Although I thought your article was a good review of the more common
causes of bloody diarrhoea in children, I was somewhat troubled by the
absence of any mention of general paediatrics.
As you point out, serious complications are thankfully rare, but
there are some very important conditions that need to be considered. In
Cumbria, with a large rural and farmaing population, we are very concerned
about the possibility of E Coli 0157 and subsequent development of HUS.
Hirchsprung's colitis and intussusseption again are rare, but they do
happen.
An average GP will likely never see these is a career, whereas a
general paediatrician in a DGH setting probably will. You are therefore
neglecting a massive resource in your management plan, outlining that
these children can either be managed in primary care or should see a
tertiary specialist - with nothing in between.
I think you aren't considering that the majority of children with any
episodes of bloody diarrhoea will be seen by general paediatricians. I
would suggest that GP's managing such children tap into this resource
either by admitting these children, or asking for advice. In practice, I
think this is what many GP's are doing.
Rapid Response:
What about general paediatrics
Although I thought your article was a good review of the more common causes of bloody diarrhoea in children, I was somewhat troubled by the absence of any mention of general paediatrics.
As you point out, serious complications are thankfully rare, but there are some very important conditions that need to be considered. In Cumbria, with a large rural and farmaing population, we are very concerned about the possibility of E Coli 0157 and subsequent development of HUS. Hirchsprung's colitis and intussusseption again are rare, but they do happen.
An average GP will likely never see these is a career, whereas a general paediatrician in a DGH setting probably will. You are therefore neglecting a massive resource in your management plan, outlining that these children can either be managed in primary care or should see a tertiary specialist - with nothing in between.
I think you aren't considering that the majority of children with any episodes of bloody diarrhoea will be seen by general paediatricians. I would suggest that GP's managing such children tap into this resource either by admitting these children, or asking for advice. In practice, I think this is what many GP's are doing.
Competing interests: None declared
Competing interests: No competing interests