We all suffer with mouth ulsers at some point in time. They can be quite painful and becomes a major problem in little children when they refuse to eat or drink. They can be caused by
- viral infections – including the cold sore virus, chickenpox, and hand, foot and mouth disease, vitamin B12 or iron deficiency
Rare causes include
Most of the time, they can be treated with Antinicrobial mouth washes (Not possible in small children < 5), local anaesthetic gels like Bonjela, LA sprays. Sometimes, they can get infected, needing Antibiotics, but this is rare as long as good oral hygeine measures are followed.
Recently, I’ve seen lots of patients being prescribed Laxido, instead of Movicol. It is bascially the same composition and pretty much the same electrolyte balance.
Each sachet of LAXIDO contains the following quantitative composition of active ingredients: The laxatives are very safe and should be used in the correct doses to releive constipation.
Sodium Hydrogen Carbonate
The content of electrolyte ions per sachet following reconstitution in 125ml of water is equivalent to:
Hydrogen Carbonate (Bicarbonate)
Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. (Source: Wikepedia)
Erythema multiforme is a skin reaction that can be triggered by an infection or medication. It’s usually mild and goes away in a few weeks.
The rash comes on suddenly and develops over a few days. It tends to start on the hands or feet, before spreading to the limbs, upper body and face. The rash:
- starts as small red spots, which may become raised patches a few centimetres in size
- often has patches that look like a target or “bulls-eye”, with a dark red centre that may have a blister or crust, surrounded by a pale pink ring and a darker outermost ring
- may be slightly itchy or uncomfortable
- usually fades over two to four weeks
In more severe cases, the patches may join together to form large, red areas that may be raw and painful. It can sometimes be associated with headache, temperature, red eyes, mouth ulcers, painful & swollen joints and swollen lips. See your GP as soon as possible if your child may have erythema multiforme. If you’re unable to see a GP, contact your local out of hours service or NHS 111 for advice.
Most cases are caused by a viral infection – often the herpes simplex virus. This virus usually lies inactive in the body, but it can become reactivated from time to time. It can also be triggered by mycoplasma bacteria, a type of bacteria that sometimes cause chest infections. Medication can occasionally cause the more severe form of erythema multiforme. Possible medication triggers include:
- antibiotics, such as sulfonamides, tetracyclines, amoxicillin and ampicillin
- non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- anticonvulsants (used to treat epilepsy), such as phenytoin and barbiturates
Treatment aims to tackle the underlying cause of the condition, relieve your symptoms and stop your skin becoming infected. Treatment may include:
- stopping any medication that may be triggering your symptoms – do not try this without speaking to your doctor first
- antihistamines and moisturising cream to reduce itching
- steroid cream to reduce redness and swelling (inflammation)
- painkillers for any pain
- antiviral tablets, if the cause is a viral infection
- anaesthetic mouthwash to ease the discomfort of any mouth sores
Reference : NHS Choices
Permission for picture taken from the child and his parents. He wanted his hand to be famous 😉
There are many causes of fainting, including heart disease, dehydration, epilepsy, medications, low blood glucose level etc.
Many children faint, usually after a painful trigger, like bump in the head or a cut. I have seen adults fainting at the site of blood. These episodes are usually due to vagal nerve stimulation. Vagus is a nerve in the body to calm us down. It gets stimulated by several triggers and the blood flow from the heart slows down. This leads to a reduction in blood supply to the brain. Body is clever and to restore the supply to the brain, we fall down, so that brain gets at the same level as the rest of the body. The blood supply gets back to the brain and we wake up.
Usually no investigations are needed, but sometimes if their is family history of heart disease, we may do an ECG (Electrocardiogram, a trace of the heart) or an EEG (Electroencephalogram, a trace of the brain activity). Their is no treatment required, but I advise children to drink plenty of water, specially in hot weather. If you usually eat a very low salt diet, eat some salty food, as low Sodium in the body can lead to dizziness.
Here are some useful links
Scarlet fever has made a comeback after many years. http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(17)30694-1.pdf
It is a bacterial (Group A Streptococci) infection, thus needs antibiotics for treatment. Here is a good link about the condition https://www.nhs.uk/conditions/scarlet-fever/
Easy way to give Vitamin D to kids. Daily maintenance dose is around 400 IU /day but most of Non Caucasians are deficient!