Guidelines
441 entriesNDoH Hospital-level paediatric STG
- MeningococcaemiaICD-10 code: A39.2/A39.4 DESCRIPTION Palpable bleeding into skin caused by N. meningitides and is associated with rapid spread. This is a medical emergency and can be fatal. See: Infective/Infectious Diseases: Sepsis Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 5: Dermatology, 5.4. Purpura,&nb→
- Miliary TB In ChildrenDescription Medicine Treatment ICD-10 code: A19.9 DESCRIPTION Miliary tuberculosis is a potentially fatal form of TB disease due to the spread of the organism in the bloodstream to the lungs, brain and other organs. Patients with miliary TB are assumed to have CNS involvement and are treated accordingly. MEDICINE TREATMENT Children < 8 years: The 75/50 RH and 75/50/150 RHZ formulations a→
- Mucosal Bleeds - Paediatric Palliative CareDescription General and supportive care Medicine treatment DESCRIPTION Massive bleeds at the end of life, although rare, can occur in several conditions and include: Haematemesis (e.g. bleeding varices, fulminant liver failure). Epistaxis (in haematological malignancies). Haemoptysis (rare in children). Tumour related erosion of blood vessels (less common in children). GENERAL AND SUPPORTIVE CARE→
- Multisystem Inflammatory Syndrome in ChildrenDescription Diagnostic criteria Treatment Referral ICD-10 code: U10.9 *Notifiable condition. DESCRIPTION A rare but serious inflammatory syndrome has been linked to COVID-19. Also known as Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 infection (PIMS-TS) or Kawasaki-like syndrome. The syndrome occurs after resolution of acute COVID-19 or following→
- MumpsICD-10 code: B26 See: Primary Health Care Standard Treatment Guidelines and Essential Medicines List, Infections and Related Conditions, Mumps Click here for the pdf . Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024 Chapter 8: Infective/Infectious Diseases, 8.14 Mumps→
- Myasthenia GravisMyasthenia Gravis→
- Myasthenic Crisis (MC)Myasthenic Crisis (MC)→
- Mycobacterium Avium Complex (MAC) InfectionDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A31.0 DESCRIPTION Atypical mycobacterium, causing disease in extremely immunocompromised patients. MAC infection in HIV-infected children usually presents with disseminated disease, often enlarged intra-abdominal lymph nodes and pancytopenia. Pulmonary, GIT or skin disease is less common→
- MyocarditisDescription Diagnostic criteria General and supportive measures Medicine treatment of viral myocarditis Referral ICD-10 code: I40 DESCRIPTION Myocarditis is an inflammatory disease of the cardiac muscle. The majority of paediatric myocarditis cases are caused by viral infection. Viral myocarditis should be suspected whenever a child presents with arrhythmia, heart failure or cardiogenic sho→
- Nausea And Vomiting - Paediatric Palliative CareDescription General and supportive measures Medication and treatment ICD-10 code: R11 DESCRIPTION Nausea is an unpleasant sensation vaguely referred to the epigastrium and abdomen that often but not always culminates in vomiting. Vomiting is the forcible expulsion of the contents of the stomach through the mouth. It should be distinguished from passive regurgitation and reflux.  →
- Necrotising PeriodontitisDescription General and supportive measures Medicine treatment Referral ICD-10 code: K05.6 DESCRIPTION An acute very painful infection of the gingival margin characterised by: foul smelling breath, loss of gingiva and supporting bone around teeth, and presence of underlying disease, e.g. HIV. May lead to loss of surrounding lips and cheeks if not adequately treated. GENERAL AND SUPPOR→
- Neonatal Abstinence Syndrome (NAS)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: P96.1 DESCRIPTION Postnatal opioid (or non-opioid illicit drug) withdrawal syndrome occurring in 55–94% of newborns whose mothers were addicted to or treated with opioids or other nonopioid illicit drugs, during pregnancy. Can result in: foetal malformation, intrauterine death, preterm d→
- Neonatal Issues Related to COVID-19Description General and supportive measures Medicine treatment DESCRIPTION Most neonates born to mothers with COVID-19 will not be seriously affected, although prematurity seems to be more common. Vertical and breast milk associated transmission are exceedingly rare. GENERAL AND SUPPORTIVE MEASURES Preferably, do not separate babies from their mothers. Encourage breastfeeding unless contra-→
- Nephrotic Syndrome (NS)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: N04 DESCRIPTION Nephrotic syndrome (NS) is a clinical syndrome associated with massive proteinuria due to increased permeability of the glomerular basement membrane. Most children have primary (idiopathic) nephrotic syndrome associated with minimal change nephrotic syndrome (MCNS) or focal seg→
- NeurocysticercosisNeurocysticercosis→
- Neuroleptic PoisoningDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T43.5 DESCRIPTION Neuroleptic overdose may cause a depressed level of consciousness, hypotension, tachycardia and cardiac dysrhythmias and seizures. Commonly used neuroleptics include chlorpromazine, haloperidol and phenothiazine anti-emetics (e.g. promethazine). Acute dystonic reactions→
