndrome-hypermobility-type-heds-children#footnote5_xb0pjtb •••Head First by Alistair Santhouse Head First: A Psychiatrist's Stories of Mind and Body https://www.amazon.co.uk/dp/1838950311/ref=cm_sw_r_apan_glt_fabc_6KB3WZ7BY8XBW3WEYA8Q •••It's All in Your Head by Suzanne O'Sullivan It's All in Your Head: Stories from the Frontline of Psychosomatic Illness https://www.amazon.co.uk/dp/0099597853/ref=cm_sw_r_apan_glt_fabc_M77GAQV12ES834PWHCTT

A look inside the world of adolescent medicine and the benefits of the HEEADSSS tool with Dr David James, who explains to Marisa McMillan how we can be opportunistic in reaching the 10-22 year olds presenting to our ED departments. Check out the must-have HEEADSSS app on Google Play/Apple or http://app.heeadsss.uk Review on itunes 🌟🌟🌟🌟🌟 if you like what you hear and get in touch if you want to get involved. Spread the word and share the knowledge!

Abdominal pain is common in children and concerning for parents with a wide range of differentials. In this episode Dr Mark Tighe, paediatrician in Poole, takes us through some common acute presentations, including appendicitis, torsion and intussusception, as well as the differentials to be considered. He takes us through history and examination, when and where to refer and how to investigate and manage. He then addresses in some depth the problem of recurrent abdominal pain, which he divides up regionally into functional dyspepsia, functional abdominal pain and IBS. Mark describes biophysical modelling and discusses how the enteric nervous system is potentiated by stress. Fascinating and very useful material for any GP or paeds trainee. Many thanks to Mark Tighe for opening up this area. Don't forget to refer to the excellent clinical pathway, red flags and parent information leaflets on Healthier Together https://www.what0-18.nhs.uk/professionals/gp-primary-care-staff/clinical-pathways/padiatric-pathways If you like what you hear, please rate 🌟🌟🌟🌟🌟 and review on iTunes. For any suggestions please get in touch with me, Caroline Storey at Fontanellepod@gmail.com

Lymphadenopathy in children is common and usually benign. How can we distinguish between harmless reactive lymphadenopathy and more sinister causes which might require treatment or further evaluation? Dr Phil Wylie takes us through the history and examination, showing us what to look out for so we can reassure parents all is well, or pick up cases which call for further action. Red flag features include nodes over 2cm and growing, supraclavicular and popliteal nodes nodes, fever, weight loss, night sweats, pain and itching, as well as hepatosplenomegaly, pallor and easy bruising. In this podcast we refer to the Clinical Pathway on Healthier Together https://what0-18.nhs.uk/download_file/493/0 If you enjoy the podcast please subscribe, share and leave a review on iTunes🌟🌟🌟🌟🌟 Please let me know if you have any suggestions by emailing me, Caroline Storey at fontanellepod@gmail.com Thank you for listening!

Respiratory tract infections in under 5s represent two thirds of all presentations to primary care and ED. But why do we see so many of them? What are parents looking for when they bring their children to see a doctor? Dr Sanjay Patel, consultant in paediatric infectious diseases, says the data tells us that parents are not seeking antibiotics, but rather reassurance that their child is well enough to be managed at home without antibiotics. With the emphasis in popular media on serious illness, health-seeking behaviour is going up year on year, with a 25% increase in activity for under 5s with RTIs annually. In our increasingly risk-averse society, there needs to be a seismic change in health seeking behaviour, if we are to avoid the dangers associated with inappropriate antibiotic use. Severity, not aetiology of respiratory tract infections should guide decision making around antibiotic use. Reference is made to the SCAN Guidelines, which can be found at www.nhsantibioticguidelines.org.uk the PIER Guidelines at www.piernetwork.org and the MicroGuide app. Changes to antibiotic policy aim to improve compliance and include use of Amoxicillin for all respiratory tract infections, with a BD dosing regime of 40mg/kg, as well as shortening the course from 10 to 7 days in tonsillitis. Scoring systems discussed include FeverPAIN for suspected Group A Strep tonsillitis. Pneumonia can be diagnosed based on fever, and respiratory distress, with auscultation providing little to support a diagnosis. Please subscribe and leave a review at iTunes ⭐⭐⭐⭐⭐ and send me any feedback or ideas to fontanellepod@gmail.com Thank you and enjoy.

I'm joined by Dr Sanjay Patel, consultant paediatrician and lead for Healthier Together, who describes the background and aims of this wonderful, innovative health education resource. Addressing the felt confusion and anxiety of parents, as well as the changing needs of our increasingly risk-averse society, this resource aims to deliver high quality and consistent information to parents and professionals, providing a safe way to identify the sickest patients whilst keeping the well children out of hospital. This podcast serves as an overview - stay tuned for more on the individual clinical pathways as seen on www.what0-18.nhs.uk

D&V, or gastroenteritis, can usually be managed safely at home by parents with appropriate advice and safety netting. To help provide that information, Phil Wylie, consultant paediatrician in Dorset County Hospital joins me to talk about red flags, recognising and treating dehydration (think 2ml/kg every 10 mins), shock, and long term sequelae such as transient lactose intolerance. With reference to Healthier Together pathways and parent information leaflets www.what0-18.nhs.uk Thanks Phil. Please go to iTunes to rate ⭐⭐⭐⭐⭐ and review. Any feedback, please email me at fontanellepod@gmail.com

Dr Phil Parslow, Consultant Paediatrician with an interest in nephrology talks UTI - in primary and secondary care. Referencing Healthier Together www.what0-18.nhs.uk NICE Guidelines, InfoKid.org.uk and ERIC.org.uk. Thanks to Phil, please go to iTunes to rate ⭐⭐⭐⭐⭐ and review, and please send any feedback to me, Caroline Storey at fontanellepod@gmail.com

Dr Sarah Williams, Consultant paediatrician with an interest in gastroenterology and nutrition, summarises her thoughts on important areas in nutrition such as managing patients in nutritional crisis, the importance of phosphate and tackling obesity. Reference is made to the very useful MARSIPAN Junior guidelines - See http://www.marsipan.org.uk Sarah spoke at the PIER Conference 2018 and I chatted to her between talks - Thanks Sarah.

In this episode, Dr Clare Hollingsworth, consultant general paediatrician, discusses our favourite topic for these winter months: bronciolitis. Reference is made to the Wessex Healthier Together material, an excellent resource for those in both primary and secondary care, which can be found here: https://www.what0-18.nhs.uk Other topics in WHT to be covered soon on the show.