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Rotterdam, Netherlands

Geurts D.H.,Erasmus MC Sophia Kinderziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2011

A 15-year-old girl presented with fever and pain in her legs. A viral infection was suspected, but within 24 hours she became confused and developed meningeal signs, based on which she was diagnosed as having meningitis. Within a few hours a 6-month-old boy developed fever, a grey colour, bulging fontanel, cold hands and feet, and was groaning. He too appeared to have meningitis. It is important to recognize this serious infection in children with fever, since delay of diagnosis and treatment may result in serious complications. Recognition is difficult because of non-specific symptoms on presentation and a lack of alarm symptoms early in the course of the disease. Alarm symptoms of serious infection in children are cyanosis, rapid breathing, decreased capillary refill, petechial rash, meningeal signs, leg pain and decreased consciousness. If serious infection is uncertain in a child with fever, parents should be advised on the potential course of the disease, the alarm symptoms and the need to seek medical help in time.

Early recognition of Guillain-Barré syndrome (GBS) is crucial to anticipate and adequately respond to possible respiratory insufficiency. Young children with GBS frequently have non-specific complaints and are more difficult to examine, which may cause a significant delay in diagnosing GBS. We present 3 children, all boys, aged 22 months, 7 years and 4 years respectively, with GBS in whom the diagnosis was missed upon admission, resulting in a failure to appreciate the risk of acute respiratory insufficiency. Two children had to undergo emergency intubation, and one of these cases had a fatal outcome. Young children with GBS often present with pain and refusal to walk, or with difficulty swallowing, and are often initially misdiagnosed with e.g. tonsillitis or coxitis. These nonspecific symptoms can be a first sign of a progressive polyradiculoneuropathy and should prompt a full neurological examination and timely referral to a paediatric neurological centre with Intensive Care facilities.

Moll H.A.,Erasmus MC Sophia Kinderziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2015

Today, in 2014, the Manchester Triage System is an evidence-based triage system for the emergency room. It has been nationally and internationally validated and is safe for children. Why use the non-validated Netherlands Triage Standard that has no specific triage that has been suitably adapted and tested for children?

Verhulst F.C.,Erasmus MC Sophia Kinderziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2010

In the Netherlands, a rising number of children are being diagnosed with autism spectrum disorder. It is unlikely that this rise is due to an increase in the prevalence of autism spectrum disorder. There is no indication that the current level of behavioural and emotional problems of children in the Netherlands is higher than 20 years ago. Moreover, the level of behavioural and emotional problems of children in the Netherlands is comparable to that of children elsewhere. This rise might, however, be explained by a lack of reliability in making this diagnosis. Autism spectrum disorders should not be regarded as a disease entity that is either present or absent but as a mix of the behavioural and cognitive characteristics of a child. This change in the concept of diagnosing autism spectrum disorders may enhance diagnostic comparability and result in the needs of children and their parents being better supported.

A multidisciplinary working group has outlined evidence-based practice guidelines for the diagnosis and treatment of inflammatory bowel disease in children (IBD). Both diagnosis and treatment of IBD in children differ significantly from practice in adults. The incidence of IBD in children is low (5.2 per 100,000 per year in the age group 0-17 years), but most of the presenting symptoms are non-specific; therefore it is difficult for the general practitioner to recognise the disease in children. For a correct diagnosis, ileocolonoscopy and upper gastrointestinal endoscopy are necessary, often combined with radiological imaging of the small bowel. In children and adolescents with Crohn's disease, nutritional therapy is the first choice of treatment for remission induction. As maintenance treatment, immunomodulators (azathioprine or mercaptopurine) should be started from the time of initial diagnosis. In children and adolescents with ulcerative colitis, the first treatment is with aminosalicylates. Prednisone and/or immunomodulators (azathioprine, cyclosporin) are indicated if there is insufficient response to aminosalicylates. A final treatment option is colectomy. The transition from paediatric to adult health care needs special attention as the patient and his or her parents may be reluctant to change trusted contacts which they have made.

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