Oral Problems Issues

Transcription

Oral Problems Issues
Oral Problems
Paediatric Palliative Care
For Home Based Carers
Funded by
British High Commission, Pretoria
Small Grant Scheme
Oral Problems
ƒ Oral problems are common in
children with HIV
ƒ Often a sign that HIV disease is
progressing
ƒ Type, frequency and severity of
problems depend on the child
©TALC
Issues
ƒ Oral problems are commonly
painful and distressing for a
child
ƒ A child may refuse to drink
or eat
ƒ Children are therefore at risk
of dehydration and/or
malnutrition
©TALC
ƒ Early diagnosis and
treatment is essential to
prevent complications
©TALC
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Oral Thrush
ƒ Common in children
ƒ Caused by candida infection
ƒ White patches on roof of
mouth, inside cheeks, back
of tongue or throat
ƒ May be very painful
©TALC
ƒ May be in corners of mouth
or in throat
Oral Thrush
ƒ Pain is distressing for child
ƒ May be difficult to swallow
ƒ Child may not want/ be unable to
eat or drink
ƒ May lead to dehydration and/or
malnutrition
ƒ If severe, recurrent or in throat,
suggestive of HIV
©TALC
Management of Oral Thrush
ƒ Wash hands
ƒ Wet a clean soft cloth with salt water and
use to wash child’s mouth
ƒ Refer for:
Daktarin oral gel (4-6 hourly x 7-14 days)
and /or
Nystatin 6 hourly
ƒ Try both if severe/persistent
ƒ If N/A, paint with Gentian Violet
ƒ Avoid feeding for 20 minutes after
medication
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Management of Oral Thrush
ƒ If breast fed, check mother’s breasts for
thrush
ƒ If thrush present, treat breasts with
nystatin or Gentian Violet
ƒ Advise mother to wash breasts after
feeds
©TALC
ƒ If bottle fed, change to cup and spoon
Management of Oral Thrush
ƒ Ensure regular pain relief to
relieve discomfort and
encourage drinking/eating
ƒ Encourage small, frequent
drinks and food to prevent
dehydration & malnutrition
Management of Oral Thrush
If thrush is no better / worse
or swallowing is painful:
ƒ refer child to clinic for
investigations & medication
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Preventing Oral Thrush
ƒ Thorough washing of
bottles, teats, cups, spoons
ƒ Daily Tooth brushing
ƒ Breastfeeding
ƒ Nutritious foods
ƒ Vitamins
©TALC
Herpes Simplex
ƒ Painful, small blisters or
open sores on lips or in
mouth
ƒ May also be around nose
ƒ May be accompanied by
fever
ƒ Herpes >1 month = AIDS
defining condition
CDC/J.D.Millar
Herpes
ƒ May be very painful
ƒ Child may not want/be
unable to eat or drink
ƒ May lead to dehydration or
malnutrition
©TALC
ƒ May last long time/recur
ƒ Can be spread from one
person to another
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Management of Herpes
ƒ Paracetemol (Panado)
ƒ Encourage fluids
ƒ Hand Washing
ƒ Soft diet
ƒ Thorough cleaning of
utensils
Management of Herpes
ƒ Refer for oral Acyclovir
ƒ May need IV Acyclovir if severe
ƒ May need antibiotics for secondary infection
ƒ Child needs clinic/ hospital urgently if:
- Child is not drinking
- Child is dehydrated
- Signs of difficulty breathing, jaundice or behaviour change
Preventing Herpes
ƒ Nutritious Foods
ƒ Vitamins
ƒ Hand Washing
ƒ Avoid touching mouth
ƒ Avoid kissing if herpes
present
ƒ Thorough cleaning of
feeding implements and
utensils
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Mouth Ulcers
ƒ Painful blisters on tongue or in
mouth
ƒ Size 2-3mm to 2-3 cm
ƒ Occur as single blister or in
‘clusters’
ƒ Occur on roof of mouth, tongue,
inner cheek, tonsils
ƒ Child may be reluctant to eat or
drink
©TALC
Management of Mouth Ulcers
ƒ Wash hands
ƒ Wet a clean soft cloth with salt
water and use to wash child’s
mouth
ƒ Paint mouth with Gentian Violet,
twice daily
ƒ Continue using Gentian Violet
until 48 hours after ulcers have
been cured
ƒ Give Paracetemol for pain relief
Dental Problems
ƒ Inflammation of gums
ƒ Tooth abscesses
ƒ Painful
ƒ May not want to eat/drink
©TALC
ƒ Secondary infection
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Managing Dental Problems
ƒ Daily Tooth Brushing
ƒ Water and Salt mouth wash
ƒ Chlorhexidine mouthwash
ƒ Dental checks
ƒ Antibiotic treatment
Preventing Oral Problems
ƒ Regular tooth brushing
ƒ Vitamins
ƒ Nutritious foods
ƒ Avoid sugary foods that will
rot teeth
ƒ Encourage calcium
Managing Oral Problems
ƒ Encourage diet and fluids
ƒ Pain relief (Paracetemol)
ƒ Salt and water mouth wash
ƒ Gentian Violet
ƒ Chlorhexidine
ƒ Regular checks
©TALC
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