6 - Community Paediatrics 1 Flashcards
Who does Jpal look like?
Perry the Platypus
What are some red flags for development?
What are some reasons for developmental variation?
- Late talking or walking (including bottom shuffling) may be familial
- Language development may seem delayed at first in children of bilingual families, but counting total words in both languages typically compensates for perceived delay
What are some correctable causes of slow development?
- Undernutrition (failure to thrive)
- Iron deficiency anaemia
- Social isolation of the family or maternal depression
- Hypothyroidism
What are some examples of behavioural problems?
- Poor sleeping
- Poor eating
- Soiling
- Over-activity and poor concentration
- Unusual, repetitive behaviours
- Disobedience, argumentative, labile mood
- Worries and fears
What factors affect the behaviour of children?
Individual
- Genetics
- Gender
Family
- Early attachment
- Family structure
- Parental style
- Domestic violence
- Parental mental illness
- Parental substance misuse
Environment
- Social class
- Abuse physical / emotional /sexual, Neglect
- Schools
What are some sleep problems in children?
- Refusal to go to bed
- Frequent night waking
- Parasomnias
- Chronic illness e.g asthma
How can sleep problems in children be managed?
What are some non-epileptic behaviours that can mimic epilepsy?
- Simple faint
- Breath holding spells
- Temper tantrums
- Hyperventilation
- Infantile colic
- Self stimulatory behaviours
What investigations need to be done for children with food refusal?
- History (feeding pattern, weaning, family eating etc.)
- Dental examination
- Abdominal examination for constipation
- Monitor growth against projected range
- Investigate for organic causes (check ferritin and FBC)
How can food refusal be managed in children?
- Social reinforcement (‘praise’) crucial
- Avoid coaxing & forcing
- Avoid using preferred foods as reward
“if mummy has to bribe me to eat this then it can’t be very nice” - Family mealtimes
- Encourage communal eating with peers
- Rejection of new foods can be overcome by repeated exposure to small quantities
What are some causes of soiling in children?
– Consider malabsorption, excessive fruit juice
– Faulty toilet training
– Neglect
– Other stressors
– Constipation with overflow diarrhoea
What is encopresis?
- Repeated passage of solid faeces in the wrong place in those >4yrs old
- It may be voluntary or non-voluntary
- Usually due to overflow in constipation, behavioural response to sexual abuse, learning disability
What investigations should you do if a child is soiling?
How can soiling in children be treated?
Constipation
- Escalating macrogol dose for impaction then maintenance dose
- Increase fluid, vegetable and fibre intake
- Regular toileting e.g after meals and before bed
- Rewarding e.g star charts
- Treat any perianal cellulitis with amoxicillin
May need some psychological input and investigation into social issues
What is the definition of enuresis and some causes of this?
Bedwetting at night after the age of 5 in girls and the age of 6 in boys
Secondary when been dry for 6 months but returns to bed-wetting
How can enuresis be managed?
- Urine dipstick and culture for UTI
- Treat any underlying constipation
- Check for diabetes
- Cut down fluids before bed
- Reward system for dry nights
- Do not punish
- Alarm
- Desmopressin sublingual dose (if >5yrs) at bedtime useful for sleepovers and school trips but relapse is common
What are some key points on managing childhood behaviour?
Positive reinforcement
What is the difference between conduct and oppositional defiant disorder?
SEE PSYCHIATRY NOTES
ODD is less severe and has emotion/mood disorders
Conduct disorder have limited pro-social emotions
What is the definition of a learning disability, including the classification?
- Lower intellectual ability (IQ<70)
- Impairment of social or adaptive functioning
- Started in childhood
What is the definition of the following types of learning disability:
- Dyslexia
- Dysgraphia
- Dyspraxia
- Auditory processing disorder
- Non-verbal learning disability
- Profound and multiple learning disability
What are some risk factors for learning disability?
- Family history
- Abuse and Neglect
- Genetic disorders such as Downs syndrome
- Antenatal problems, such as fetal alcohol syndrome and maternal infections
- Problems at birth, such as prematurity and HIE
- Problems in early childhood, such as meningitis
- Metabolic disorders e.g PKU, Homocystinuria
- Autism
- Epilepsy
- Lead exposure
What are some genetic conditions associated with learning disability?
- Tuberous sclerosis
- Downs syndrome
- Fragile X
How are learning disabilities managed?
- Exclude treatable cause is missed
- Other members of the family may need special support
- MDT
How do you communicate with a patient that has learning disabilities in the OSCE?
- Speak to patient first not their carer
- Involve patient in discussions
- Simplify information and give in small chunks
- Check understanding
- Always assume has capacity until proven otherwise
What are some causes of self-harm in children?
• expressing or coping with emotional distress
- trying to feel in control
- a way of punishing themselves
- relieving unbearable tension
- a cry for help
- a response to intrusive thoughts
What are some coping strategies that can be taught to children who self harm?
- adults can help build their self-esteem
- paint, draw or scribble in red ink
- hold an ice cube in hand until it melts
- write down negative feelings then rip the paper up
- wear an elastic band on your wrist and snap it every time feel the urge to self-harm
- listen to music
- punching or screaming into a pillow
- talk to friends or family
- take a bath or shower
- exercise
What is the prevalence of self-harm in teenagers?
10%
How can you decide whether a child who is self-harming is low-risk or high-risk?
What interventions are available when a child is self-harming?
Always develop a safety plan