Child health Flashcards
what is helf
not us
what is a child
us
how much skin to skin does orla need
a lot
what causes stridor
congenital
laryngitis, EPIGLOTTITIS, croup, anaphylaxis, bacterial traceitis
tumours, trauma
what are the features of croup
6 months to 6 years
1/2 days of illness before then suddenly struggle to breath
stridor, barking cough, hoarseness, WOB
what is the treatment for croup
keep child calm to maintain airway avoid all unnecessary exams and procedures if mild (minimal stridor/ WOB, no cyanosis) oral dexamethasone/ prednisolone at home if mod/ severe: restless, cyanosis, recession, stridor at rest, increased HH and RR, tired/ reduced conscious level) admit, steroids, nebulised adrenaline
what causes croup
parainfluenza, RSV
what causes epiglottitis
haemophilus influenza B, group A strep, trauma, inhalation, burns
what are the features of epiglottitis
present with fever, severe sore throat and stridor, difficulty swallowing, muffled voice, drooling
thumbprint sign on x ray
what is the treatment for epiglottitis
get senior help asap, anaesthetist
secure airway
IV antibiotics (ceftriaxone)
steroids
what should’nt you do in suspected epiglotttitis
examine throat
what are the features of bronchiolitis
children <1
coryza preceeds wheeze, resp crackles, apnoea, recession
tx for bronchioitis
if apnoeic episodes, not feeding/ drinking, resp distress then admit. lower threshold for admission if premature, CF, downs syndrome, congenital cardiac disease, underlying health problem
supportive: O2, CPAP, NG feeds
palivizumab prevention for vulnerable
what causes bronchiolitis
RSV
what causes whooping cough
pertussis
what are the signs of whooping cough
apnoea, coughing bouts that end in vomiting, worse at night / after feeds
infants + >14s
lymphoctyosis
admit if <6
what are acute paediatric red flags
pale/mottles/ashen/ blue skin
no response to social clues, weak/high pitched/ continuous cry
grunting, tachypnoea, moderate-severe chest indrawing
reduced skin turgor
age <3 with temp >38
non blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal neuro signs, focal seizures
when is the peak age for bronchiolitis
3-6 months
most occur under 2
when should pneumonia be considered
if high fever and persistently focal crackles
when should you consider asthma or VIW instead of bronchiolitis
if persistent wheeze without crackles
recurrent episodic wheeze
personal/ fmaily history of atopy
do you use adrenaline to treat bronchiolitis
NO (is a lower airway problem, adrenaline for croup)
acute asthma and viral wheeze tx
OSHIPMAN oxygen salbutamol and ipatropium nebulised oral pred/ IV hydrocortisone neb/ IV magnsium sulphate aminophylline if unresponsive
what causes a fixed splitting of the second heart sound
ASD
what causes the murmur in TOF
pulmonary stenosis (ejection systolic at pulmonary area)
what causes a pan systolic mumur in children
MR
TR
VSD
is a murmur that is louder or quieter on standing more worrying
louder more worrying
is a diastolic or systolic murmur more worrying in childhood
diastolic
what causes a continuous cres-decresc machinery murmur
PDA
what are the causes of cyanotic heart disease
(right to left shunts)
ASD, VSD, PDA, transposition of the great arteries
what are the duct dependent CHDs
TOF Epsteins Pulmonary stenosis transposition of the great arteries (if no VSD or ASD) coartaction of the aorta critical AS hypoplastic left heart syndrome pulomary atresia and critical stenosis
what are the cyanotic CHDs
VSD TOF ASD PDA transposition of the great arteries
why do cyanotic CHD cause cyanosis
right to left shunt cause deoxygenated blood to enter circulation (initially in ASD, VSD, PDA will be left to right shunt that causes pulmonary hypertension which then results in right to left shunt)
what is a potential neuro complication from ASD
stroke following DVT
what murmurs in ASD and VSD
ASD- mid systolic upper sternal border
VSD- pan systolic and lower sternal border
what can plethoric complexion be a sign of
polycythaemia due to chronic hypoxia e.g. in VSD
what are the components of TOF
RVH
pulmonary stenosis (worsens r-l shunt through VSD)
VSD
overiding aorta (above VSD, worsens odeoxygenated blood in circulation- R-l shunt)
tx for transposition of the great arteries
prostaglandins and balloon septosptomy until open heart surgery
what are the general red flags for development
regression
occipital frontal circumference >98th or <0.4th centile
squint
marked hyper/ hypotonia
differences between left and right strength, movement or tone
no/ limited eye contact
lack of response to sound or visual stimuli
strong parental concerns
if there is delay in more than one domain is it more or less likely to be significant
more likely
what is the most variable developmental domain
speech and language (sensitive to environmental factors)
