An approach to assessing children

Question 1

What is a childs weight measured in?

Answer 1

Kilograms (Kg) and grams (g)

Question 2

How much weight should a baby gain per week in the first 6 months?

Answer 2

150(100)-200g / week

Question 3

What are childs feed volumes measured in?

Answer 3

Millilitres (ml)

Question 4

How much feed should a baby take?

Answer 4

140-180ml/kg/day (100ml/kg/day if ill)

Question 5

Questions to ask about faeces

Answer 5

Nappies vs independent toileting 
Frequency (per day, week or even month) 
size, shape, appearance and consistency 
Difficulties passing
Blood or mucus seen 
Bristol stool chart

Question 6

What parts of a parents life can impact on a childs health?

Answer 6

smoking
alcohol 
drugs
occupation 
stress

Question 7

What do you have to be in examining children/babies?

Answer 7

Opportunistic

Question 8

Features of examining babies / children

Answer 8

Observe first
be friendly and smile
speak to the child (even if they are weeks old)
be careful moving them - keep parents close and try best to examine them when they are there
Gentle handling and gradual exposure
show interest in their toys and play

Question 9

What general features are you looking for?

Answer 9

Appearance
Play
Interaction
Obs

Question 10

What resp features are you looking for?

Answer 10

effort
noise
rate
recession 
O2
nebs

Question 11

What CVS features are you looking for?

Answer 11

Colour

Perfusion

Question 12

What GI features are you looking for?

Answer 12

Feeding
vomit
abdo distention / movement

Question 13

What neuro features are you looking for?

Answer 13

Alertness
interaction
play
posture

Question 14

What MSK features are you looking for?

Answer 14

Mobility
limb movements
posture
splints 
mobility aids

Question 15

What are you looking at on the childs hands and arms?

Answer 15

Warmth 
cap refill 
radial / brachial pulses (rate / rhythm)
clubbing
nail changes 
hand skills
pen marks

Question 16

What are you looking at on the childs head and face?

Answer 16

Eyes (jaundice)
lips (colour, moisture)
tongue
nose
scalp changes
bruises
rashes
fontanel

Question 17

What are you looking for on a childs neck?

Answer 17

Rashes and nodes

Tracheal tug

Question 18

What are you looking for on a childs chest and back?

Answer 18

Murmurs
apex beat
thrills 
chest expansion 
breath sounds
percussion 
resonance and fremitus 
rashes and skin marks 
spine alignment, deformity, sacral dimples

Question 19

What are you looking for on a childs abdomen and groin?

Answer 19

Tenderness
masses (esp stool)
organomegaly 
bowel sounds and bruits (v rare)
femoral pulses (essential in infants)
hernias and testis 
genital / anal appearance

Question 20

What are you looking for on legs and feet on children?

Answer 20

Mobility
changing posture
tone 
reflexes, plantars, clonus 
power
coordination 
sensory assessment if older 
pulses
warmth
cap refill 
colour 
mottling 
rashes, bruises, marks
deformity and gait

Question 21

Differentials for fever and cough

Answer 21

LRTI/URTI
Bronchiolitis
Viral induced wheeze
Viral croup

Question 22

Causes of fever with rigors

Answer 22

UTI

Pyelonephritis

Question 23

What should be asked in the antenatal history?

Answer 23

Rheus status
Screening
- syphilis
- HIV
- Hep B
- varicella
- measles
Scans
- 12 weeks
- 20 weeks

Question 24

How many weeks on is the anomaly scan done?

Answer 24

20 weeks

Question 25

Examples of congenital infections

Answer 25

CMV HIV Herpes Hepatitis

Question 26

What does PET lead to in infants?

Answer 26

Placental insufficiency which leads to growth restriction

Question 27

What should be asked in the birth history?

Answer 27

``` Mode of delivery How was the labour? - IOL - Hormones Gestation Complications ```

Question 28

What are the risk factors for sepsis after labour?

Answer 28

GBS Prolonged ROM Intrapartum pyrexia

Question 29

What post natal history should be taken?

Answer 29

``` Birth weight Feeding - how much - what method Passage of meconium ```

Question 30

When should meconium be passed by?

Answer 30

Within 24 hours

Question 31

Causes of unpassed meconium

Answer 31

CF No formed anus Hersprungs disease

Question 32

What is hirspringus disease?

Answer 32

Absence of ganglionic cells in rectum/sigmoid

Question 33

What age are solids introduced?

Answer 33

6 months

Question 34

What age do you get the MMR vaccine?

Answer 34

13 months

Question 35

What is the first vaccine babies receive, at what age and how many doses are given?

Answer 35

5 in 1 2 months old 3 doses at 1 month intervals

Question 36

What are the 4 forms of abuse?

Answer 36

Physical Neglect Sexual Emotional

Question 37

Causes of rashes in children

Answer 37

``` Molluscum contagiousum Slap cheek HFM disease Eczema Chicken pox Non blanching rash (meningococcus) Viral ```

Question 38

What is the 1st milestone?

Answer 38

Holding head

Question 39

What metabolic changes occur in vomiting?

Answer 39

Metabolic alkalosis Hypocholaraemia Hypokalaemia

Question 40

What is the treatment of pyloric stenosis?

Answer 40

Ramsteds pyloromyotomy

Question 41

What is used to look at a childs growth?

Answer 41

Percentiles

Question 42

What does FTT stand for?

Answer 42

Failure to thrive

Question 43

Definition of FTT

Answer 43

Failure to be on an expected weight/height trajectory

Question 44

What centiles are found on a percentile growth chart?

Answer 44

``` 50 25 / 75 99.6 / 0,4 9 / 91 98 / 2 ```