Common childhood conditions Flashcards
What are some common childhood conditions you may see?
What should you always remember with children?
Acute disease --> URTI/ LRTI, rashes, fever, vomiting and diarrhoea, abdominal pain
Chronic disease --> asthma, diabetes, congenital disease
Developmental issues
Behavioural issues (massively interlink with social issues and physical issues)
Social issues (foster care, asylum seekers, different role in supporting them).
Always think of safeguarding, mental health and look out for sepsis.
What is the condition shown?
How does it present?
Eczema –> common skin condition, presents in 20% of children in the uk. Usually benign but can cause complications.
Presents with erythema, macula, dry and scaly, excoriated (damage/ removal of part of the skin)
thickened/lichenified (leathery) skin
weeping
What is the condition shown?
What is the cause? when does it present?
how do we treat?
Cradle cap –> Seborrhoeic (related to sebaceous gland secretion) dermatitis with a thick yellow crusting rash
Common in the first two weeks of life
Self limiting and benign, therefore no treatment required.
What is this condition?
Who does it affect?
what is the tx?
Neonatal milia
Affects 40-50% of new born babies, few to numerous lesions often seen on the nose, widely on the scalp, face and upper trunk
Heal spontaneously w/in few weeks of birth, no Tx. required.
What is this condition?
How does it present?
What is the Tx?
Paronychia –> infection of the nail folds
Presents with erythema, nailbed swelling, pus
Cause: often staphylococcal infection, following skin break often caused by nailbiting or finger sucking
Tx: oral abx
What do we take into account when assesing the severity of a child’s illness?
History:
1) Age of the child –> serious infection much more common in babies under 6 months old (immature immune sx.)
2) Activity –> what are they normally like at home? Happy, playing, sleepy or miserable?
3) Function –> any change to eating/ drinking/ vomiting/ wet nappies
4) length of illness (e.g. unexplained fever > 5 days)
5) other sx -> rash/ breathing difficulties/ posture?
Examination -> ABC, general exam
Does the child LOOK well or ill? (To you or the parent?).
What are the key physiological differences between children and adults?
1) Respiratory system –> Children’s ribs are much more horizontal than adults, no bucket handle effect, unable to expand upwards and forwards. They increase tidal volume by increasing RR, therefore higher respiratory work, uses more oxygen just to maintain respiratory work, also risk of exhaustion from increased Respiratory work. RR key marker of illness in children.
Airway -> large head, short neck, prominent occiput, large tongue.
2) Cardiac –> myocardium is less contractile than adults, cannot easily increase stroke volume. To increase CO must increase their heart rate
3) Renal –> high vascular resistance and immature tubular function, process differently, dehydration is poorly tolerated.
4) Liver –> initially immature (due to enzyme immaturity), poor processing of opiods, always give dose specified for the age group.
5) Glucose metabolism –> Stress reaction in newborn is hypoglycaemia (may occur in infection/ disease), RED FLAG.
6) large surface to weight ratio -> poor temp control, high risk dehydration
What are factors that make a child vulnerable during minor illness?
- Premature birth and small babies in general –> due to large surface to weight ratio, dehydrate quickly and become cold quickly.
- Chronic conditions –> e.g. asthma (respiratory reserve smaller, even more at risk). Epilepsy, T1DM, CF
- Chidlren from families w significant social issues
- Developmental problems (cerebral palsy)
How does BMI values change with children?
Children’s weight to body surface ratio changes overtime.
Adult w BMI of 23 would be perfectly fine, however 10 year old boy with BMI of 23 would be in the obese category.
15 year old boy with BMI 23 would be in the healthy weight category.
What are the 4 key stages of cognitive development in children?
Piaget’s 4 stages of cognitive development:
- Sensorimotor stage (Birth - 2yrs): Experiences world through direct sensory and motor contact. Object permanence: can form a mental representation of the object. Separation anxiety also develops.
- Preoperational stage (2-6 yrs): Begin to think symbolically, thinking is still egocentric, infant has difficulty taking viewpoint of others.
3) Concrete operational stage 6- 12 yrs -> major turning point, marks beginning of logical or operational thought. Able to think logically about concrete objects, add and subtract and understand conversation.
4) Formal operational stage 12 yrs –> begins at approx 12 lasts into adulthood, people begin to think abstractly and logically test hypotheses.
Common causes of fever in a child?
- URTI
- LRTI
- Otitis media
- pneumonia
- gastroenteritis
- UTI
- Osteomyelitis
- Septicaemia
- meningitis
What is this condition?
What are the red flags for this condition?
Meningitis with a purpuric non blanching rash.
