Febrile/irritable infant or child Flashcards
What can be the causes of an acute fever for an infant?
Viral Illness:
- non-specific viral infection
- URTI
- influenza
- Gastro
- tonsillitis
Bacterial Illness
- Septicaemia
- Meningitis
- Arthritis, osteomyelitis
- Pneumonia
- Urinary tract infection
What should you ask in a history of a child with an acute fever
- duration and pattern
- pain? earache, difficulty swallowing, dysuria or frequency
- Associated features
- Contact with other infections
- Vaccinations
- Drinking adequate fluid?
- Antipyretics and cooling measures tried?
What investigations should be done for a febrile child
- Full blood count
- throat swab
- blood culture
- Lumbar Puncture
- Urine analysis
- CXR
What are the commonest causative organisms of otitis media?
- Strep pneumoniae
- Haem. Influenzae
Is tonsillitis usually viral or bacterial in nature
Viral
What are the signposts of a serious bacterial infection vs an intercurrent viral one?
What should you be thinking of if the fever persists for >5days, and what concurrent symtpoms will you likely see?
Kawasaki Disease
- rash, conjunctivis, lymphadenopathy, red lips*
- Also rule out inf endocarditis, osteromyolitis*
What is the purpose of the 3-minute toolkit
- as children can be hard to pick up signs and can appear relatively normal even when decompensating, the toolkit allows for rapid assessment of the child
How does irritability usually present in infants and for what common reasons?
When shold you consider more serious reasons?
Usuually periodic and due to discomfort or stress?
If it starts suddenly and is associated with a change of behaviour
What is infantile Colic
Periodic crying affecting infants in the first 3 months of life.
Crying associated with hunger/swallowed air or discomfort, is paroxysmal and often occurs in the evening.
Can last hours, with a distended tense abdo and lifted legs.
What are some of the more serious causes of sudden crying?
- any acute illness
- otitis media
- intusseception
- Strangulated inguinal hernia
passage of the classical ‘red currant jelly’ suggests?
Severe vascular compromise due to intersusception of the bowel
What is Transient tachypnea of the newborn (TTNB)
- most common cause of respiratory distress in term infants
- Caused by delay in the absorption of lung liquid especially following elective caesarian.
- Usually settles in 1-2 days
- May need O2
Risk factors for pneumonia in newborn babies
PROM
maternal fever
chorioamnionitis
preterm
How should infants with respiratory distress be investigated?
- Blood culture then start on broad spec AB
- CRP
- CBC
- Lumbar puncture
What’s the concern surrounding meconium aspirate and whats the risk factor surrounding which babies
- asphyixiated infants may start gasping and aspirate meconium before delivery, which is thick and causes mechanical obstruction, chemical pneumonitis and inactivation of surfactant.
Dysmorphic features of Trisomy 21
- flattened nasal bridge
- Low set ears
- epicanthal folds
- brachydactyly
- single palmar crease
- HYPOtonia
- sandle gap toes
Associated problems with Trisomy 21
- Duodenal atresia
- cardiac abnormalities
- otitis media
- hypothyroidism
- coeliac
Clubbing in children, three most common causes!
- Cystic Fibrosis
- Congenital Heart Disease
- Bronchiectasis
What ages do we get immunisations
- 6 weeks
- 3 months
- 5 months
- 15 months
- 4 years
- 11-12 years
Increased and decreased tone in children, the two most likely reasons are….
- Increased: Cerebral palsy
- Decreased: down syndrome, prada willi
TORCH stands for what?
Types of Congenital infections
- Toxoplasmosis
- Others: syphillis, varicella, paravirus B19
- Rubella
- CMV
- HSV/ HIV
also Hep B, STIs and genital flora (group B strep)
what has changed the incidence of spina bifida dramatically and what are the three types?
FOlic acid supplementation during pregnancy
- Meningocele
- myelomeningocele
- Spinabifida oculta
What causes the whoop from pertussis?
The whoop occurs following the paroxysms of coughs with a sudden inspiratory effort against a narrowed glottis due to an infection from bordetella pertussis
