Childhood Conditions

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Objectives
◦ Objectives
 Identify specific questions you need to ask the patient that help you assess his/her conditions.
 Identify signs and symptoms where referral to doctor is necessary.
 Preparations that you can recommend for different presenting symptoms

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Topics:
 Head lice頭蝨
 Threadworm蟯蟲
 Colic腸絞痛
 Fever
 Teething出牙
 Nappy (Napkin) rash尿布疹
 Oral thrush口腔念珠菌(鵝口瘡）

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Head lice
◦ Specific questions to ask the patients
 Age (most commonly found in children, particularly 4‐11 years; girls showing higher incidence than boys
(‐adult women occasionally infected
‐adult male rarely affected, especially as men lose hair through
male pattern baldness男性型脫髮 offer less shelter遮蔽 to lice)
 Presence of live lice
 Presence of egg shells 頭蝨卵/蛋殼 (Nits)
◦ How to check the presence of head lice? Method: Check by combing the child’s wet hair over a piece of white‐ or
light‐coloured paper, using a fine‐toothed comb梳子
 Presence of itching (itch is not always present in head lice infection; ?dandruff, ?psoriasis, eczema/dermatitis皮膚炎?)

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Head lice
◦ Management and treatment
 Only those individuals with an active head lice infestation should be treated. Family members suspected of having
head lice should visit their doctor for examination and treatment.
 Malathion – Chemical insecticide殺蟲劑
 Apply once weekly for 2 doses, rub preparation into dry hair and scalp, allow to dry naturally. Remove by
washing after 12 hours.
 Permethrin – Chemical insecticide
 It is not generally recommended because of its short contact time.
 Chemical insecticide poisons毒死 the head lice by chemical means. Resistance抗藥性 has been reported.
Which formulation?
 Alcohol‐based formulation
 Can cause stinging 刺痛when applied to scalps with skin broken as a result of scratching.
 Evaporating alcohol might irritate the lungs and cause wheezing.
 Alcohol‐based formulations are best avoided in patient with asthma.
 Aqueous‐based formulation: should be used first line because of their lower potential for adverse effect
 Dimeticone – Physical insecticide: It works by physically 物理作用coating覆蓋 the surfaces of head lice and
suffocating窒息 them, so resistance抗藥性 is unlikely to develop.
Counselling: Treatment should be reserved for infected heads. It should not be used prophylactically.
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Threadworm 蟯蟲
 Threadworms are small, white, thread‐like worms between 2.5 and 12 mm long. They infect human guts (intestines).
Threadworms live about 5‐6 weeks in the gut. They are common in children, but anyone of any age can be affected.
◦ Specific questions to ask the patient
 Age (very common in school children)
 Perianal肛周itching (worst at night‐ female worms lay their eggs with sticky irritant fluid at the perianal skin)
 Other symptoms (in severe cases, diarrhea may be present)
 Appearance 外形 of worms
 Recent travel aboard
 Other family member affected

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Threadworm 蟯蟲
◦ Conditions where referral is necessary
 Infection other than threadworm is suspected
 Recent travel abroad (may need to refer to doctor for further investigation)
 Secondary infection of perianal skin due to itching and scratching
 Medication failure
 Correct use is essential if treatment is to be successful, therefore, also ask how the treatment was
used, in order to establish if treatment failure might be due to incorrect use

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Threadworm 蟯蟲
◦ Managements and treatments
Mebendazole (Vermox®)‐ Oral Anthelmintic 口服抗蠕蟲藥
 Can be given to children aged 2 years and over, and to adults.
 Reinfection is common and a second dose may be needed after 2 weeks.
 All family members should be treated at the same time, even if only one has been shown to have threadworms.
 Complementary to drug treatment is the need for strict hygiene measures 衛生措施
 NOT recommended for pregnant women

 Pregnant women should be advised to practice hygiene measures衛生措施for 6 weeks to break the cycle of
infection.

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Threadworm 蟯蟲
◦ Managements and treatments (continued)
Hygiene measures 衛生措施
 Nails should be kept short and clean.
 Careful washing and nail scrubbing 洗擦 before meals and after each visit to the toilet is essential to prevent
re‐infection.
 Bed linen, towels and sleepwear should be washed and rinsed well.
 Underwear should be worn underneath night clothes to prevent scratching.
 Shower immediately on rising each morning, washing around the anus to remove any eggs laid by the worms during
the night.
 Damp dusting and daily vacuuming 吸塵 are recommended to remove eggs.