Red flags:
Ill looking child
neck stiffness
Bulging fontanelle
decreased conciousness
Convulsive status epilepticus
Any non-blanching rash, epecially purpuric (larger than 2mm in diameter)
Cap refill of > or equal to 3 secs
What is respiratory recession?
Respiratory recession –> with each breath the skin between the ribs will move in, compensation for increased respiratory work and use of accessory muscles.
Associated with pneumonia.
What are the signs of pneumonia?
How would the key sign of RR change with the age of the baby (0-1 yrs)?
Expect to see raised RR:
In young baby 0-5 months > 60 breaths per min
6-12 months > 50 breaths per min
age > 12 months > 40 breaths per min (note in an 1-3 yrs RR 24 - 40 is normal, 3-5 yrs 22-34 normal, 6-12 yrs RR 18-30 normal).
Other Signs:
crackles in the chest
nasal flaring
respiratory recessions
cyanois
O2 sat < or equal to 95%
What are the RED flags on the NICE guidlines Traffic lighting system for identifying risk of serious illness?
Appearing ill to a HCP:
Pale/ cyanotic skin lips or tongue / mottled skin
Behaviour:
No response to social cues, does not wake or if roused unable to stay awake, weak high pitched or continuous cry
Grunting –> trying to maintain raised intraalveolar pressure, sign of increased Respiratory work
Examination signs:
RR > 60 breaths/ min
respiratory recessions
reduced skin turgor
bulging fontanelle
What are the signs of intermediate risk for children?
- Pallor (skin/ lips/ tongue/ reported by carer)
- No response to social cues/ no smile
- wakes only with prolonged stimulation
- decreased activity
- nasal flaring
- dry mucous membrane
- poor feeding in infants
- reduced urine output
- rigors (sudden cold and shivering followed by raising temperature and sweating).
What is the action plan for a child with no red/ amber flags?
Child can be cared for at home with app. advice for parent/ carer
Advice from the healthcare service on when to seek further attention
What are the normal HR/ RR parameters for children?
Infant < 1 yr
Toddler 1-2 yrs
Pre school 3-4 yrs
School 5- 11 yrs
What is asthma characterised by?
- Airways obstruction (reversible)
- Airways inflammation
- Airway hyperresponsiveness
What are the signs looked for in an asthma diagnosis in a child?
1) presentation with respiratory sx –> wheeze/ cough/ breathlessness/ chest tightness
2) PMH –> recurrent episodes or sx, recorded observation of wheeze, Hx. of atopy, history of variable PEF/FEV1, sx. variability, abscence of sx. of alternative diagnosis
What are the diagnositic tests for the different probabilities of asthma?
High probability of asthma –> initiate treatment and asses response objectively with lung function test, improvement = asthma.
Intermediate probability –> test for airway obstruction with spirometry or bronchodilator reversibility, can test for expired NO which is produced by inflammatory cells or test for eosinophils or atopy. If suspected can commence treatment and assess response or watchful waiting.
Low probability of asthma -> investigate or treat for more likely diagnosis
What is the management of childhood chronic asthma?
Every child diagnosed with asthma is given 1) reliever (salbutamol) 2) preventer (corticosteroid).
Always check inhaler technique, advise on how to use it.
What are the acute severe signs of an acute asthma attack in a child?
Oxygen saturation < 92%
PEF 33-50% best or predicted
cannot complete sentences in one breath or too breathless to talk or feed
HR > 125 (5 yrs and above) or > 140 (1-5 yrs)
RR > 30 breaths/ min (> 5 yrs or)
> 40 (1-5 yrs)
What are the life threatening signs of acute asthma attack?
- Life threatening –> childs respiratory reserve and heart rate may appear normal due to exhaustion
- ox sat < 92%
- PEF < 33% best or predicted
- silent chest
- cyanosis
- Poor resp effort
- exhaustion
- confusion
- hypotension
What is the management for an acute asthma attack in children?
OSHIT
high flow O2
Salbutamol
Hydrocortisone
Ipratroprium bromide
Theophylline –> Note aminophylline not recommended for children w mile to moderate acute asthma, recommended for severe or life threatening asthma unresponsive to max dose bronchodilator/ steroid
Note also start oral prednisilone as soon as is possible.
Also consider magnesium sulphate addition to nebuliser.
What needs to be recorded during acute asthma attack in children?
Record RR and HR
Degree of breathlessness (issues with talking, activities)
Accessory muscle use/ respiratory recession
Amount of wheezing (heard w/ out steth, with steth, no audible wheeze)
Agitation and concious level
–> note clinical signs occasionally will correlate poorly with severity of airway obstruction, some acute attacks will not appear distressed
