Acute Flaccid Paralysis

Acute flaccid paralysis is rapid onset weakness with reduced tone and usually reduced reflexes. It is a syndrome requiring urgent evaluation, both because respiratory failure can develop and because poliomyelitis surveillance depends on recognition of every compatible case.

Causes include Guillain Barré syndrome, poliomyelitis, transverse myelitis, botulism, hypokalaemia and spinal cord disease.

Headache In Children

Most paediatric headaches are primary headaches such as migraine or tension type headache. The clinical priority is identifying secondary causes that require urgent investigation.

Migraine commonly produces episodic headache with nausea, vomiting, photophobia or phonophobia. Children may have bilateral rather than unilateral pain and attacks may be shorter than in adults.

Red flags include:

• Progressive worsening
• Early morning vomiting
• Headache waking the child
• Focal neurological deficit
• Papilloedema
• New seizures
• Personality or school performance change
• Occipital headache with neurological signs
• Headache in a child with cancer or immunosuppression

For acute migraine:

• Ibuprofen 10 mg/kg PO, maximum 400 mg per dose

• Paracetamol 15 mg/kg PO, maximum 1 g per dose.

Give treatment early in the attack.

Ondansetron may be used for significant nausea or vomiting.

Frequent disabling migraines require trigger management and consideration of prophylactic therapy under paediatric or neurological supervision.

Avoid medication overuse, which can itself perpetuate chronic headache.

Acute Flaccid Paralysis

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management