Children are not Small Adults Flashcards
What is a child?
- There is no single law that defines the age of a child across the UK
- UN definition, adopted by the UK in 1991 - “every human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier.”
(Up to and not including the 18th birthday)
Locally (aberdeen) - what is a child and who do we look after?
- Paediatrics <16 (Upto and not including 16th birthday for new presentations)
- Learning disabilities <25
- Rarely 20-30 year olds in RACH (small stature people as need a small endoscope to look after these people)
Why are children not small adults? - what is different?
- Physical
- Physiological
- Psychological
- Pathologies
Physical differences in child comapred to adults?
Smaller but disproportionate
Look at arm and head length - Cant touch top of head when born, Easier to lose heat with big head
When is growth normal?
Find yourself a growth trajectory and keep to it
Median in middle and 2/3 of a standard deviation above and below
95% of population lie between 2 standard deviations above and below
what is normal and not on a growth chart?
FTT – failure to thrive
To detect abnormal growth you need 2 points to compare growth
how do you interperate BMI?
Almost impossible to interoperate a BMI without converting it to a sentile score
Physiological differences -
- Not just different size
- Different ________
physiology
What are the Physiological differences?
Physiological differences:
what is Ketotic hypoglycaemia?
- 6-7am hypoglycaemic episode
- 1-2 year old
- Skinny
- Intercurrent illness
Brought in early in morning unarousable
Body used up glycogen reserve and started to break down fat reserve
Management – recognise, manage, slow release starchy meal before bed like porridge
Don’t get this in adults
Physiological differences:
how is pulse, respiratory rate and blood pressure different in children?
- Faster pulse, respiratory rate
- Lower blood pressure - Maintained until very shocked
Maintain BP much better than they do in adults
Maintain blood pressure by increasing HR until BP drops profoundly
what is the immune system like in children?
- Trust nature
- Immune system remarkably robust!
- MMR, unconjugated pneumococcal vaccine
- Need to have infection before become immune
Not fair to say they have a weak immune system
That’s why they have so many infections when they are young. When born we gave a dolup of passive immunity and these were antibodies lasting 6 months and then weayed and then start to pick up infections and then become immune to an awful lot more things
Expected for children to have coughs, cold, vomiting illnesses
If child has had chicken pox and cleared it they have a fine immune system as it tests both the humeral and cellular components of the immune system
Development - at birth how are childrne different to adults?
- Unable to walk
- Unable to speak
- Doubly incontinent
- Free GOR
- When is THIS normal? (In adult this is not normal)
- Understanding range of normal
Pathological differences - Some conditions not seen in adults
- Abdominal migraine
- Bronchiolitis
- Bronchopulmonary dysplasia
- Croup
- Enuresis
- Febrile convulsion
- Glue ear
- Intraventricular haemorrhage
- Necrotising enterocolitis
- Non accidental injury
- Sudden unexplained death of infants
- Toddler’s diarrhoea
- Vesico-ureteric reflux
- Viral induced wheeze
what are some Chronic conditions with childhood onset?
- Asthma (COPD)
- Autism
- Cerebral palsy
- Cystic fibrosis
- Gastroschisis
- Hirschsprungs disease
- Spina bifida
- Many others (?dementia)
Evidence that dementia does have origins in childhood