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Colic (腸絞痛)
 Colic is usually defined as repeated episodes of inconsolable無法安撫 crying哭 in an infant嬰兒 that otherwise
appears to be healthy.
 It generally begins in the first few weeks after the baby is born and usually resolves by the baby is 3‐4 months old.
◦ Specific questions to ask the patient
 Age
 History of crying
 Aggravating 惡化factors
◦ Clinical features of colic
 Inconsolable無法安撫 crying ‐ typically, high‐pitched and occurring frequently in the afternoon or evening.
 Red in face
 Clenching緊握 of the fists拳頭
 Drawing up拉起 of the knees膝蓋
 Passing wind放屁

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Colic (腸絞痛)
◦ Conditions where referral is necessary
 Baby's cry does not sound like his/her normal cry
◦ Managements and treatments
 Assure parents that colic will resolve on its own with no long‐term adverse effects
 Infant can be comforted安撫 by being held抱, rocked搖動 or patted輕拍 gently
 Use of pacifier奶嘴
 Review feeding餵食 technique
 Body massage按摩
 Simeticone (activated dimeticone)(Infacol®) ‐ an anti‐foaming agent抗泡沫劑; it decreases the surface tension表面
張力 of gas bubbles, causing them to combine into larger bubbles)

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Fever
◦ Specific questions to ask the patients
 Age of the child
 How is the child: how poor the child is relative to normal behaviour?
 Associated symptoms: e.g. Cough? Runny nose? Sore throat?

◦ Conditions where referral is necessary

 Children of age under 3 months old It does not fade if you press the
 Fever associated with convulsion 痙攣/抽搐 side of a clear glass firmly against
the skin‐ REFER
 Stiff neck 頸部僵硬
 Purpuric rash 紫斑 can be the presenting symptoms of serious condition e.g. meningitis腦膜炎

◦ Managements and treatment

 Paracetamol
 Ibuprofen 12
Teething 出牙
 Discomfort associated with teething
 May cause sleep disturbances or irritability in some infants

◦ Management and Treatment

 The treatment goal is to relieve gum pain and irritation
 Massage of gum around the erupting tooth
 Biting on a clean and cool object e.g. cold wet cloth is soothing 舒緩
 Use of analgesics e.g. paracetamol or ibuprofen suspension

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Nappy (Napkin) rash 尿布疹
Contributory factors
 Contact of urine and faeces with the skin
 Due to infrequent nappy changes
 Inadequate skin care
Clinical feature of napkin rash
 Appears as an erythematous rash紅疹 on the buttock area臀部
 Presence of weeping液體滲出 and yellow crusting結硬 might indicate bacterial infection 細菌感染 (Refer)

Specific questions to ask the patients

 Nature and location of rash
 Severity
 Broken skin
 Signs of infection
 Duration

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Nappy (Napkin) rash 尿布疹
◦ Conditions where referral is necessary
 Bacterial infection (signs: i.e. weeping and yellow crusting)
 Broken skin, severe rash
 Other body areas affected
 Condition present for longer than 2 weeks

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Nappy (Napkin) rash 尿布疹
◦ Management and treatment
 Emollient 潤膚劑 preparations
 Other ingredients included in preparations for the treatment and prevention of nappy rash:
 Zinc鋅 i.e. zinc oxide
 acting as a soothing agent 舒緩
 Lanolin羊毛脂:
 lanolin emollient 潤膚劑hydrates the skin
◦ It can sometimes cause sensitivity reactions過敏反應
 Castor oil蓖麻油/cod liver oil魚肝油:
 they provide a water‐resistant layer 防水層on the skin

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Nappy (Napkin) rash 尿布疹
◦ Management and treatment (continued)
 Antibacterials抗細菌劑 (e.g. chlorhexidine gluconate):
 They may be useful in reducing the number of bacteria on the skin
 Some antibacterials may produce sensitivity reactions過敏反應

 Antifungals抗真菌藥:
 Secondary infection with Candida 念珠菌 is common in nappy rash and the azole antifungals would be effective.
 Example: Miconazole or clotrimazole. They should be applied twice daily, and should be continued for 4 to 5 days after the
symptoms have apparently cleared. Patient should be advised to consult the doctor if the rash has not improved within 5 days.
An emollient cream乳膏or ointment油膏can still be applied over the antifungal product.

