Children (differences from adults) & general Flashcards
What is the definition of 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 18 unless, under the law applicable to the child, majority is attained earlier’
What aspects make a child not an adult?
- Physical-smaller but disproportionate (arm & head length)-
- Physiological
- Psychological
- Pathologies
When is growth normal?
On growth charts-each line corresponds to certain number of thirds of a standard deviation above and below the mean
95% of the population lie between 2nd & 9th
Trajectory of growth
To detect abnormal growth need at least 2 measurements plotted
Do you use BMI in children?
Do not use absolute BMI
Impossible to interpret a BMI without converting it to a centile score
What are the physiological difference between child and adult?
Surface area:volume
% water content (more water content)
Metabolic reserves (less sugar stores)
Children more easily get cold, dehydrated and hypoglycaemic
What is ketotic hypoglycaemia?
Most common form of hypoglycaemia in children between 18 months to 5 years of age
How does ketotic hypoglycaemia present?
- 6-7am hypoglycaemic episode
- 1-2 year old
- Skinny
- Intercurrent illness (used up glycogen reserves in their liver & their muscle-now breaking down fat stores-produces ketones)
The management of this is to recognize it, to diagnose it,
and when these children are ill, they need a slow-release,
starchy meal before they go to bed, such as porridge.
Describe child’s pulse, RR, & BP in comparison to adults?
Faster pulse & RR
Lower BP-maintained until very shocked
How is a child’s immune system different?
- Need some vaxes at a later stage (after 12 months of age)-MMR, unconjugated pneumococcal vax
- Need to have infection before immune (e.g. chickenpox)
- Abs from mother wean at about 4-6 months - between then and 5 years is when children have lots of infections
Why is chicken pox a good test to see if immune system is fine?
Chicken pox tests both the humoral and the cellular components of the immune system
What is normal things that we are unable to be able to do at birth?
- Unable to walk or speak
- Doubly incontinent
- Free GOR
Understand the range of normal
When is the latent phase and what happens?
- Between 6 years to until puberty
- Represses all interest in sexuality and develops social and intellectual skills
What are some conditions that are only seen in children?
- Abdo migraine
- Croup
- Bronchiolitis
- Glue ear
- VIW
What are some chronic conditions often of childhood onset?
- Asthma (COPD)
- Autism
- CP
- CF
What are some examples of immunisations?
- Measles
- Diphtheria
- Polio
- Rotavirus
What percentage of acute presentations are <2 years?
> 50%- Typically with resp
(Mostly watchful waiting is done)
Understanding the … allows you to understand what is abnormal
RANGE OF NORMAL
Why is it thought that low birth weight is linked to increased % IGT in later life?
‘Energy’ deprived foetus makes priorities-impaired development of the pancreas
What are some examples of chronic diseases that are affected in adolescents ?
- Highest graft failure rates (35% lose kidney)
- Deteriation in HbA1c in diabetes (associated with lasting complications)
Consistent across medical conditions
In what way do adolescents have more negative health outcomes?
Mortality is higher & disease control is not as good
What is adolescence?
- Specific, unique developmental stage- period of unique & significant development (biological, psychological, social)
Occurs between 11-25
Brain undergoes significant development during period of adolescence: what can this help explain?
The myriad of social, emotional and behavioural changes often attributed to adolescence
(Reduction in grey matter-Prefrontal cortex maturing towards end of adolescence (executive functions))
What forms of social development occur in adolescence?
- Developing self identity (increased self consciousness)
- Growing independence and own views
- Increased risk taking behaviours
Why can healthcare provisions for adolescents be challenging?
- May have different priorities with long term health not being of paramount importance at this stage
- Growing independence and developing identity (self in relation to condition and self management, need opportunities to build self confidence to lay foundation for longer term self care)