- Non - Typhoid Salmonella (NTS)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A02.9 DESCRIPTION Present as: gastroenteritis, or extra-intestinal (invasive) disease. DIAGNOSTIC CRITERIA Clinical Self-limiting mucosal intestinal disease presenting with diarrhoea and vomiting in immunocompetent patients. Young infants (< 3 months) and immunodeficient children (esp→
- Non-Penetrating Eye InjuryDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: S05.1 DESCRIPTION An intact cornea and sclera, but severely contused eye. A foreign body on or embedded in the cornea of an intact eye. DIAGNOSTIC CRITERIA Signs depend on the site affected and nature of the non-penetrating trauma. Corneal injury Contusion: hazy oedematous cornea. A foreign body embedded on/in the corn→
- Non-Severe Tuberculosis DiseaseIndications Includes smear-negative pulmonary TB (low bacillary load) or with no more than mild to moderate lymph node enlargement and/or lung field opacification, or simple pleural effusion. See: https://theunion.org/sites/default/files/2022-03/The%20Union_Diagnostic%20Atlas%20for%20TB%20in%20Children_2022.pdf Dosing Adjust treatment dosages to current body weight. If calculating dosages,→
- Nutritional Care in the ICUMalnutrition is common (25%) among critically ill children and is associated with increased morbidity, delayed recovery and increased mortality. Nutritional goals in PICU include: Prevention and/or treatment of malnutrition – both macro and micronutrient deficiencies as well as overfeeding. Maintenance of gut integrity with enteral nutrition. Optimization of organ function. Standard Treatment Gui→
- ObesityObesity→
- Obsessive Compulsive Disorder (OCD)Obsessive Compulsive Disorder (OCD)→
- Obstructive Sleep ApnoeaDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: G47.3 DESCRIPTION Affects all ages as either partial or complete airway obstruction that disrupts gas exchange and sleep patterns. Associated with truncal obesity and increased BMI, recurrent otitis media, allergic rhinitis/asthma and syndromic conditions e.g. Down syndrome, T→
- Odynophagia - Paediatric Palliative CareDescription General and supportive measures Medication and treatment ICD-10 code: R13 DESCRIPTION Pain that arises from the oropharynx and/or pain with swallowing. Not only does it lead to irritability and discomfort but can affect intake of feeds and medication. May be an unrecognised source of pain in neurologically impaired non-verbal children. GENERAL AND SUPPORTIVE MEASURES Perform a t→
- Opioid PoisoningDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T40.2 DESCRIPTION Codeine is a common drug of abuse. The duration of action of morphine is 3–6 hours. Other oral agents, e.g. codeine and long acting morphine, demonstrate a delayed effect of up to 4–12 hours. DIAGNOSTIC CRITERIA Altered level of consciousness. Classic triad of CN→
- Opioid WithdrawalOpiod Withdrawal→
- Organophosphate PoisoningDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T60.0 *Notifiable condition DESCRIPTION Organophosphates are potent inhibitors of acetylcholinesterase. Note: Where the history is of an unspecified rat poison or pesticide ingestion, consider other active ingredients such as amitraz and ‘super-warfarin’ anticoagulants. DIAGNOSTIC→
- Osteitis/Osteomyelitis, AcuteDescription Diagnostic criteria General and supportive measures Medicine treatment Antibiotics according to sensitivities Referral ICD-10 code: M86.1 DESCRIPTION Most cases result from haematogenous deposition of organisms in the bone marrow after a transient bacteraemic episode. Osteomyelitis most commonly begins in the metaphyses of long bones, which are highly vascular. The spread of inf→
- Otitis ExternaOtitis externa→
- Otitis Media, Acute (AOM)Otitis Media, Acute (AOM)→
- Otitis Media, Chronic, SuppurativeOtitis media, chronic, suppurative→
- Otitis Media, with Effusion (OME)Otitis Media, with Effusion (OME)→
- P. Ovale/P. Vivax & P.MalariaeICD-10 code: B53.0/B51.9/B52.9 Chloroquine, oral, 10 mg base/kg as a single dose. Follow with 5 mg base/kg given 6, 24 and 48 hours after the first dose. PLUS (for P. ovale and/or P. vivax) To eradicate the organism: Primaquine, oral, 0.25 mg base/kg/day for 14 days (obtained using section 21 approval). Continue chloroquine once weekly until primaquine is obtained. Note: Exclude G6PD defici→
- P.Falciparum Malaria, Non-Severe, UncomplicatedDescription Medicine treatment ICD-10 code: B50.9 DESCRIPTION A child with uncomplicated malaria is alert, can tolerate oral medication, has an age-appropriate level of consciousness and has no clinical or laboratory evidence of severe malaria. Ideally, treatment should be started in hospital. Initial doses should be directly observed. Observe for 1 hour to ensure dose is not vomited. MEDIC→
- P.Falciparum Malaria, Severe, Complicated (Or If Repeated Vomiting)Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B50.0/B50.8 DIAGNOSTIC CRITERIA Clinical Unable to drink or breast feed. Vomits everything. Renal failure. Cerebral malaria: manifests with convulsions, which may be subtle, and/or any change in mental state, ranging from irritability, lethargy to coma, stiff neck or bulging fontanelle. Respiratory→
- PICAPICA→
- Paediatric Emergencies: IntroductionNDoH STG Paeds 2023→
