370 Paediatric Emergencies
Sudden Unexpected Death in Infancy
(iii) Age 11–15 years
(a) slipped capital femoral epiphysis (SCFE)
(b) trauma: overuse syndromes
(c) arthritis, including Still’s disease, juvenile rheumatoid
arthritis and ankylosing spondylitis
(d) infection: sexually transmitted disease (arthralgia and
arthritis)
(e) neoplasia.
6 Transient synovitis and septic arthritis are difficult to differentiate and
warrant urgent investigation.
7 Send blood for FBC, erythrocyte sedimentation rate (ESR), C-reactive
protein (CRP) and blood culture, if infection is considered possible.
8 Request plain X-rays of the affected limb including ‘frog lateral’ X-rays of the
hips if SCFE is suspected.
9 Arrange an ultrasound scan to demonstrate a hip effusion, if the X-rays are
normal and pain is localized to the hip region.MANAGEMENT
1 Administer oral pain relief, and immobilize a fracture and acute traumatic
limb injury with a splint.
2 Disposition and further management is dependent on the underlying
problem.
3 Patients with constitutional symptoms, fever, leucocytosis and elevated ESR
and CRP require joint aspiration under anaesthesia to exclude a septic
arthritis.
(i) Refer these and traumatic fractures, slipped capital epiphysis,
Perthes’ disease and developmental dysplasia of the hip to the
orthopaedic team.SUDDEN UNEXPECTED DEATH IN INFANCY
DIAGNOSIS
1 Sudden unexpected death in infancy (SUDI) is used to describe any infant
under the age of 1 year who dies suddenly or unexpectedly, and whose
manner and cause of death are not immediately obvious prior to investiga-
tion.
(i) It includes sudden infant death syndrome (SIDS) in 50%, deaths
from medical problems, and injuries such as neglect, suffocation
and homicide.