Community Paeds

Question 1

What is Section 47 Investigation?

Answer 1

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’

Question 2

What is an Emergency care order and how long does it last?

Answer 2

Local authority applies to the court to remove the child/

Lasts 8 days.

Question 3

What is an Interim care order + how long does it last?

Answer 3

This lasts 8wks + can continually be renewed until the child can go back to the family/ into permanent care.

Question 4

What are RED FLAG areas for bruising?

Answer 4

Buttocks, back, fleshy areas of cheeks/neck, upper arms, front thighs.
Long, linear bruise on cheeks= slap.

Question 5

How do you age a bruise?

Answer 5

The age of a bruise CANNOT BE ACCURATELY ESTIMATED!

Question 6

What type of fracture is most specific for child abuse?

Answer 6

Metaphyseal fractures

Question 7

What can a torn frenulum indicate?

Answer 7

Force feeding! (alot of bleeding)

Question 8

What type of burn may indicate child abuse?

Answer 8

Glove + stocking distribution (intentional immersion)

Question 9

What are the signs of Shaken Baby Syndrome?

Answer 9

• Retinal haemorrhages
• Encephalopathy
• CT scan: subdural haemorrhages

Question 10

Key Red Flags for child abuse?

Answer 10

• Any bruising on an immobile child
• Delayed presentation
• Varying/multiple explanations of Hx
• Repeated attendance

Question 11

What is a differential of a child with unexplained fractures?

Answer 11

Osteogenesis imperfecta (brittle bone disease)

• Type 1 (autosomal dominant- so may be FHx)
• Clinical signs: blue sclerae, generalised osteoporosis, Wormian bones in the skill.

Question 12

What are some differentials for bruising in a child?

Answer 12

• Coagulation disorders

- Mongolian Blue spots

Question 13

What is colostrum?

Answer 13

The initial breastmilk- which has much higher levels of protein + immunoglobulins.

Question 14

How long is breast-feeding/ formula recommended?

Answer 14

Until 12months (pros of continuing until 18months)

Question 15

When can cow’s milk be given to an infant?

Answer 15

• From 1 year (but deficient in Vit A/C/D/iron so need supplements)
• Full fat cows milk up to 5yrs.

Question 16

When can soya formula be given to an infant?

Answer 16

-Should not be used <6months as high aluminium content + contains phytoestrogens.

Question 17

When can an infant begin weaning?

Answer 17

• 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.

Question 18

What are the 5 key causes of failure to thrive in children?

Answer 18

1. Inadequate intake (organic/ environmental)
2. Inadequate retention (GORD, vomiting)
3. Malabsorption (coeliac disease, CF, cows milk protein intolerance)
4. Failure to utilise nutrients (Syndromes: chromosomal disorders, IUGR, metabolic disorders)
5. Increased requirements (thyrotoxicosis, CF, malignancy, congenital heart disease)

Question 19

1. Enteral nutrition?

2. Parenteral nutrition?

Answer 19

1. Used when GI tract is functioning. Feeds given by NG, gastronomy, often continuously overnight.
2. To provide nutritionally complete feed in an appropriate volume of IV fluids. (peripherally sited cannula, or if long term: central venous catheter).

Question 20

Presentation of Kwashiorkor?

Answer 20

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.

Question 21

Pathophysiology of Rickets?

Answer 21

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.

Question 22

What is the difference between Rickets and Osteomalacia?

Answer 22

Rickets= failure in mineralisation of the growing bone or osteoid tissue.
Osteomalacia= failure of mature bone to mineralise.

Question 23

What drugs may cause Rickets?

Answer 23

Anticonvulsants: phenobarbitol + phenytoin. (interfere w/ Vit D metabolism)

Question 24

Presentation of Rickets?

Answer 24

• Ping-pong ball sensation of skull (craniotabes)
• Costochondral junctions palpable
• Widened wrists/ankles (metphyses)
• Delayed dentition
• Hypotonia
• Bowed legs
• Seizures (late)

Question 25

Blood test results for Rickets?

Answer 25

• Serum calcium low/normal.
• Phosphorous low
• Plasma Alk Phos increased ++
• 25-hydroxyvitamin D low
• PTH elevated

Question 26

Management of Rickets?

Answer 26

• Balanced diet/ correct predisposing factors

- Daily Vit D3 (cholecalciferol)

Question 27

What are 3 key causes of Obesity in childhood?

Answer 27

• Endogenous causes (Cushing’s, hypothyroidism): short, obese children.
• Syndromic (Prader-Willi): if also learning disabilities/ dysmorphia.
• Genetic defects (Leptin def.): severely obese <3yrs.