community paeds Flashcards
features of ADHD
- inattention
- hyperactivity
- impulsivity that are persistent.
Mx of ADHD
ten-week watch and wait period
5 or more drug
mild/moderate Sx - parents attending education and training programmes
severe Sx
Methylphenidate is first line in children and should initially be given on a six-week trial basis. It is a CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor
If there is inadequate response, switch to lisdexamfetamine;
Dexamfetamine should be started in those who have benefited from lisdexamfetamine, but who can’t tolerate its side effects.
perform ECG prior starting
SEs of ADHD medication
abdominal pain, nausea and dyspepsia. In children, weight and height should be monitored every 6 months
leukopenia
pancytopenia
hepatic come
key features of patau syndrome trisomy 13
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
features of edwards syndrome trisomy 18
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
features of fragile X
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
features of noonan syndrime
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
features of pierre robin syndrome
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
features of prader willi syndrome
imprinting where the phenotype depends on whether the deletion occurs on a gene inherited from the mother or father:
Hypotonia
Hypogonadism
Obesity
features of williams syndrome
microdeletion on chromosome 7
- elfien facies
- Short stature
- strabismus
- broad forehead
- Learning difficulties
Friendly, extrovert personality - Transient neonatal hypercalcaemia
- Supravalvular aortic stenosis
Diagnosis - FISH studies
features of autism
may have comorbidities
including ADHD, however the core impairments of social interaction difficulties, social
communication difficulties, and rigid repetitive behaviours
features of oppositional defiance disorder
- frequent temper tantrums
- refusal to comply with adult requests
- excessive
arguing with authority figures - behaviour intended to annoy, upset or anger other.
screening tools used in the assessment of ADHD
- Conners Questionnaire
- Dundee Difficult Times of the Day Scale (D- DTODS)
- SNAP – IV
diagnosis of ADHD involves who
- the Community Paediatrician (or Child Psychiatrist),
- Speech and Language Therapist, and
- Educational Psychologist.
DSM 5 Criteria for ADHD
inattention 6 or more Sx present for at least 6 months
- careless mistakes
- trouble focusing
does not seem to listen when spoken to directly
- does not follow instructions
- has trouble organising tasks and activities
- cant do mental work for a long period of time
- often loses things necessary for tasks
- easily distracted
- forgetful in daily activities
hyperactivity and impulsivity 6 or more Sx at least 6 months
- fidgets, taps, squirms
- leaves sear
- runs or climb in inappropriate situations
- cant take part in activities quietly
- ” driven by a motor”
- talks excessively
- blurts out an answer before a q has been completed
- trouble waiting their turn
- interrupts/intrudes
Ix done before starting on possible ADHD medication if family has cardiac disease
referred to the paediatric cardio assessment
B: Blood pressure measurement
C: ECG with calculation of QTc
D. Echocardiogram
A: 24-hour ECG tape monitoring DONE IF THERE IS A FH OF CARDIAC Hx
what is monitored with ADHD meds
SEs
- BP
- height - appetite suppression -> child’s growth can slow down or even stop
- weight
- pulse
cardiac arrest, angina pectoris, neuroleptic malignant syndrome and sudden cardiac death
features of autism
- difficulties of social interaction
- social
communication skills
- cant have a good convo
- reduced emotions
- challenges in understanding or responding to social cues - eye contact/facial expressions - restricted/repetitive behaviours
- hand flapping toe walking
- speaking in a unique way
2-3 yrs
more common in boys than girls
screening tool for autism
GARS questionnaire
Gilliam Autism Rating Scale
what is done to give a diagnosis of autism
educational psychology assessment ->childs diff in preschool, identify any co-morbid learning difficulties
FH of autism -> parental views about a diagnosis
school report - access support
SALT
DSM-5
- persistent deficits in each of the three areas of social comm and interaction
- plus at least two of four types of repetitive behaviour
red flags of ASD
not responding to name by 12 doesnt play pretend game prefers to be alone flapping hands, rocking body intense reactions to the way things smell or feel
RFs of autism
prematurity parental schizo maternal use of valproae LD ADHD neonatal encephalopahty HIE genetic - fragile X TS NF muscular dystrophies
Mx of autism
behavioural Mx OT SALT dietician - supplements sleep hygiene
cerebral palsy
chronic condition affects movement posture motor
non progressive permanent lesion in brain
1. spastic - cerebrum, muscle rigidity anterior cerebral artery legs - diplegic, MCA ULs are affected
ICA - quadraplegic
2. basal ganglia dyskinetic - dystonia, athetoid
3. cerebellum - ataxic
4. mixed
what is turner syndrome and its features
presence of only one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes. Turner’s syndrome is denoted as 45,XO or 45,X.
