Child health assessment Flashcards
Which antibodies cross the placenta from mother to child?
Maternal IgG can cross the placenta
At term, the concentration of IgG in the fetal blood is higher than that of the mother
The half life of the IgG is only several weeks
By what age will most of the maternal antibodies have disappeared from the fetal circulation?
Most of these antibodies will have disappeared from the circulation by 4-5 months
What does colostrum contain? (and what is colustrum)
Colustrum is secreted by the breast during the first few days of lactation
Contains ten times more protein than milk produced later in lactation
Protein is mostly in the form of IgA!!!
What does breast milk contain?
IgA, macrophages, lymphocytes and complement
Atopy is characterised by high levels of…
IgE
Name three types of lymphocyte
B cells
T cells
Natural killer cells
What is stridor
-is stridor an inspiratory or expiratory noise?
Stridor refers to the harsh monophonic noise from the upper airway during INSPIRATION
The correct name for croup?
Laryngotracheobronchitis
Organism which causes croup
Parainfluenza
Do children maintain their oxygen saturations in croup?
Yes - oxygen levels may be falsely reassuring
the upper airway problem does not affect gaseous exchange at an alveolar level
Which bacteria causes epiglottitis?
H. influenzae
Is MMR contraindicated in children who are allergic to eggs?
No, fire away
(for children who have had anaphylactic shock to eggs, seek specialist advice and give vaccination uner controlled conditions)
When would illness stop you giving the MMR?
If child has had minor illness without fever or systemic upset then it is fine to give the vaccine.
If child has had acute febrile illness then don’t give vaccine.
(let them recover first)
- this is so they don’t blame the vaccine on the symptoms
Where is the MMR vaccine given?
Given by IM injection into the outer aspect of the thigh
Why would you not give an injection in the bum?
Incase you damaged the sciatic nerve
How old is a neonate?
A neonate is a child who is less than one month old
How old is an infant?
An infant is a child up to the age of 12 months
What is cryptorchidism?
Hidden testis (i.e. abdominal testis)
Which structure allows fluid to enter the scrotum? and what does this result in?
A patent processus vaginalis allows fluid to enter the scrotum from the peritoneal cavity
Results in a hydrocele
- varies in size but usually resolves by age 2
- Transillumination is not absolutely diagnostic since children’s tissues contain a high percentage of fluid and transilluminate easily
Reduced blood flow on doppler
Testicular torsion
Increased blood flow on doppler
Epidymo-orchitis
What causes epidymo-orchitis?
Usually a result of trauma
How do you classify obesity in children?
Based on BMI percentile rather than number
A BMI percentile >95th is considered obese
(BMI percentile takes into account the physical changing shape of children as they grow)
Are most obese children short or tall?
Most obese children are tall, this is as a result of increased caloric intake during the growing years
What does a short obese child suggest?
Suggests an endocrine aetiology, which would require invesitgation
Has an increased energy intake or a decreased energy expenditure caused modern levels of obesity?
Generally people are actually eating less, they’re just not doing nearly as much
BUT –> excessive energy intake is responsible for most cases of childhood obesity
Pertussis immunisation protects against which disease?
Whooping cough
Pneumococcal vaccine protects against which disease?
Meningitis
Which vaccine would protect against epiglottitis?
Haemophilus inflenza b (Hib)
What causes epiglottitis?
Haemophilus infleunza b
What is failure to thrive?
Failure to thrive, or faltering growth, describes an infant or child who does not gain weight or height at the expected rate for his or her age
What might cause failure to thrive or faltering growth?
Increased metabolic demands of chronic disease or malabsoprtion
Commonest cause of anaemia worldwide?
Iron deficiency anaemia is the commonest cause of anaemia in children worldwide
i.e. main cause is dietary
Principle sign of anaemia in children
Pallor
When do signs and symptoms of cardiopulmonary decompensation occur in anaemia?
Occur when haemoglobin has decreased below 6g/dl
Why might you see irritability, behavioural changes and mood swings in iron deficiency anaemia?
Thought to be related to the malfunction of cellular enzymes dependent on iron
Hallmark of iron deficiency anaemia?
Hypochromic microcytic blood film
Ferritin levels in iron deficiency?
BUT WHY SHOULD YOU BE CAREFUL MEASURING THESE
Decreased
BUT ferritin is an acute phase protein so should be interpreted with caution - may be artificially high in children who are unwell
(i.e. might have normal/high levels if child is ill which means you might miss iron deficiency anaemia)
Why is iron deficiency anaemia bad?
Has bad effect of neurodevelopment
Which countries are thalassaemias more common?
More common in children of Asian, Middle east and south east asian descent
Sign of elbow fracture on x-ray
visible posterior fat pad
A child has unusual bruising, what do you need to investigate them for?
Investigate for thrombocytopenia, leukaemia, non-accidental injury
Uses toys meaningfully, like cup and spoon
2 years
Walks and runs without falling, kicks a ball
2 years
Names 3-5 pictures or objects, joins 2 words together
2 years
Builds a tower of 5 or 6 cubes, imitates a straight line, turns pages singularly
2 years
The average age for walking in boys and girls
girls - 13 months
boys - 14.5 months
(walking - taking two consecutive steps)
When should most children be able to walk by?
By 18 months, if not then refer
When does duchenne muscular dystrophy present?
And which inheritance pattern?
Begin to walk in second half of second year
Autosomal recessive
Gower’s sign
Duchenne muscular dystrophy
What does breastmilk contain?
Contains IgA, lymphocytes, macrophages and complement