 Topical hydrocortisone cream or ointment

 Applied thinly, only a small amount is needed for effectiveness.
 A steroid cream or ointment should not usually be used for more than seven days.

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 Nappy (Napkin) rash 尿布疹
◦ Management and treatment (continued)
◦ Practical advice
1. Nappies should be changed as frequently as necessary.

2. Nappies should be left off wherever possible so that air is able to circulate around the skin, helping the affected skin
to become and remain dry.

3. Waterproof防水 pants create an occlusive barrier封閉屏障, which prevents the evaporation of moisture and can
worsen napkin dermatitis. They should only be used for short periods of time, or avoid altogether if possible.

4. At each nappy change the skin should be cleansed thoroughly by washing with warm water or using fragrance‐free
and alcohol‐free baby wipes嬰兒濕巾. The skin should then be dried by patting, not by rubbing, with a towel.

5. The regular use of an emollient cream乳膏or ointment油膏to clean dry skin can help to protect the skin against
irritant substances.

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Oral Thrush (口腔念珠菌病（鵝口瘡)
 Thrush is a fungal infection, which occurs commonly in the mouth (oral thrush), in the nappy area in babies and in
the vagina (i.e. vaginal candidiasis).
◦ Specific questions to ask the patient:
◦ Age
 Oral thrush is most common in babies, particularly in the first few weeks of life. It is often passed on by the mother
during childbirth.
 Oral thrush is rarer in older children and adults. However, it may occur after antibiotic or inhaled steroid treatment.
In this older group it may also be a sign of immunosuppression免疫抑制, and referral to the doctor is advisable.
◦ Location
 Oral thrush affects the surface of the tongue and the insides of the cheeks臉頰.
◦ Previous History
 In babies recurrent infection is uncommon. Therefore, babies with recurrent infections should be referred to their
doctor for further investigation.

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 Oral Thrush (口腔念珠菌病（鵝口瘡)
◦ Specific questions to ask the patient: (continued)
◦ Medication
 Antibiotics – broad‐spectrum antibiotic therapy can wipe out the normal bacterial flora, allowing the overgrowth過度
生長of fungi (i.e. Candida念珠菌)
 Immunosuppressives免疫抑制劑(i.e. any drug used for immunosuppression)
 Cytotoxic therapy (化療‐細胞毒劑)
 Inhaled steroids for asthma – steroid is deposited at the back of the throat during inhalation, especially if the inhaler
technique is poor, which may lead to oral thrush
 Rinsing the throat with water after using the inhaler may be helpful
 Counsel patient on proper inhaler technique

◦ Conditions where referral is necessary

 Adults and older children without obvious cause
 Recurrent多發性/persistent持續thrush
 Failed medication
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 Oral Thrush (口腔念珠菌病（鵝口瘡)
◦ Management and treatment
 Topical antifungal
 Miconazole (oral gel)
Counseling point:
 Miconazole gel should be applied to the plaques 斑塊 using a cotton bud棉花棒 or the handle of a teaspoon.
 Treatment should be continued for 2 clear days after the disappearance of the symptoms to ensure that all
infection is eradicated根治.
Practical advice實用建議
Oral thrush and nappy rash
 If a baby has both oral thrush口腔念珠菌病 and nappy rash尿布疹, both should be treated at the same time.
 An antifungal cream containing miconazole or clotrimazole can be use for the nappy area
Breastfeeding
 For baby who is breast‐fed母乳餵養, small amount of miconazole gel can be applied to the nipples乳頭to eradicate
根治the fungus present存在
 For baby who is bottle‐fed奶瓶餵養, it is advisable to sterilize消毒the bottles and teats奶嘴 21
References:
1. P Rutter. Community pharmacy: symptoms, diagnosis and treatment. Churchill Livingstone 2017.

2. A. Blenkinsopp, M. Duerden, J. Blenkinsopp. Symptoms in the Pharmacy: A Guide to the Management of

Common Illness (Eighth edition). Wiley‐Blackwell, 2018.

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