108 - The Normal Child Flashcards
How common are heart murmurs?
Very - 50% all children. Mostly innocent. Only 0.8% incidence of congenital heart disease
How common are heart murmurs?
Very - 50% all children. Mostly innocent. Only 0.8% incidence of congenital heart disease
When is an innocent murmur loudest
When baby is lying down.
What age is a neonate
Birth-1 month
What age is a toddler
1-2yrs
What age is an infant
1 month - 1 year
What age is a pre-school child
2-5yrs
What is important to check for when considering a serious illness
Growth - if a child is growing well then it is unlikely to be a serious, chronic condition.
How to check for growth in children
Measure weight, height and head circumference
In babies - what additional body parts should always be examined
Genitals, hips, femoral pulses.
Define birth
Movement from in-utero to ex-utero environment. Traumatic change that requires respiratory, circulatory, thermal and nutritional adaptations.
Why important to check SATs of newborns?
50% children with significant structural cardiac abnormalities are not prenatally detected. If abnormal - ECG.
In newborn babies - always consider
Infection.
e.g. Group B Strep. 1/4 women infected. 1/1000 children of +ve mothers die.
2 key structural differences in foetal circulatory system.
Ductus arteriosus - aorta and pulmonary artery linked in foetus to bypass lungs. Closes at birth to become ligament arteriosum.
Foramen ovale - Hole in septum between right and left atria to allow blood to shunt past pulmonary circulation.
2 key structural differences in foetal circulatory system.
Ductus arteriosus - aorta and pulmonary artery linked in foetus to bypass lungs. Closes at birth to become ligament arteriosum.
Foramen ovale - Hole in septum between right and left atria to allow blood to shunt past pulmonary circulation.
When is an innocent murmur loudest
When baby is lying down.
What is important to check for when considering a serious illness
Growth - if a child is growing well then it is unlikely to be a serious, chronic condition.
How to check for growth in children
Measure weight, height and head circumference
Most important thing to do before resuscitating a newborn.
Get it dry and warm. Will not resuscitate a cold, wet baby.
Put a hat on it - 30% babies heat lost through head as large.
Define birth
Movement from in-utero to ex-utero environment. Traumatic change that requires respiratory, circulatory, thermal and nutritional adaptations.
Why important to check SATs of newborns?
50% children with significant structural cardiac abnormalities are not prenatally detected. If abnormal - ECG.
In newborn babies - always consider
Infection.
e.g. Group B Strep. 1/4 women infected. 1/1000 children of +ve mothers die.
Why is foetal circulation different to newborn?
Foetus gets O2 from placenta but newborn has to get from lungs. Most of circulation work done in right side of heart in foetus compared to left in newborn.
2 key structural differences in foetal circulatory system.
Ductus arteriosus - aorta and pulmonary artery linked in foetus to bypass lungs. Closes at birth to become ligament arteriosum.
Foramen ovale - Hole in septum between right and left atria to allow blood to shunt past pulmonary circulation.
Changes at birth:
What happens when infant takes first breath.
Lungs fill with air, fluid cleared from lungs.
Changes at birth:
What happens when lungs fill with air for the first time?
Pulmonary capillaries absorb O2, pulmonary arterioles dilate and blood flows into the pulmonary vascular system.
What closes the ductus arteriosum?
Smooth muscle contracts in response to O2. Closes ductus arteriosus which fibroses over.
What closes the foramen ovale?
Pressure changes in the heart as blood starts coming from the lungs instead of the placenta.
What does a blue baby at birth indicate
Nothing. Only 60% O2 in utero so normal to be blue.
What does a white baby at birth indicate.
Bad sign - can indicate mother has had a haemorrhage.
When do congenital cardiac abnormalities present?
May not be at birth as ductus arteriosum doesn’t close fully until day 5.
Problems with providing O2 for newborns
Can cause blindness if [O2] too high