General Paediatric Clinic Follow Up

Specialty: Paediatrician Problem(s) list: * Asthma, mild persistent * Eczema, atopic * Recurrent otitis media Investigations: Full blood count and IgE levels were ordered today to investigate potential allergies. Previous ear swab results for recurrent otitis media showed no bacterial growth. Medications: * Salbutamol inhaler 100mcg, 2 puffs as needed * Fluticasone propionate nasal spray 50mcg, 1 spray each nostril daily * Cetirizine syrup 5mg/5ml, 5ml daily Weight: 22.5 kg Height: 120 cm Head circumference: 52 cm Age: 7 years 3 months Attended today's follow-up consultation with mother, Mrs. Sarah Davies. The reason for attendance was a routine follow-up for monitoring of existing chronic conditions, primarily mild persistent asthma and atopic eczema, and to discuss recent episodes of recurrent otitis media. Clinical progress has been stable for both asthma and eczema since the last visit, with good control achieved through current medication regimens. Past medical history is significant for a febrile seizure at 18 months of age, with no recurrence. On examination: General appearance was well, active, and interactive. Afebrile. Respiratory rate 18 breaths per minute, heart rate 85 beats per minute. Chest auscultation revealed clear breath sounds bilaterally with no wheezes or crackles. Cardiovascular examination was unremarkable, with normal S1 and S2 sounds and no murmurs. Abdomen was soft, non-tender, and no organomegaly was palpated. Skin examination showed mild residual erythema in the antecubital fossae bilaterally, consistent with well-controlled atopic eczema. Tympanic membranes were visualised and appeared pearly grey with no signs of inflammation or effusion. Throat was clear, and tonsils were not enlarged. Impression: The patient's asthma remains well-controlled on current therapy, with no exacerbations reported. Atopic eczema is also stable. The recent episodes of otitis media are concerning for potential underlying contributing factors, and allergy testing has been initiated to investigate this. No immediate signs of infection were noted today. Differential diagnoses for recurrent otitis media include allergic rhinitis or Eustachian tube dysfunction. Discussion: Discussed the importance of continued adherence to asthma and eczema medication. Explored potential triggers for the recurrent otitis media, including environmental allergens. The mother raised concerns about the frequency of ear infections and the potential impact on hearing and school performance. Reassured her that we are actively investigating the cause and will implement a targeted management plan. Decisions were made to proceed with allergy investigations. Plan: * Allergy blood tests (FBC and IgE) to be completed within the next week. * Review allergy test results at the next appointment. * Continue current asthma and eczema medications as prescribed. * Advise mother to monitor for any signs of acute ear infection (fever, ear pain, discharge) and seek immediate medical attention if present. * Follow-up appointment scheduled in 4 weeks to review results and reassess symptoms.