Community Paeds Flashcards
What is Section 47 Investigation?
Multi-professional process with the aim of deciding whether a child needs safeguarding.
Needs to have:
‘reasonable cause to suspect that a child who lives in their area is suffering/likely to suffer significant harm’
What is an Emergency care order and how long does it last?
Local authority applies to the court to remove the child/
Lasts 8 days.
What is an Interim care order + how long does it last?
This lasts 8wks + can continually be renewed until the child can go back to the family/ into permanent care.
What are RED FLAG areas for bruising?
Buttocks, back, fleshy areas of cheeks/neck, upper arms, front thighs.
Long, linear bruise on cheeks= slap.
How do you age a bruise?
The age of a bruise CANNOT BE ACCURATELY ESTIMATED!
What type of fracture is most specific for child abuse?
Metaphyseal fractures
What can a torn frenulum indicate?
Force feeding! (alot of bleeding)
What type of burn may indicate child abuse?
Glove + stocking distribution (intentional immersion)
What are the signs of Shaken Baby Syndrome?
- Retinal haemorrhages
- Encephalopathy
- CT scan: subdural haemorrhages
Key Red Flags for child abuse?
- Any bruising on an immobile child
- Delayed presentation
- Varying/multiple explanations of Hx
- Repeated attendance
What is a differential of a child with unexplained fractures?
Osteogenesis imperfecta (brittle bone disease)
- Type 1 (autosomal dominant- so may be FHx)
- Clinical signs: blue sclerae, generalised osteoporosis, Wormian bones in the skill.
What are some differentials for bruising in a child?
- Coagulation disorders
- Mongolian Blue spots
What is colostrum?
The initial breastmilk- which has much higher levels of protein + immunoglobulins.
How long is breast-feeding/ formula recommended?
Until 12months (pros of continuing until 18months)
When can cow’s milk be given to an infant?
- From 1 year (but deficient in Vit A/C/D/iron so need supplements)
- Full fat cows milk up to 5yrs.
When can soya formula be given to an infant?
-Should not be used <6months as high aluminium content + contains phytoestrogens.
When can an infant begin weaning?
- From 6months: small quantities of pureed fruit, root veg, rice.
- Avoid wheat, eggs, fish to begin.
- Avoid honey <1yr due to risk of infantile botulism.
What are the 5 key causes of failure to thrive in children?
- Inadequate intake (organic/ environmental)
- Inadequate retention (GORD, vomiting)
- Malabsorption (coeliac disease, CF, cows milk protein intolerance)
- Failure to utilise nutrients (Syndromes: chromosomal disorders, IUGR, metabolic disorders)
- Increased requirements (thyrotoxicosis, CF, malignancy, congenital heart disease)
- Enteral nutrition?
2. Parenteral nutrition?
- Used when GI tract is functioning. Feeds given by NG, gastronomy, often continuously overnight.
- To provide nutritionally complete feed in an appropriate volume of IV fluids. (peripherally sited cannula, or if long term: central venous catheter).
Presentation of Kwashiorkor?
Severe protein malnutrition, generalised oedema + wasting.
Also: ‘flaky-paint’ skin rash w/hyperkeratosis, distended abdomen + enlarged liver, angular stomatitis, low plasma albumin, potassium, glucose + magnesium.
Pathophysiology of Rickets?
A low serum calcium (due to low Vit D) triggers the secretion of PTH to normalise the serum calcium, but demineralise the bone.
- PTH causes renal loss of phosphate (so low serum phosphate levels, reducing potential of bone calcification)
- Other Sx of hypocalcaemia: seizures, neuromuscular irritability (tetany), apnoea.
What is the difference between Rickets and Osteomalacia?
Rickets= failure in mineralisation of the growing bone or osteoid tissue. Osteomalacia= failure of mature bone to mineralise.
What drugs may cause Rickets?
Anticonvulsants: phenobarbitol + phenytoin. (interfere w/ Vit D metabolism)
Presentation of Rickets?
- Ping-pong ball sensation of skull (craniotabes)
- Costochondral junctions palpable
- Widened wrists/ankles (metphyses)
- Delayed dentition
- Hypotonia
- Bowed legs
- Seizures (late)
Blood test results for Rickets?
- Serum calcium low/normal.
- Phosphorous low
- Plasma Alk Phos increased ++
- 25-hydroxyvitamin D low
- PTH elevated
Management of Rickets?
- Balanced diet/ correct predisposing factors
- Daily Vit D3 (cholecalciferol)
What are 3 key causes of Obesity in childhood?
- Endogenous causes (Cushing’s, hypothyroidism): short, obese children.
- Syndromic (Prader-Willi): if also learning disabilities/ dysmorphia.
- Genetic defects (Leptin def.): severely obese <3yrs.
