10: Paediatrics B

Question 1

what to do if you’re worried a child is being abused

Answer 1

document appearance, behaviour and demeanour, interations between the carer and young person, and any disclosures
if further signs refer again

Question 2

what does the heel prick test screen for

Answer 2

CF
sickle cell
congenital hypothyroidism
severe combined immunodeficiency
homocystinuria
phenylketonuria
and more

Question 3

when do health visitors follow up the baby after birth

Answer 3

10-14 days: advise on safe sleeping, vaccinations, feeding, development

9-12 months: review for language, learning, safety, diet, and behaviour.

24-30 months: development, growth, eating, managing behaviour and sleep, tooth brushing

Question 4

how much weight loss is acceptable after birth

Answer 4

up to 10% in the first 10 days

Question 5

what are the main landmarks for gross motor development

Answer 5

6wks - holds legs up in ventral suspension
3months - head at 45 degrees when prone
9 months - sits steadily
15 months - walking independently
18 months - walks alone steadily

Question 6

what are some of the main landmarks for fine motor and vision development

Answer 6

6wks - fix and follow object through 90
8months - transfers objects, reaches for objects, palmar grasp, mouth objects
12 month- pincer grip
18 month - tower of three, scribbles

Question 7

what are some main landmarks for language and hearing development

Answer 7

6wks- gurgles, startles at loud sound
8month - two syllable babbling, turns to name
12 month- 3 words other than mama/dada
18 month- knowns 25-50 words

Question 8

what are some main landmarks in social and self-help development

Answer 8

6wks - smiles responsively
9 month - peek a boo
12 month - waves bye
15 - drinks from cup
18 month - uses spoon
24 month - dry by day

Question 9

define infantile collic

Answer 9

Defined as when babies spend more than 3 hours crying a day for at least three days a week
hard to soothe or settle, fist clenching, red face, bringing their knees up to their chest, very windy. Generally starts when the baby is a few weeks old and stops by the time they are 3-4 months old.
can manage with white noise, soothing baby, winding them and keeping them upright after feeds

Question 10

what causes infantile reflux

Answer 10

Infant reflux is when the baby tends to bring up milk/ be sick shortly after feeding. Can be silent if they show signs of reflux but aren’t actually sick.
Tends to be caused by the oesophagus not being fully formed/ weakness of the lower oesphageal sphincter mechanism
tends to start before 8 weeks and resolves by the time they are 1.
The baby may cough, hiccup or be unsettled during feeding. They may also swallow, gulp or burp after feeding. May cry or be unable to settle. May also have weight loss.

Question 11

what are red flags for infantile reflux

Answer 11

Red flags: starts experiencing reflux when they are over 6 months old, is over a year and still experiencing reflux, or if the baby is not gaining weight or losing weight.

Question 12

management for infant reflux

Answer 12

conservative advice at first: ensure baby isn’t feeding too much, that positioning of baby is correct, keeping baby upright during and after feeds. Can increase frequency and decrease the amount of milk. Burping the baby regularly during feeds. Ensuring baby is kept flat on their back during sleeping

If these modifications aren’t successful then you can consider a thickener for milk and omeprazole to prevent acid reflux.

In very severe cases surgery to strengthen oesophageal muscles is considered.

Question 13

describe pyloric stenosis

Answer 13

When the passage between the stomach and the duodenum is narrowed
presents around 6 weeks, M>F, and can run in families.
Starts by bringing up small amounts of milk after feeding, progresses to inability to keep milk down and projectile vomiting (yellow, curdled milk).
decreased bowel movement
You are generally able to palpate the thickened muscle (more prominent during feeding), and can be a small hard lump in the right side of the baby’s stomach.
Can sometimes see the muscles around the stomach moving left to right and straining as they try to push through the pylorus.

NG tube to drain off stomach contents before surgery.
Pyloromyotomy can be done through a keyhole surgery but some cases may require open surgery.

Question 14

how does asthma present in children

Answer 14

Unlike viral wheeze, asthma tends to be more persistent in symptoms, affects them even when there isn’t an infection, and can affect them during sports. More commonly they have a family history of asthma or atopy.

