Common Childhood Conditions Flashcards
What types of childhood conditions exist?
Acute disease (URTI, LRTI, rashes, fever, UTI, vomiting/ diarrhoea and abdominal pain) Chronic disease (asthma, diabetes and congenital disease) Developmental issues Behavioural problems Social issues Safeguarding Mental health Sepsis
What are the symptoms of eczema?
Erythema/papular Dry/scaly Excoriated Thickened/lichenified skin Weeping Low self-confidence Usually benign and self-limiting but can cause complications
What is cradle cap?
Seborrhoeic dermatitis with a thick yellow crusting rash
Common in first 2 weeks of life
Self-limiting and benign
What is neonatal milia?
Few to numerous lesions often on nose or more widely on the scalp, face and upper trunk that affects 40-50% of new-born babies and that heal spontaneously within a few weeks of birth
What is paronychia?
Erythema, nailbed swelling and pus following a skin breaks e.g. finger sucking or nail biting often as a result of staphylococcal so may need oral antibiotics
How do you assess the severity of a childhood condition?
- History:
- Age of child (more serious in babies <6 mths usually)
- Activity: happy/playing or sleepy/miserable
- Function: eating/drinking or vomiting/wet nappies
- Length of illness e.g. unexplained fever > 5 days
- Other symptoms e.g. rash, breathing difficulties and posture - Exam:
- ABC and general
- Does the child LOOK well/ill? TRUST YOUR/PARENTS INSTINCTS
What is the differences that exist in children’s bodies in comparison to adults?
CV: Limited SV/CO so HR dependent
Renal: High vascular resistance, immature tubular function and dehydration poorly tolerated due to poor compensation
Liver: initially immature so poor opioid processing
Large surface-weight ratio: poor temp control and high risk of dehydration
Airway: large head, short neck, prominent occiput and large tongue
Breathing: less able to increase TV and smaller no. of alveoli
What can be a sign showing that a neonate is stressed?
Hypoglycaemia - can affect brain functioning
Why can children not exert the bucket handle effect?
They have more horizontal ribs so they increase TV by increasing RR meaning they have higher respiratory work and need more O2 to maintain this meaning they get exhausted more quickly
Ill babies should be kept ___ so that they do not become ____.
Warm
Acidotic (can cause resp. depression and decrease CO)
What babies/children are more vulnerable?
Born prematurely
Developmental problems e.g. cerebral palsy
Small babies
Chronic illnesses (asthma, epilepsy, T1DM + CF)
From families with sig. social issues
What are Piaget’s stages of cognitive development?
- Sensorimotor (0-2yrs): infant explores world through direct sensory and motor contact - object permanence and separation anxiety develop
- Pre-operational (2-6yrs): child uses symbols (words/images) to represent objects but does not reason logically but has ability to pretend - child is egocentric
- Concrete operational (6-12yrs): child can think logically about concrete objects and can add/subtract - understands conversation
- Formal operational (12yrs-adult): adolescent can reason abstractly and think in hypothetical terms
What can cause a fever in a child?
Post-immunisation URTI inc. otitis media LRTI Pneumonia Gastroenteritis UTI Osteomyelitis Septicaemia Meningitis
What are the red flags for bacterial meningitis/meningococcal disease?
Ill-looking Neck stiffness Bulging fontanelle Decreased conciousness Convulsive status epilepticus Non-blanching rash and esp. purpura (>2mm) Cap refill > 3 secs
What is tachypnoea in children?
0-5mths: >60bpm
6-12mths: >50bpm
> 12mths: >40bpm
What are the symptoms of pneumonia?
Tachypnoea Crackles in chest Nasal flaring Chest in-drawing (recessions) Cyanosis O2 sats < 95%
What are the symptoms and signs of a child that is at HIGH-RISK of being seriously ill?
Pale/mottled/ashen/blue skin, lips or tongue
No response to social cues
Appearing ill to HCP
Does not wake or if roused does not stay awake
Weak, high-pitched or continuous cry
Grunting
RR > 60bpm
Moderate or severe chest in-drawing (recessions)
Reduced skin turgor
Bulging fontanelle
Is grunting always pathological?
Healthy babies can do it but if the baby is ill or feverish, grunting is a sign that the baby is trying to keep alveoli open and trying to compensate for lower O2 saturation
What are the symptoms and signs of a child that is at INTERMEDIATE-RISK of being seriously ill?
Pallor of skin, lips or tongue reported by parent Not responding normally to social cues No smile if you smile at them Wakes only with prolonged stimulation Decreased activity Nasal flaring Dry mucous membranes Poor feeding in infants Reduced UO Rigors
Children with green features or none of the amber (intermediate risk) or red (high risk) features can:
Be cared for at home with appropriate advice for parents/carers and gain advice from healthcare services regarding when to seek further attention
At what age is it difficult to diagnose asthma? Why?
Children under 5 years old as viral infections can trigger temporary asthma that self-resolve - only treat if they are SOB and unwell as well as wheezing, trial for 6-8 weeks and see how they are w/o it
What are the commonest causes of asthma in children?
Viruses e.g. rhinovirus, parainfluenza and RSV
Dust/dust mites
Parental smoking
How should you diagnose asthma?
Clinically i.e. based on symptoms and history NOT off basis of tests; just use these as more evidence
How do you treat asthma?
- Monitored initiation of very low-low dose ICS
- Regular preventer of very low dose ICS (LTRA < 5 yrs)
- Initial add-on preventer of very lose dose ICS plus inhaled LABA in > 5 years or LTRA in < 5 years
- Additional add-on therapies:
- If no response to LABA, stop and increase to low dose ICS
- If benefit but inadequate response to LABA continue and increase ICS to low dose
- Trial other therapy e.g. LTRA if still inadequate - High dose therapy by trialling ICS medium dose or 4th drug addition e.g. Theophylline (refer for specialist care)
- Continuous or frequent use of oral steroids in lowest dose needed and continue other treatment (refer for specialist care)
What classes as acute severe asthma?
SpO2 < 92% PEF 33-50% best or predicted Cant complete sentences in 1 breath or too breathless to talk/fed HR ( >140 in 1-5yrs or >125 in >5yrs or) RR (>40 in 1-5yrs or >30 in > 5 yrs)
What classes as life-threatening asthma?
SpO2 < 92% PEF <33% best or predicted Silent chest Cyanosis Poor resp. effort Hypotension Exhaustion Confusion HR/RR may actually be normal as they are exhausted
How do you manage life-threatening asthma or spO2 less than 94%?
High-flow O2
How do you manage mild-moderate asthma?
B2 agonist one puff every 30-60 seconds according to response, up to a maximum of ten puffs (pMDI and spacer)
How do you manage severe asthma?
Nebulised B2 agonist (salbutamol) plus if needed Ipratropium Bromide mixed in the nebuliser with the B2 agonist solution - consider adding 150mg magnesium sulphate to act on SM of bronchi in nebuliser too
What should be given early in acute asthma attacks in children?
Oral steroids
What drug should not be given in children with mild-moderate acute asthma but in severe/life-threatening asthma unresponsive to max dose of bronchodilators and steroids?
Aminophylline
What findings would you record in an acute asthma attack?
Pulse rate
RR and degree of breathlessness
Use of accessory muscles of respiration
Amount of wheezing (w or w/o stethoscope)
Degree of agitation and conscious level (give calm reassurance)
Do clinical signs correlate well with severity of airway obstruction?
Not always as some children with acute severe asthma do not appear distressed
How are the guidelines for asthma treatment changing?
NICE recommend just starting with Salbutamol but BTS now recommending you start Salbutamol and Corticosteroid straight away together
