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
Difference when looking at blood pressure in newborns compared to adults
Look at mean not diastolic/systolic. Should be > weeks of gestation. Term baby should have 40 mean BP
What is vermix?
‘Yellow cheese’ Helps waterproof baby in utero. Greasy but keeps baby warm. Only seen in preterm babies as disappears by term.
What is surfactant?
Lines alveoli to lower surface tension and allow newborn to breathe more easily. Can inactivate if baby is cold.
Why are metabolic adaptations needed in newborns?
In utero - constant sugar supply from mother but halt at birth at the same time as demands increase. Newborn has to adapt to feed/fast cycles
What to check if concerns over childs height (tall or short)
Parents height
Thyroid hormones
Bone age
If younger - check growth hormones - might be lacking.
If older - something added. Likely sex hormone issue.
Much more likely to be chronic disease in short stature than hormone issues.
What is MCAD?
Metabolic disease where baby cannot breakdown nutrients for energy. Need to supply constant sugar or will die.
Average birth weight
3.5kg
Average birth length
50cm
Average head circumference
35cm
Average newborn temperature
36.5-37 celcius
Example of genetic disorder with mitochondrial inheritance
Leber’s hereditary optic neuropathy
Newborn respiratory rate
40-60 min. Review if persistently >60
Normal blood pressure in a newborn
65/40mmHg
What is periodic breathing and when does it occur
Regular respiration but with successive periods of apnoea. Usually occurs while sleeping.
Occurs in 5% healthy term babies.
Difference when looking at blood pressure in newborns compared to adults
Look at mean not diastolic/systolic. Should be > weeks of gestation. Term baby should have 40 mean BP
What is meconium? When to be concerned if hasn’t occurred.
First bowel movement. Should pass in 1st 24 hours. If not find out why.
What is physiological jaundice?
Jaundice appearing day 2-3 of life (peaks day 5, resolved by day 14). 10% require phototherapy. If severe and untreated can result in brain damage due to bilirubin deposits in brain.
What is a morphogen gradient and what is its importance in embryology?
Some cells secrete a morphogen which diffuses across the cells creating a gradient. The gradient of the morphogen tells cells where they are in the embryo and dictates how they develop.
What to check if concerns over childs height (tall or short)
Parents height
Thyroid hormones
Bone age
If younger - check growth hormones - might be lacking.
If older - something added. Likely sex hormone issue.
Much more likely to be chronic disease in short stature than hormone issues.
First pubertal change in girls
Breast budding. 9-13yrs
First pubertal change in boys
Increase in testicular volume
Precocious puberty
Girls - Any sign of puberty
Delayed puberty
No sign of puberty before 13yrs-girls 14yrs-boys
Staging of puberty
Tanner staging - based on Breast development Pubic hair penile growth Testicular sizing
Example of genetic disorder with mitochondrial inheritance
Leber’s hereditary optic neuropathy
In embryology - what is the embryonic period?
Fertilisation to end of week 8. Almost all structures of body laid down during this time.
In embryology - What is the foetal period?
End embryonic period to birth
What is classed as a premature birth?
Birth that occurs >3 weeks before due date.
Prior to week 35/38 (clinically 37/40)
What is growth by proliferation
Increase in cell number
What is growth by hypertrophy
Increase in cell size
What is growth by accretion
Increase in extracellular material
What is a morphogen gradient and what is its importance in embryology?
Some cells secrete a morphogen which diffuses across the cells creating a gradient. The gradient of the morphogen tells cells where they are in the embryo and dictates how they develop.
What is morphogenesis?
Generation of form.
What occurs in embryological development on day 0
Fertilisation. Ovum released from ovary - 24hr lifespan. Fertilised as travels along fallopian tube.
What occurs in embryological development on day 1
Zygote - new genetic individual.
What occurs in embryological development on day 2
Cells divide into smaller cells (Blastomeres) - overall cell mass does not increase.
What occurs in embryological development on day 4
Morula - ball of >16 cells. Organisation starts to occur - the cells in the middle of the morula will form the embryo while those at the edges form the placenta
What occurs in embryological development on day 5
Blastocyst/Blastula (sphere of cells with fluid filled central cavity) moves to uterus.
What occurs in embryological development on day 6
Start of implantation. Blastocyst ‘rolls’ so cells that will become the embryo are on the side of the blastocyst closest to the epithelium of the uterus.
What occurs in embryological development on day 7
Cells of embryoblast organise into 2 layers - epiblast and hypoblast. Cells of trophoblast begin to invade epithelial cell wall
What occurs in embryological development on day 8
Formation of syncytiotrophoblast. A large single cell with a loose plasma membrane. Cells of epiblast form the bilaminar embryonic disc - will be the embryo.
What occurs in embryological development on day 9
Primary yolk sac develops to support embryo until yolk sac is in place. Uterine blood supply to embryo begins to develop.
What occurs in embryological development on day 12
Uterine epithelium completely surrounds embryo. May lose clot of blood as closes - often mistaken for a light period so can affect dating of pregnancy.
What occurs in embryological development on day 13
Embryo tiny - most development to this point has been the development of supporting structures.
What occurs in embryological development on day 14
Human chorionic gonadotrophin (HCG) produced. Signals to ovary that pregnancy has occurred so progesterone will continue to be produced to retain endometrium.
What occurs in embryological development on day 15
Some cells migrate to midline. Form primitive streak (grove) with primitive node located at one end.
What occurs in embryological development on day 17
Gastrulation - layers of embryo form. All cells of body originate from one of these 3 layers
What develops from the embryological ectoderm
Mostly everything external.
What develops from the embryological mesoderm
Muscle, connective tissue - pretty much everything
What develops from the embryological endoderm
Internal external surfaces of body - e.g. epithelia of respiratory tract.
