Fontanelle paediatric education

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!

Low appetite? Tired? Tummy ache? Perhaps your child is constipated. Let Dr Mark Tighe guide you through the essentials of constipation - what it is, what sets it off, and most importantly, what you can do about it. Go to eric.org.uk for excellent resources. Please review 🌟🌟🌟🌟🌟Meet us online @fontanellepod - we'd love to hear from you.

Dr Antoinette McAulay, General Paediatrician in Poole talks to Dr Marisa McMillan, Wessex Paediatric Trainee, guest hosting on Fontanelle - Thank you Marisa and Antoinette! Refer to www.bsped.org.uk (British Society for Paediatric Endocrinology and Diabetes) for up to date guidelines. Get in touch if you would like to get involved in any of the work of the Fontanelle team by writing to me, Caroline Storey at fontanellepod@gmail.com

Dr Phil Parslow, training programme director for ST4-8 in Wessex Deanery guides us through the whole appraisal process, with plenty of advice and wisdom to light your way! Amazing nuggets on how to write an effective reflection. ***************************************************🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟🌟 Fontanelle is growing and has now reached 50 countries with over 5000 listens. Many thanks for all your support. If you would like to help Fontanelle or get involved in any way, please get in touch! Thanks 🌟🌟🌟🌟🌟

Dr Mich Lajeunesse consultant in paediatric allergy takes us through using the EATERS method to take an allergy focused clinical history and help diagnose food allergies. EATERS stands for Exposure, Allergen, Timing, Environment, Reproducibility, Symptoms. Based on a 15 Minute Consultation in E&P edition of ADC (http://dx.doi.org/10.1136/archdischild-2018-316397) If your interest is piqued Mich also directs us to the RCPCH Paediatric Allergy Training study days.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other news: Fontanelle is nearly 1!🎂🎈To celebrate our first birthday we're giving away a pair of Sony headphones so the winner can listen to educational podcasts on their way to work. For a chance to win, go to Twitter, find me @fontanellepod and retweet the pinned tweet. The winner will be announced at the PIER conference 2019. Tickets still available. Come and find me there and say hello! Thanks so much for listening! 🌟🎂❤🍭🍬

Dr Amy Mitchell takes us through a real case looking at two oncological emergencies: hyperleucocytosis and tumour lysis syndrome. With reference to the PIER guidelines at piernetwork.org.uk Children's Cancer and Leukaemia Group cclg.org.uk stjude.org If you found it useful, leave a review on iTunes 🌟🌟🌟🌟🌟 and thank you for listening👏🏻👏🏻👏🏻 @fontanellepod

Inconsolable crying. Is it CMPA? Transient lactose intolerance? GORD? Infantile colic? The majority of babies cry for 2-3 hours a day, and that's completely normal. It's just how babies express themselves! Aude Cholet, dietician who designed the Hampshire Infant Feeding Guidelines, joins me on this episode of Fontanelle to discuss the treatable causes of excessive crying, which include CMPA, transient lactose intolerance and GORD. If red flags and treatable causes have been excluded, in a baby under 3 months who is crying for more than 3 hours a day, more than 3 days a week for longer than 3 weeks, you're looking at infantile colic. Infantile colic has a huge effect on bonding and attachment. It is the most common reason for stopping breast feeding as well as being the leading cause of shaken baby syndrome. for more information and links go to www.fontanellepod.com www.what0-18.nhs.uk https://cks.nice.org.uk/colic-infantile#!topicSummary Don't forget to subscribe and leave a review on iTunes 🌟🌟🌟🌟🌟 Thank you for listening!

Sepsis can be deadly, but difficult to spot. Sepsis is life threatening organ dysfunction characterised by altered physiology. Capilliary leak leads to tachycardia, tachypnoea, reduced oxygen saturations, poor peripheral perfusion, reduced urine output and altered level of consciousness. Sepsis evolves quickly, but is easily confused with common viral infections, which is why we have sepsis screening tools, alerting clinicians to the possibility that this child could be septic. See http://www.sort.nhs.uk/Guidelines/Guidelines-diseases.aspx for the PIER tool developed and used by Thames Valley and Wessex, as well as SORT sepsis management pathway. For Paediatric Sepsis 6 see https://adc.bmj.com/content/99/Suppl_1/A93.2 For parent safetynetting sheets on fever, refer to www.what0-18.nhs.uk . Also worth looking at the NICE Guidelines on both Sepsis and Fever in Under 5s. This podcast explores the recognition and management of sepsis, as well as the difficult job of balancing the need to treat sepsis aggressively with trying to combat the rising use of broad spectrum antibiotics. How can we get better at managing sepsis whilst not overtreating simple viral infections? Please share and leave a review on iTunes 🌟🌟🌟🌟🌟 Find me on Twitter @Fontanellepod . Enjoy the podcast!

I'm joined by Dr Charlie Powell to discuss abdominal migraine and associated syndromes - cyclical vomiting and benign paroxysmal vertigo. Debilitating, recurrent abdominal pain which is central, associated with pallor and being withdrawn in an otherwise well, thriving child. Associated with poor school attendance. Once red flags have been ruled out (see what0-18.nhs.uk) explore the history and consider this diagnosis. Charlie discusses excluding trigger foods such as chocolate, cheese, citrus and marmite, as these contain vasoactive amines. Moving on to medical management, consider pizotifen and propranolol for prophylaxis or tryptans for acute episodes in older children. Ondansetron can be used in cyclical vomiting. For cyclical vomiting support, Charlie recommends visiting cvsa.org.uk Please subscribe, leave a review🌟🌟🌟🌟🌟on iTunes and share with your colleagues. Any suggestions please to me, Caroline Storey at fontanellepod@gmail.com or on twitter @fontanellepod Thanks for listening!

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.

Dr Dan Magnus, Paediatric Emergency Medicine Consultant at Bristol Children's Hospital came to the PIER Conference 2018 to talk about staff wellness and wellbeing. This was a tiny snapshot of some of the ideas he presented in his talk, but certainly gives you a taste of his motivation and ideas he's developing to help us all get involved in improving staff wellbeing. I'm definitely inspired, and am sure you will be too! You can check out his work at https://www.yougotthiswellness.com and find Dan at @drdanmagnus . And remember you don't need to set yourself on fire in order to keep others warm! Enjoy!

I caught up with Dr Mark Tighe, consultant paediatrician and associate editor of Archives of Disease in Childhood. He shared some golden nuggets from his recent talk at PIER 2018 about writing right for publication. There are some super useful tips and ideas here, on how to prepare material in a way which is likely to be accepted by journals, and hence read by colleagues, which is, of course the aim. Particularly as we're all so busy and suffer from the rather wonderful sounding affliction - Tsundoku - the art of buying books and journals, and never reading them!