What are the common pediatric presentations in Australia and their management in general practice (GP)?

Common Pediatric Presentations in Australian General Practice

The most common pediatric presentations in Australian general practice include respiratory infections, acute gastroenteritis, and influenza-like illnesses, which should be managed according to evidence-based guidelines prioritizing early diagnosis and appropriate treatment to reduce morbidity and mortality.

Respiratory Infections

Pneumonia

Pneumonia is a significant cause of pediatric morbidity requiring careful assessment and management:

• Clinical presentation:

  • Fever, tachypnea (respiratory rate >70 breaths/min in infants or >50 breaths/min in older children)
  • Respiratory distress (nasal flaring, chest indrawing, grunting)
  • Oxygen saturation <92% 1

• Management in GP setting:

  • For children under 5 years: amoxicillin as first-line antibiotic
  • For children 5 years and older: macrolide antibiotics (azithromycin, clarithromycin) due to higher prevalence of Mycoplasma pneumoniae 1
  • Clear discharge instructions on expected recovery course and when to return

• Indications for hospital referral:

  • Oxygen saturation <92% or cyanosis
  • Severe respiratory distress
  • Inability to maintain oral hydration
  • Altered mental status 1

Otitis Media

Otitis media is particularly prevalent in Australian Aboriginal children, often beginning in the first 3 months of life 2:

• Clinical presentation:

  • Ear pain, irritability, fever
  • Bulging tympanic membrane or middle ear discharge
  • In Aboriginal children: often painless and persistent 3

• Management:

  • Antibiotics are indicated for all episodes of acute otitis media in high-risk populations (including Aboriginal children) 3
  • For non-Aboriginal children with mild symptoms, watchful waiting may be appropriate
  • Follow-up is essential, particularly in Aboriginal children where persistent disease may lead to chronic suppurative otitis media 2

• Common pitfalls:

  • Overprescribing of antibiotics is common in Australian general practice for otitis media 4
  • Lack of systematic follow-up in high-risk populations 3

Gastrointestinal Conditions

Acute Gastroenteritis

One of the most frequent diagnoses in pediatric presentations 5:

• Clinical presentation:

  • Vomiting, diarrhea, abdominal pain
  • Varying degrees of dehydration

• Management:

  • Oral rehydration therapy is first-line treatment
  • Assessment of dehydration status is critical
  • Antibiotics generally not indicated

• Indications for hospital referral:

  • Severe dehydration
  • Persistent vomiting preventing oral rehydration
  • Age <6 months with significant symptoms

Influenza-Like Illness and Pandemic Influenza

During influenza season or pandemics, a structured approach is recommended:

• Clinical categorization:

  1. Mild symptoms (cough and mild fever):

     • Home management with antipyretics and fluids
     • Parental education on warning signs 6

  2. High fever (>38.5°C) with cough:

     • Assessment by GP
     • Consider oseltamivir in children >1 year of age
     • Supportive care with antipyretics and fluids 6

  3. High fever with risk factors or concerning symptoms:

     • Risk factors include chronic comorbid disease
     • Concerning symptoms: breathing difficulties, severe earache, vomiting >24 hours, drowsiness
     • Management: antibiotics plus oseltamivir (if >1 year) 6

• Indications for hospital referral:

  • Signs of respiratory distress (marked tachypnea, grunting, recession)
  • Cyanosis
  • Severe dehydration
  • Altered consciousness
  • Complicated seizures
  • Signs of septicemia 6

Special Considerations for Aboriginal Children

Aboriginal children require particular attention due to higher rates of severe infections:

• Otitis media:

  • Earlier onset, more persistent, and more severe 2
  • Requires aggressive treatment and close follow-up
  • High rates of persistent bacterial colonization of the nasopharynx 3

• Management approach:

  • Lower threshold for antibiotic prescription
  • Scheduled follow-up rather than as-needed
  • Education of parents/caregivers about importance of completing treatment courses

Emergency Department Presentations

The Paediatric Research in Emergency Departments International Collaborative (PREDICT) data shows:

• Most frequent diagnoses in pediatric ED: acute gastroenteritis, acute viral illness, and upper respiratory tract infections
• Asthma is also a common presentation
• Presentations peak in late winter and early spring
• Overall admission rate of 24% 5

Practice Recommendations

1. Implement structured assessment protocols for common conditions like respiratory infections and gastroenteritis

2. Recognize high-risk populations, particularly Aboriginal children who may require more aggressive management and follow-up

3. Use clear criteria for antibiotic prescription to avoid overuse while ensuring appropriate treatment for those who need it

4. Establish clear referral pathways for children requiring hospital assessment

5. Provide comprehensive parent education on expected disease course, warning signs, and when to seek further medical attention

By following these evidence-based approaches, GPs can effectively manage the most common pediatric presentations while minimizing complications and unnecessary hospitalizations.