Children are not Young Adults Flashcards
What are the physiologicaldifferences
Large SA: volume = more cold
Reduced metabolic reserves = hypoglycaemia and dehydration
Smaller target = greater amount of energy absorbed
Large head = easily injured
Smaller mass = drug dose and fluid differ
Skeleton not calcified = deforms and less protection
Less elastic tissue =degloving
Less type 1 respiratory fibres
What is the most common form of hypoglycaemia in <5
Ketotic hypoglycaemia
Common in skinny 1-2 y/o with intercurrent illness
What are CVS differences in children
Faster pulse (110-160) Faster RR (30-40) Lower BP - can maintain until very shocked (60-70) Sats threshold <92% Smaller circulating volume SV increases as increase size Pulmonary resistance decreases as get older Systemic resistance increases
What are conditions that are not seen in adults
Abdominal migraine Bronchiolitis Croup Febrile convulsion Glue ear Intraventricular haemorrhage Toddler diarrhoea VUJ reflux Viral induced wheeze NAI Sudden unexplained death of infants
What are chronic conditions with childhood onset
Asthma Autism Cerebral palsy CF Gastroschisis Hirschsprung Spina bifida
What accounts for reduced mortality in children
Obstetric care Better housing Better nutrition Immunisations Antibiotics NHS
Who most commonly presents to inpatient and how long do they stay
<2 years
Respiratory
<48 hours
What are other causes of acute admission
Acute LRTI Asthma Bronchiolitis Croup Febrile convulsion Fever Gasrtoenteritis URTI Vomiting Wheeze
What are the most common treatmnet
Watchful waiting Ax Prednisolone Salbutamol Dexamethasone
What is decreased birthweight associated with
Impaired glucose tolerance / DM Hypertension CHD Stroke Renal failure Asthma
How does metabolism differ in children
Brown fat
Immature shivering
Hypoglycaemia as little glycogen stores which exacerbates hypothermia
How do you assess paed
ABCDE
When do you start oxygen / neb
Sats <92%
What do you do for viral wheeze
SABA
What do you do if child deteriorates
ABCDE IV access Fluid Increase O2 Nebulised SABA / steroid ABG CXR
What are respiratory differences
RR higher Higher O2 requirement Smaller airway Diaphragmatic / accessory muscles to breath Easily fatigued Soft bones = compliant chest wall so indrawing and recession Less type 1 respiratory fibres Can tolerate lower sats
Airway differences in babies
Large head to body Large tongue Large adenoids Nasal breather so obstruct easily Narrow airway Short neck
Differences between adult and children bone
Children have growth plate (physic) which is metabolically active cancellous bone
Some bones are still cartilage - patella / tibia / fibula
Ligaments stronger than cartilage
Young bone more porous and tolerate defomration
Less protection of internal organs
What are absorption changes in children
Reduced gastric acid
Reduced gastric emptying
Delayed IV
Increased through skin
What are distribution changes
CHldren have high ECF / TBW
Low fat
Low plasma protein so more active drgu
BBB not fully developed
What are elimination changes
Immature liver metabolism so increased half life
Decreased renal
What increases sensitivity
Fever
Dehydration
Acidosis
What are problems in adolescent
Changes in hormone secretion
Change in growth and body weight
Non-compliance
Ilicit and legal drugs used
What are problems in prescribing
Effect on growth and development not known Lack of studies on efficacy / toxicity Lack of SPS information More sensitive Greater variation Increased risk of ADR
