Dr Joseph Mizzi

L-iskarlatina (‘scarlet fever’) hi infezzjoni kkaġunata mill-mikrobu msejjaħ streptococcus (Strep A). Tolqot l-aktar lit-tfal fl-età tal-iskola. Tissejjaħ hekk minħabba r-raxx ħamrani li joħroġ fuq il-ġilda. L-infezzjoni titfejjaq b’kors antibiotiċi, u b'hekk niffrankaw komplikazzjonijiet fil-kliewi u rewmatiżmu. Kull sena jkun hawn xi każijiet ta’ skarlatina f’Malta, imma jiġu snin li jkun hawn aktar mis-soltu. Is-Sintomi Dawn huma s-sintomi tal-iskarlatina: Deni u tkexkix ta’ bard Il-griżmejn u ilsien iffjammati Il-glandoli ta’ l-għonq minfuħin Raxx aħrax fil-ġilda (jinħass qisu 'sandpaper'), ħmura fuq il-wardiet tal-wiċċ u bjuda madwar il-ħalq. L-ilsien mgħotti b'lega bajda u aktar tard jidher minfuh ('strawberry tongue'). Linji ħomor fl-apt u postijiet oħra. Id-deni u l-ġriżmejn ħomor huma l-ewwel sintomi. Jista’ jkun hemm ukoll uġigħ ta’ ras u rimettar. L-għada li jitla’ id-deni jitfaċċa r-raxx fuq l-għonq u s-sider, li mbagħad jinfirex lejn id-dirgħajn u

Il-walker mhux irrikkmandat. Ħafna tfal weġġgħu serjament bih. Qabel jitilqu jimxu, it-trabi għandhom jitħallew jilgħabu fuq tapit u crawling fl-art. Tħallix it-tarbija weħidha fuq is-sodda, sufan, il-high-chair jew fil-cot bil-ġemb imniżżel. Ipprepara kollox ħdejn in-nappy changer (ħrieqi, wipes, ilbies) qabel tibda, biex ma jkollokx bżonn tħalli lit-tarbija weħidha. Għamel xatba fit-taraġ – kemm fuq kif ukoll isfel. Ara li hemm ċint fuq il-bejt, u poġġaman fit-taraġ , l-landing u l-gallarija. Waħħal ‘corners’ tal-plastic artab mal-kantunieri tal-għamara li jistgħu jolqtu wiċċhom magħha. Tħallix lit-tfal żgħar jilgħabu jew jersqu lejn kitchen equipment u għodda li jaqtgħu. Tħallix is-sikkina fit-tarf tal-mejda, minn fejn it-tfal jistgħu jiġbudha fuqhom.

In childhood obesity, parents hold the key to success. Parents cannot afford to wait for the government, health department or school authorities to take action. If they do, well and good, but the parents must take the responsibility for the children's well-being in their hands. Parents do not help by criticizing their children or preaching to them. They help when they themselves adopt a healthy and active lifestyle, and get the children onboard with them. It involves commitment and perseverance (as well as the joy of spending more quality time as a family). But it's definitely worth the effort. A healthy lifestyle is the best investment in the well-being and happiness of our children.

10 - the % of overweight/obese children worldwide 20 - the % of overweight/obese children in Europe 40 - the % of overweight/obese children in Malta. 50 - the % chance that a child will be obese if one of his parents is obese. 80 - the % chance that a child will be obese if both parents are obese 90 - the % risk that an obese teenager will continue to be obese in adulthood 7 - the number of years lost in life expectancy

L-aktar ikel komuni li jaghti allergija. L-allerġija għall-ikel hi reażżjoni qawwija u immedjata għal ċertu ikel. Madwar 6% tat-tfal u 2% tal-adulti ibgħatu minn din il-kundizzjoni. L-allerġija għall-ikel hi aktar komuni jekk l-individwu jew xi ħadd fil-familja tiegħu jkollhom xi tip ta’ allerġija. Kull tip ta’ ikel jista’ jikkawża allerġija, imma fit-tfal, l-aktar komuni huma l-ħalib, il-bajd, il-qamħ u s-soya. Fl-adulti, l-aktar ikel komuni huma l-karawett, lewż, ħut u frott tal-baħar. Is-sintomi jistgħu ikun tnemnim, nefħa u ħakk fix-xoftejn u l-ilsien, għajnejn idemmgħu, raxx fil-ġilda, urtikarja u dardir. It-trabi jista’ jkollhom demm mal-koko. L-anaphylaxis hi allerġija qawwija ħafna u tinvolvi nefħa fil-passaġġ ta’ l-arja, qtugħ ta’ nifs, raxx, għejja, stordament u pressjoni baxxa. Il-pazjent jista’ jintilef minn sensih. Din il-forma ta’ allerġija hi perikoluza għax tista’ tkun fatali. Allerġija jew Intolleranza Hu importanti li nagħmlu distinzzjoni bejn ‘allerġija’