Question 15

what is viral wheeze

Answer 15

Occurs mainly in children as they already have narrower airways, so when there is inflammation associated with a disease the further narrowing of the airway produces a wheeze. Most common in children under 6.

often given salbutamol to help relieve
They may also be given a couple days of prednisone.

Question 16

how does dietary intolerance present

Answer 16

Lactose intolerance is the most common intolerance.
Can be primary (decrease in lactase as baby becomes less dependent on milk, tends to appear around 2yrs old),
secondary (due to GI disease, such as gastroenteritis),
developmental (if born <37wks may not be able to produce lactase just yet, tends to resolve)
or congenital (cant produce lactase, will require different milk)
can happen 1-3 hours after eating, tends to have bloating, cramping, flatulence and diarrhoea (may be green or frothy as milk ferments). Can vomit, be irritable, have issues during feeding and trouble settling

Question 17

what test can you do for dietary intolerance

Answer 17

hydrogen breath test

Question 18

how does cows milk intolerance present

Answer 18

presents in first few months of life
Can be Ige mediated (immediate reaction), or non IgE (can react up to 72hrs later)
Immediate reactions tend to present with urticaria, most cases are moderate. in severe cases it is possible to have anaphylaxis
Delayed symptoms are more likely to be mild to moderate and may present with colic, reflux, diarrhoea, and even eczema.

Question 19

what are the alternative milk options to cows milk for infants who are intolerant

Answer 19

removing cows milk from mothers diet
extensively hydrolysed formula
amino acid formula

Question 20

what are risk factors for infants contracting a respiratory infection

Answer 20

shorter respiratory tract so infection is quicker to spread,
lack of breastfeeding,
exposure to pathogens from siblings or in child care,
exposure to secondhand smoke or environmental pollutants,
not developed acquired immunity, immunosuppression,
CF,
premature birth,
congenital heart disease.

Question 21

red flags of children with respiratory tract infections

Answer 21

high respiratory rate,
intercostal, subcostal and sternal recessions,
grunting,
intermittent apnea,
infants who have fed less than 50% of their expected daily intake,
clinically dehydrates (fast HR, less urine output, sunken fontanelle, crying with no tears).

Question 22

what is Bronchiolitis

Answer 22

inflammation of the bronchioles
peak age being 3–6 months.
RSV is the most common causative organism followed by Rhinovirus

Presentation: Bronchiolitis is a viral RTI characterised by fever, nasal discharge, coughing, and wheeze. poor feeding, dehydration, and fever. only 1/4 become symptomatic

Question 23

what O2 saturation is indicative of hospital admission in children with respiratory infections

Answer 23

<92%

Question 24

what is croup

Answer 24

Croup is considered to be an upper airway condition in which diffuse inflammation with exudate and edema narrows the subglottic area of the airway.
Predominantly caused by parainfluenza virus,

seal-like, barking cough along with hoarseness of voice and restlessness, mainly affects 2 yr old. symptoms worse when upset

Low-grade pyrexia, coryzal symptoms, and a mild cough may precede the main symptoms of croup in some cases.

Question 25

management of croup

Answer 25

generally conservative:
rehydration and antipyretic
saftey net
some benefit from a short course of oral steriods

Question 26

what is epiglottitis

Answer 26

Inflammation and swelling of the epiglottis, often caused by infection but may be caused by throat injury.
Cases of epiglottitis have been substantially reduced since the introduction of H. influenzae type B vaccine, so it is important to enquire about the child’s immunisation history when they present with a stridor.

Question 27

how does epiglottitis present

Answer 27

usually develops quickly and gets rapidly worse, although in older children/adults it can develop over a few days.
Severe sore throat, dysphagia, drooling, stridor, difficulty breathing which can be relieved by leaning forwards, fever, irritability, hoarse voice,
The main symptoms of epiglottitis in young children are breathing difficulties, stridor and a hoarse voice.
In adults and older children, swallowing difficulties and drooling are the main symptoms.

Question 28

management of epiglottitis

Answer 28

do not to examine the airway as this can cause the airway to close entirely.
Firstly secure the airway, if supplemental oxygen isn’t adequate, then a supraglottic airway or tracheotomy may be used.
Once stable, imaging to assess swelling and blood tests to assess infection may be used.