- Paediatric Palliative Care - Symptom Control And Principles For PrescribingICD-10 code: Z51.5 DESCRIPTION The World Health Organisation (WHO) defines paediatric palliative care as the active total care of the child’s body, mind and spirit that also involves giving support to the family. Palliative care should begin when illness is diagnosed and continue regardless of whether or not a child receives treatment directed at the disease. Healthcare providers must evalu→
- Pain ControlDescription Pain management General and supportive measures Non-medicine pain management strategies ICD-10 code: R52.9 DESCRIPTION Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage, or described in terms of such damage. Pain is an inherent part of the pathology of most medical and surgical diseases.→
- Paracetamol PoisoningDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: T39.1 DESCRIPTION Poisoning due to paracetamol by adolescents is generally due to intentional ingestion. The accidental ingestion of paracetamol elixir preparations by toddlers very rarely causes toxicity. Toxicity can be due to acute ingestions or repeated supratherapeutic ingestion (RSTI). Toxicity due to IV paraceta→
- Parenteral NutritionComplications of PN Dose and duration of PN infusion Average daily parenteral requirements Parenteral nutrition (PN) should be prescribed and administered under the supervision of a medical specialist and dietician. PN should be used only when it is not possible to meet nutritional requirements enterally or when there is gastrointestinal dysfunction resulting in inability to tolerate enteral nutr→
- Patent Ductus Arteriosus (PDA) in the NewbornDescription Diagnostic criteria General and supportive measures Medicine treatment Surgical treatment Referral ICD-10 code: Q25.0 DESCRIPTION Patent ductus arteriosus (PDA) is the extra-uterine persistence of the normal foetal vessel that joins the pulmonary artery to the aorta. DIAGNOSTIC CRITERIA Clinical Depending on size of PDA: A systolic or continuous murmur at the upper left sternal→
- Penetrating Eye Injury With/Without a Foreign BodyDescription Diagnostic criteria General and supportive measures Surgical treatment Referral ICD-10 code: S05.5 / S05.6 DESCRIPTION Penetration through the cornea or sclera to deeper structures with/without a foreign body still present. DIAGNOSTIC CRITERIA Urgently refer the patient with a penetrating eye injury or a severely contused eye to an ophthalmic specialist to avoid endoph→
- Peptic Ulcer DiseaseDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: K27 DESCRIPTION Varying degrees of gastritis or frank ulceration of the stomach or duodenum due to acid and pepsin-laden stomach contents on the gastric and duodenal mucosa in the face of inability of mucosal defence mechanisms to prevent these effects. Peptic ulcers may be primary (e.g.→
- Pericardial EffusionDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: I30 DESCRIPTION Accumulation of fluid in the pericardial space, usually secondary to pericarditis. DIAGNOSTIC CRITERIA Clinical Most patients present with a prolonged history of: low cardiac output, distended neck veins, muffled or diminished heart sounds. Patients with HIV may be asympt→
- PericarditisDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: I30.9 DESCRIPTION An inflammation of the pericardium. Causes include viral or bacterial and autoimmune disease. The commonest cause is viral but the clinician should entertain a high index of suspicion for tuberculous and bacterial pericarditis as these require specific antimicrobial treatment. DIAGNOSTIC CRITERIA Infl→
- PeriodontitisDescription General and supportive measures Medicine treatment Referral ICD-10 code: K05.4 DESCRIPTION Progressive gingivitis to the point where the underlying bone is eroded, is characterized by teeth becoming loose in their sockets. It is a cause of tooth loss in adults. GENERAL AND SUPPORTIVE MEASURES Advice on improving and maintaining oral hygiene. See: Gingivitis, uncomplicated→
- Persistent AsthmaMild persistent asthma Moderate persistent asthma Severe persistent asthma Referral MILD PERSISTENT ASTHMA When needed for acute exacerbations: ß 2 -agonist (short-acting), e.g.: Salbutamol, inhalation, 100–200 µg , as required 3–4 times daily using a metered-dose inhaler with a spacer device until symptoms are relieved. PLUS For daily maintenance treatment: Low dose inhaled corticosteroids→
- Persistent DiarrhoeaDescription General and supportive measures Medicine treatment DESCRIPTION Persistent diarrhoea is a diarrhoeal episode of presumed infectious aetiology that begins acutely but has a prolonged duration lasting more than 14 days. GENERAL AND SUPPORTIVE MEASURES Treatment strategy includes a stepwise approach with modification of the diet, which are not mutually exclusive and are applied according→
- Persistent/ Chronic Pain (Non-Cancer Pain)ICD-10 code: R52.2 Persistent/chronic pain is pain that lasts longer than the expected time for healing, and does not always have an obvious physical cause. Best practices for the management of chronic pain in children as recommended by the World Health Organization include: Use a comprehensive biopsychosocial assessment to inform pain management and planning. Screen for and monitor pain in→