The 'Communication Skills' is one of the stations in the paediatric viva of the final exam. The following scenarios are intended for students to practice communication skills (with one another or with a relative or friend). The interview lasts for 4 minutes. You can speak in English or Maltese. Tips (1) Introduce yourself, 'Good morning, I am Joseph Mizzi, one of the doctors who is taking care of your child.' (2) You can begin by giving a resume of the information you had been given. 'So you have brought your son John because of fever. He has been vomiting and complaining of a headache. When we examined him, we noted that he had neck stiffness.' (3) Answer any questions clearly and honestly. If asked whether meningitis may lead to death or long term problems, for instance, answer: 'Yes, meningitis is a serious illness that may cause death or long-term problems such as hearing loss. However, most children recover completely without any complications.' (4

Paediatrics Revision Questions © 2012-20 Dr. Joseph Mizzi 1. A 6-year-old girl is brought to A&E complaining of severe earache and a fever 39ºC. On inspection, the tympanic membrane on the right appears inflamed. a) What is the diagnosis? b) What are the likely organisms? c) How would you treat this child? 2. A child presents to COP with a 4-week history of headaches, which are worse in the morning and coughing. Ophthalmoscopy showed bilateral papilloedema. a) What is the differential diagnosis? b) What investigations will you perform? 3. An 8-year-old girl presents with pallor and bruises. Hb 6.3; WBC 28; Plt 12; blood picture: blasts. a) What is the probable diagnosis? b) How would you confirm the diagnosis? c) What are the prognostic factors? 4. A toddler is referred to COP for pallor. Hb 7.0; WBC 5.3; Plt 240; MCV 68. a) What is the differential diagnosis (two most likely diagnoses)? b) What two other tests would you perform? c) What is the management?

Il-cot death tfisser il-mewt għall-għarrieda ta’ tarbija fl-irqad. Tista’ tiġri fl-ewwel xhur tal-ħajja. Fortunatament il-cot death hi rari ħafna. Illum nafu x’nistgħu nagħmlu biex nipproteġu t-tarbija waqt l-irqad. Kif Tipproteġi t-Tarbija Dejjem raqqad it-tarbija fuq daharha; traqqadhiex fuq il-ġenb jew fuq iż-żaqq. Jekk tħalli t-tarbija man-nanniet jew carer, għidilhom ċar biex iraqqduha fuq daharha. Meta t-tarbija tkun mqajjma, ara li tagħmel ħin tilgħab fuq żaqqha (dan jgħin fl-iżvilupp tal-muskoli tal-għonq u l-ispallejn, u biex r-ras ma tiġix ċatta). (Ara: Tummy time ). It-tarbija għandha torqod fl-istess kamra mal-ġenituri. Tista’ tredda' jew tisqi t-tarbija fis-sodda tal-ġenituri, imma wara li tkun xorbot l-aħjar tqegħdha lura fil-cot tagħha. Torqodx fuq is-sufan jew putruna bit-tarbija f’dirgħajk. Uża saqqu sod mgħotti b’liżar; tpoġġix ħwejjeġ rotob taħt it-tarbija. Ħalli r-ras mikxufa, tużax imħadda, u tħallix soft-toys, biċċiet jew ħwejjeġ oħra fil-cot. Ara li

Sudden Infant Death Syndrome (SIDS) remains a leading cause of infant death after the immediate neonatal period. The cause remains uncertain. However there are some steps that parents should take to minimize the risk. Back to sleep The baby should always be placed back to sleep with the feet touching the foot of the cot. Parents should be reassured that there is no increased risk of choking. To avoid plagiocephaly, the baby should be placed on the abdomen (‘tummy to play’) several times a day when awake. Grandparents and other carers should be told clearly that the baby should always be placed to sleep on the back. Unaccustomed prone sleep increases the risk of SIDS by as much as 18-fold. Sleep in cot The baby should sleep in the parents’ room for at least the first six months. The baby’s cot (not the parents' bed) is the safest place for the baby to sleep. Firm mattress A firm mattress should be used, covered with a sheet. The baby should not sleep on soft thing

Exclusive breastfeeding is recommended for the first 6 months of life. Breastmilk is nutritionally perfect, easily digested, and always at the right temperature. It’s free and readily available whenever and wherever needed. Breastfeeding builds a strong emotional bond between mother and baby. Infant Less GI, chest and ear infections Less hospitalization Less constipation Protects against obesity and NIDDM Less eczema and wheezing Protects against SIDS Protects preterm infants against NEC Mother Protects agains breast and ovarian cancer Faster weight loss Reduce risk of PPH Delays fertility