short stature
shield chest, widely spaced nipples
webbed neck
bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
primary amenorrhoea
cystic hygroma (often diagnosed prenatally)
high-arched palate
short fourth metacarpal
multiple pigmented naevi
lymphoedema in neonates (especially feet)
gonadotrophin levels will be elevated
hypothyroidism is much more common in Turner’s
horseshoe kidney: the most common renal abnormality in Turner’s syndrome
CFs of down
- face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face, small mouth, flat nasal bridge
- hypertelorism
- flat occiput
- single palmar crease, pronounced ‘sandal gap’ between big and first toe, clinodactaly (incurved little finger
- hypotonia
- congenital heart defects (40-50%, see below)
- duodenal atresia
- Hirschsprung’s disease
cardiac complications of downs
other compl
- endocardial cushion defect AVSD
- VSD
- secundum atrial septal defect (c. 10%)
- tetralogy of Fallot (c. 5%)
- isolated patent ductus arteriosus
- subferitlity
- learning difficulties short stature
- repeated repsiratory infections
- short stature
- acute lymphobalstic leukaemia
- hypothyroidism
- alzheimers
- atlantoaxial instability
most common fractures ass w child abuse
- Radial
- Humeral
- Femoral
presentation of child abuse
story inconsistent with injuries
repeated attendances at A&E departments
late presentation
child with a frightened, withdrawn appearance - ‘frozen watchfulness’
- pregnancy
- STIs, recurrent UTIs
- sexually precocious behaviour
- anal fissure, bruising
- reflex anal dilatation
- enuresis and encopresis
- behavioural problems, self-harm
- recurrent symptoms e.g. headaches, abdominal pain
bruising
fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
torn frenulum: e.g. from forcing a bottle into a child’s mouth
burns or scalds
failure to thrive
sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas
Trisomy 21 results from
RFs
Ix
most commonest cardiac anomalies
2 most common GI abnromalities
heam anomalies <3 yrs
- meiotic non dysjunction
- robertsonian translocation
- mosaicism
- pt w a translocation mutation of chromosome 14 and 21
- advancing maternal age
- having already had a child w DS
Ix FBC - thrombocytopenia, neutrophilia and polycythaemia 2. HEARING SCREEN 3. TFTs - hypothyroidism 4. cardiac echocardi
AVSD - SOB , wheeze, failure thrive, poor fedding
surgery before 6ms
Duodenal atresia/Hirschsprung
acute myeloid leukaemia
what do u do if a child comes in with inconsistent history and NAI bruises
Ix done in suspected NAI
check child protection register
admit for further Ix and senior review
- FBC and clotting - exclude bleeding tendency
- CT scan of the head
- skeletal survey
- examination of the fundi
Role of the child protection team
- initially convene a case conference to include the parents, police officer, Paediatrician, GP, health visitor and the social worker
- case discussed then they decide whether abby should be placed on child protection register
- the social worker and health visitor can support family and check in baby
- paediatrician is asked to do a regular follow up in terms of growth and development
what is seen in spastic hemiplegia
Arm held flexed, adducted, internally rotated.
Leg extended, stiff and in plantar flexion.
Leg dragged in circumduction (semi-circle).
Risks of having a downs child
pt with translocation mutation
advanced maternal age
child with Downs