what are the developmental red flags at 6 weeks
no visual fixation/following failure to respond to sound asymmetrical neonatal reflexes excessive head lag failure to smile
what are the developmental red flags at 6-8 months
hand preference (too early), fisting not reaching persistence of primitive reflexes floppy, poor head control lack of social response/ vocalisation
developmental red flags at 12 months
unable to sit or bear weight
absence of saving reactions (parachute reflex)
persistence of hand regard (seen in 3-5 months, when baby on back will watch hands)
poor communication
no babble
what are the developmental red flags at 18 months
not walking cannot understand simple commands no pointing no words no pincer grip
red flag developmental points at 2 years
not running
cant follow a 2 step command
unable to speak 2-3 words
when are all primitive reflexes usually lost
by 12 months
what questions can you ask in a history to determine sensory issues in children
what foods do they eat, restrictive diet
bathing/ hair washing/ hair cutting
noise sensitivities
clothing, dislike of materials
when does a hand preference usually develop
between 2-4 years
when should you not do a LP if you suspect meningitis
if signs of raised ICP (bradycardia, hypertension, low RR= cushings response, pupil dilation, abnormal breathing pattern or posture)
GCS min seizure
imaging showing CSF path obstruction
circulatory shock/ meningococcal disease
is an absence seizure generalised or focal
generalised
is a myotonic seizure focal or generalised
generalised
treatment for status epilepticus
5 mins IV lorazepan/ buccal medazolam/ rectal diazepam
10 mins repeat dose
20 mins pheynotoin/ phenobarbitol if alread on regular phentoin
call anaesthetist
what is the risk with carbamazepine
agranulocytosis
what is the risk of prescribing sodium valproate and carbamazepine to girls
teratogenicity
treatment for focal seizures
carbemazepin or lamotrigine
what anti seizure medications impair effectiveness of OCP
carbamazepine, oxcarbazepine, phenytoin and topiramate
treatment for tonic clonic
valproate
lamotrigine 2nd line
treatment for absence seizures
ethosuzimide or sodium valproate
describe thrombotic thrombocytopenic purpura
haemolytic anaemia and thrombocytopenia
non specific symptoms- fever, renal failure, neuro chanes
describe ITP
immune thrombocytopenia
preceeding viral illness, lower limb petichiae, bruising, mucosal bleeding
treated with steroids. IV immunoglobulin
describe HUS
microangiopahtic haemolytic anaemia, thrombocytopenia and AKI
following ecoli bloody diarrhoea
abdo pain, fever, swelling
describe HSP
IGA vasculitis
purpuric rash, abdo pain, arthritis/arthalgia, glomerulonephritis
treatment for whooping cough
supportive
arthromycin/ clarithromycin
notifiable disease
what are the features of pyloric stenosis
projectile vomiting after feeding in first few weeks of life olive mass in upper abdomen hypochloric metabolic alkalosis USS laparoscopic pyloromyotomy
signs of biliary atresia
jaundice for >14 days, >21 if premature
features of hirschprungs
absence of parasympathetic ganglions
>24hrs to pass meconium, chronic constipation from birth, abdo pain and distention, vomiting, poor weight gain and failure to thrive
need resus and surgery
features of intussusception
6 months to 2 years severe colicky pain vomiting yellow then green recurrent jelly stool sausage shaped mass preceded by viral upper resp infection USS- target sign air enema
features of volvulus
baby
bilious vomiting obstruction (malrotation with volvulus) until proven otherwise
what vaccinations should kids have had by 1 year
2x DTaP/IPV (polio)/HiB/ HepB
2x Men B
2x rotavirus
pneumococcal (PCV)
at 12 months get HiB/MenC, PCV booster, MMR, MenB booster
flu if eligible
what vaccinations at 3 years 4 months
dTaP/IPV
MMR
what vaccinations at 12-13
HPV
what vaccinations at 14
Td/IPV
menACWY
what vaccines for adults
65- pneumococcal
flu annual
70-70 shingles
when do you get head control
2-3 months
when can you sit without support
6 months
when can you crawl and cruise
9 months
when should you follow something by turning head
6 weeks (limit 3 months)
when should you reach for toys and have a palmar grasp
4 months (limit 6)
when should you transfer hands between toys
9 months
when should you have a pincer grip
10 months (limit 12)
what ages should you be draw: line, circle, square, triangle
line 2
circle 3
square 4
triangle 5
what ages should you laugh, turn to sound, polysyllabic babble, mama dada, 6-10 words, phrases, 3-4 word sentences
laugh 3-4 months turn to sound 7 months mama-dada 7-10 12- 5 words 18 months 6-10 phrases (2-3 words) 2 years short sentences 3 years
limit for symbolic play
2 years
when should you be able to drink from a cup
12 months
when should you be able to use spoon by seld
18 months
limit for social smile
8 weeks