Status epilepticus is defined as recurrent or continuous seizure activity lasting longer than 30 minutes in which the patient does not regain baseline mental status. Prolonged seizures are associated with cerebral hypoxia, hypoglycemia, and hypercarbia and with concurrent and progressive lactic and respiratory acidosis. Neuronal destruction can occur and may be irreversible, Management Secure airway and suction High-flow 100% O 2 by mask. Pulse oximetry. Establish IV access (if unsuccessful, give rectal diazepam) Check capillary blood glucose (and treat hypoglycemia) Drugs (Diazepam PO/PR at t=0; may repeat at 5 min; Phenytoin infusion at 10 min) Recovery position T=0 min Diazepam (Valium, Diazemuls) 0.3 mg/kg IV over 1 min or 0.4 mg/kg PR May cause apnoea and hypotension. T=5 min Diazepam (Valium, Diazemuls) 0.3 mg/kg IV over 1 min or 0.4 mg/kg PR As above T=10 min Phenytoin (Epanuti

Uses Diagnosis – diurnal variability > 20%, improvement of PEFR after bronchodilator or stereoids. Also useful as an assessment of response to treatment. Monitoring – as part of an individual management plan that includes education and symptom recognition (asthma symptoms during the day, interference with sleep, activities e.g. sports). There should be little variation in the reading from day to day, or morning/evening when asthma is well-controlled. Acute exacerbation – less than 50% best/predicted in severe attack; less than 33% in life-threatening attack or unable to perform measurement. Infants and young children (till 6 years) are not able to use the peak flow meter. Method Attach mouthpiece. Set the meter to zero.  Stands up or sit upright. Hold the meter level (horizontally), keep fingers away from the pointer. Deep breath and close lips firmly around the mouthpiece.  Blow as fast and strongly into the device as possible (as if you were blowing out candles o

The three main concerns are: hygiene (to prevent enteritis); correct concentration (to prevent under-nutrition or hyper-natraemic dehydration); correct temperature . How to prepare a bottle of formula milk: Wash and sterilize bottle, teat and cap (using steam sterilizer, microwave sterilizer, sterilization solution or boiling for 10 minutes). Boil mineral water. Wash your hands before preparing bottle. Pour the correct amount of warm water in the bottle to the marked level. Add the correct number of level scoops of powder using the scoop provided. (1 level scoop with every 30 mls of water). Shake gently to dissolve the powder. Check the temperature by allowing some drops to fall on the wrist. If it feels comfortable, it is the right temperature for the baby. Otherwise the milk should be cooled under running water, or heated in a bottle-warmer. The milk should be used immediately; discard any left-over milk.

DKA is a metabolic state of hyperglycemia, ketosis and acidosis resulting from deficiency of insulin and excess glucagon (gluconeogenesis, glycogenolysis, lipolysis with the formation of ketones). Hyperglycemia causes an osmotic diuresis that leads to excessive loss of free water and electrolytes. Resultant hypovolemia leads to tissue hypoperfusion and lactic acidosis. Mortality from cerebral oedema, hypokalaemia and aspiration pneumonia. Causes Newly diagnosed IDDM. Infection is the most frequent cause. Poor compliance with insulin regimens. Presentation Often insidious, especially in toddlers.  Symptoms: polydipsia, polyuria, weight loss, nausea/vomiting, abdo pain, fatigue. Signs: altered mental status, tachycardia, tachypnoea (Kussmaul), acetone odour, shock. Diagnosis BG >12 mmol/l VBG pH <7.3 or HCO3 <15 mmol/l Ketonuria. Treatment ITU if coma or shock. Treatment involves gradual and slow correction of hyperglycaemia, ketoacidosis and dehydration wi

Rare life-threatening generalized hypersensitivity reaction. The most common causes are food (seafood, nuts), antibiotics, non-steroidals, stinging insects, vaccines and transfusions. Adrenaline is life-saving! Children with previous severe allergic reactions should carry an adrenaline pen and should avoid contact/ingestion of the allergen. Clinical Signs Airway: stridor and respiratory failure from laryngeal oedema.  Breathing: respiratory failure from bronchospasm.  Circulation: shock from vasodilatation and capillary leak, clinically evident from a decreased level of consciousness, tachycardia and (late sign) hypotension.  Skin: flushing, urticaria, pallor. Management Secure Airway and 100% oxygen . Intubation and ventilation if in respiratory failure. Pulse oximetry. Adrenaline 1:1000 0.01ml/kg IM (not subcutaneously) is the first-line treatment (do not waste time on other drugs). Repeat adrenaline every 5 minutes if there is inadequate clinical improvement.Cons