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
The secret of child health:
- Know what the range of ______ is
- If in doubt, ______
normal
review
Part 2
Child health is _______
changing
Over time infant mortality has dropped
What are the Reasons for reduced mortality?
- Obstetric care
- Better housing
- Better nutrition
- Immunisations (Immunisations very important)
- ?Antibiotics? (Not sure how helpful antibiotics have been as they have caused a lot of harm)
- ?NHS?
what is the Impact of immunisations?
They are phenomenal
Once vaccination started, measles disappeared
Who delivers child health?
Emergency physicians
Neonatologists
Community paediatricians
Orthopaedic surgeons
Medical Paediatricians
Paediatric surgeons
General Practice
(Paediatricians are the peak of the iceberg)
Most delivered in house by family
Second by people in primary care
And right at the bottom is in patient facilities
What is the age range distribution? (of people presenting)
Predominantly under age of 2 years
What are the common acute medical problems in RACH today?
10 conditions that explain more than half of all acute referrals to hospitals in Aberdeen
Vast majority is infection and respiratory
How long are children admitted to RACH for?
Majority admitted for more than 24 hours
Number of children discharged on the same day they are admitted is now more than 50%
What did we do to acute admissions?
how has the Number of admissions changed?
(adjusted for population)
Graph demonstrates number of admissions to hospital over time
a lot more short admission
Severity of illness in Scotland affecting children hasn’t changed
how has duration of stay changed?
- Acute admissions typically < _ years old
- Typically _________
- _________ referrals
- Mostly _______ waiting
- No evidence of increasing _______:
- Health seeking behaviour
- Medical practitioner education
2
respiratory
Increasing
watchful (watchful waiting - assess child, oxygenation hydration and nutrition all quite normal, may have mild symptoms but we know with time they will resolve spontaneously)
severity
Key decision making in child health - what are osme key decisions?
- When is it normal? - GOR
- When to watch and wait? - Dilemmas!
- Simple solution….
The secret of child health - what are they?
- Know what the range of normal is
- If in doubt, review
How long will these symptoms last for?
Pattern recognition
Understanding _____ __ _______ allows you to understand what is ________
range of normal
abnormal
If abnormal then consider investigations and treatments
Four points to reflect on:
Children are not naturally healthy and need the right __________ to develop and thrive
What outcome? All child health outcomes are _____
Child health and wellbeing is influenced by non–___ policies e.g. housing, education, environmental etc
Children and young people (CYP) are the ______….adults, parents, workforce, carers, leaders
environment
linked
NHS
future
Get it right in children, reduce the burden of ______ later on in life
illness
- Health and well being of the child = H&W of the ____
- Intervene early! :
- ________
- __________
adult
Lifestyle
Resilience
Pulling it all together:
- Children are different to adults in many ways
- What is normal?
- Child health is ever changing
- How we manage children with acute illness - Watchful waiting
- Early origins of disease
