Febrile child and developmental surveillance Flashcards
6 most common causes of fever in a child?
1 UTI
2 pneumonia
3 meningococcal disease
4 bone and joint infections
5 bacteremia /sepsis
6 Kawasaki disease
Supportive treatment?
Pharmaceutical treatment of fever (3)
1 supportive/non pharmaceutical: plenty of fluids, enough clothes to stop shivering
2 antipyretics
- paracetamol
- NSAIDs e.g. Ibuprofen
- aspirin (not used in pediatrics, Reye syndrome)
Hx questions re fever (4)?
- onset?
- degree of fever
- response to anti-pyretics
- febrile convulsions
Risks of fever (3)
1 increased CO and O2 consumption
- cardiac insufficiency with heart disease or anaemia
- pulmonary insufficiency with chronic lung disease
- metabolic instability with metabolic disease
2 may result in:
- irritability
- crying
- drowsiness
- vomiting
- refusal to drink
- pain
3 risk of febrile convulsions esp. those with underlying epilepsy
Physiological basis of fever
hypothalamic response to cytokines/toxins
can occur:
- in any inflammatory/infection situation
- when heat production exceeds heat loss
- if defective heat loss mechanisms
Key factors in assessment of fever are (3):
1 child’s age
2 presence of toxicity
3 presence of infection focus
Risk SE of paracetamol and ibuprofen?
Paracetamol
- hepatotoxicity
Ibuprofen
- nephrotoxicity, gastric irritation, platelet dysfunction
Pathogenesis of fever
Thermostat resets in fever in response to endogenous pyrogens - interleukins, TNF-alpha and interferons
In infection, exogenous pyrogens (microbes and their toxins) stimulate macrophages and other cells to produce endogenous pyrogens
Other substances in the body e.g. antigen-Ab complexes, complement components, lymphocyte products
High index of suspicion for serious infection (6)?
1 <3 months
2 malignancy/neutropenia/ immunocompromised
3 congenital cardiac defects/ asplenia/sickle cell
4 chronic illness (metabolic, endocrine, CF, VP shunt)
5 CAR (child at risk)
6 parental concerns
Absolute red light in developmental
Not being able to do things they used to be able to do
Tools to assess what is ‘normal’ development for a child? (5)
1 experience from one’s own family
2 milestones - fail 50%
3 worry levels - see “warning signs”
4 specific questionnaires (ages and stages)
5 parents turn out to be GOOD observers
Infants vs older children (4):
1 may not have characteristic signs of serious infection at presentation e.g. temperature may be high or low
2 localising signs/symptoms may be absent (UTI, meningitis, septic arthritis)
3 can deteriorate rapidly (generally admit, investigate and treat)
4 neonates infected from birth canal e.g. group B strep
3 immunological mechanisms that tend to work better at higher temp.
1 Helper T lymphocyte proliferation
2 enhanced T lymphocyte cell killing
3 enhanced interferon production and function
Clinical assessment of hearing (3)
1 neonates: startle response
2 head turning to localise sounds (6-9mo)
3 localising sound sources to a specific quadrant in space (older infant)
NSW state-wide infant screening hearing program SWISH (2002)
What is StEPS?
Statewide Eyesight Preschooler Screening
- 4 years
- universal
- need to wait until they can tell us they can see or not
- vision cannot be detected by behaviour or appearance
- children rarely complain about eyesight
Toxicity - ABCD
A - alert, arousal, activity
B - breathing
C - colour, circulation, cry
D - dehydration (fluid status)
Physical examination (7):
1 CNS: neck stiffness
2 Skin: rash
3 Joints: swollen, tender, red
4 Abdomen: tender, organomegaly
5 Throat: injected, tonsils
6 Ears: dull tympanic mebranes
7 Chest: respiratory pattern
