Gen Paeds Flashcards by Luke Bayley

What is the most common cause of death in paeds aged 6-12months?

SIDS

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What is the most common neurologic manifestation of child abuse?

Retinal haemorrhages
Present in 60-85% of shaken baby syndrome

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What is a mnemonic for child abuse suspicion?

Bakers doze of bashed baby badness
Bullshit story, background, behaviour, back of eyes (retinal haemorrhoage), brain injury, burns, bites, bruises, broken bones, broken frenulum (mouth), bottom and genitals, blunt abdominal trauma

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Which organisms are children 3 months to 5 years particularly susceptible to?

E. coli
Strep pneumoniae
Staph aureus
Salmonella
Neisseria Meningitides

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How should a temperature be measured at different age groups?

<4 weeks - Axilla using an electronic thermometer
>4 weeks to 5 yrs - Axilla electronic or chemical dot thermometer, or infra red tympanic thermometer

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What infections are babies <3months vulnerable to?

Group B strep
E. coli
Listeria monocytogenes
Herpes Simplex Virus
All older age group infections

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In what circumstances does the nature of the fever suggest a higher risk presentation?

Fever >38C in infants < 3months old
Fever >39C in infants 3-6months old
Fever lasting >5 days
Associated rigors

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When should a suprapubic aspirate vs in-out catheter be done for UTI testing?

SPA done in children <6months, ideally ultrasound guided
In-out catheter >6 months, although can be attempted if SPA fails

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What is the utility of blood cultures in PUO?

Poor positive predictive value (contamination > actual infection) and poor negative predictive value (small volumes usually >1ml)
However younger children have higher rates of OB and SBI so it is recommended

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Why is Aspirin avoided in children?

The risk of Reye’s Syndrome, a rapidly progressive encephalopathy with hepatic dysfunction
Largely occurs when given to children infected with VZV or Influenza A + B
Very rare cases in children being treated for Kawasakis disease with Aspirin, as well as use of other NSAID’s to treat idiopathic juvenile arthritis

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What are the contraindications to an LP in children?

Focal neurological signs
Reduced level of consciousness
Continuing seizures
Suspicion of raised ICP (ie cushings triad)
Haemodynamic instability
Respiratory compromise
Skin infection overlying the spine
Coagulopathy

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What are the indications for an LP in febrile children <3 months?

< 2months old (especially <28 days)
Vomiting
Lethargy/mild drowsiness
Cerebral irritability
Poor feeding

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When is extensive investigation not indicated in children with fever <3months?

If older than 28 days with a typical respiratory source (likely bronchiolitis)
Can consider urine M/C/S

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When is NG fluid resuscitation deemed appropriate?

In Pre-school aged children not accepting oral rehydration and only mild to moderately dehydrated (10% or less dehydrated)

Caution in dehydration caused by conditions prone to SIADH (meningoencephalitis, resp infections) or known electrolyte disturbance

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How is NG bolus dosing of fluids done? What is put down the NG?

10-25ml/kg/hr over 4 hrs
so 10kg child would get 100-250mls/hr for 4 hrs with a total of 400-1000mls
Rates generally do not exceed 300mls/hr, if wanting to give more fluids then do so over longer time ie 6hrs

Pedialyte (or breast mild depending on age)

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What are the advantages of NG fluids over IV fluids

Safer due to less risk of electrolyte derangment
Usually well tolerated
Help promote recovery from Gastroenteritis
Have the option to given nutritional fluids (ie breast milk)

For maintenance fluids what is the NGT rate?

Same as IV fluids, 4mls/kg for 1st 10kg, 2mls/kg for the next 10kg, 1ml/kg every kg after this
If CNS or Resp infection the the total dose and rate should 2/3rds the amount due to risk of SIADH

What are the Can NOt MISS diagnoses, the 7 for patients under 7?

Cardiac
NAI
Oncological/Tumour
Metabolic
Ingestions + FB
Surgical
Sepsis

What are the differences in the airways of infants and small children?

Obligate nasal breathers
larger tongues
larynx more anterior and cranial
cricoid is the narrowest part of the airway (as opposed to the vocal folds in adults)

What are the redlfags for children with airway noises?

Severe croup during the day
<12 months old
Known structural abnormalities (ie laryngomalacia)
Un-immunised
Already treated but still severe (ie adrenaline and dexamethasone)
Cerebrally agitated
Signs of tiring

What is a mnemonic for NAI in children?

TEN 4 FACESp

Trunk
Ears
Neck

Frenulum
Angle of Jaw
Cheeks
Eyelids
Subconjunctiva
patterned injuries

Above are for children under 4 years

Any bruising in child <4months should be suspicious for NAI

Differential other than NAI for unusual bruising?

Coagulopathy
Malignancy
DIC
Vit K deficiency
Mongolian blue spot
ITP
sepsis with purpura

Burns red flags

<5yo
Higher TBSA
bilateral
Scalds (non-spill injury pattern)
- Immersion pattern
- thrown spill pattern
Hot water (neglect)
Posterior trunk, genitals, buttocks and legs other than the feet

Fracture red flags

Any in pre-mobile child
long bone injury <3yo
Bucket handle/metaphyseal edge
Posterior ribs
scapular/sternal/spinal
Hands and feet
Multiple, old or healing
Complex or multiple skull fracture

Differentials for severe anaemia in children?

- GI bleed - Trauma - Blood cancer - Diet (cows mild protein allergy, iron poor diet leading to deficiency etc) - Haemolysis (G6PD deficiency, sickle cell anaemia, HUS, drug induced, sepsis etc) - Vitamin K deficiency in neonates - Transient erythblastopaenia of childhood

What are the common things that should be avoided in G6PD deficiency?

Fava beans (Favism) Any infections Sulfamethoxazole Dapsone Rasburicase Amyl nitrate (sexually active)

What are the specific differentials for limp in a toddlers 0-4?

Transient hip synovitis (most common) Toddlers fracture (most specific to age) Other Acute Myositis Developmental dysplasia of the hip

Why are Down syndrome children at higher risk of respiratory presentations and deterioration?

Development delay - Late presentation Hypotonia + GORD - Risk of aspiration Heart defects - higher risk cardiac failure OSA and pulmonary HTN Relatively immunocompromised High risk of AML - Atypical infections

What is the most accurate weight for age calculation?

(3x age) +7 So a 5yo would be 15 + 7 = 22kg APLS uses (age +4) x 2 So a 5yo would be 18kg Both can be used, but 3xage +7 is considered more accurate in developed countries as it has been shown to underestimate "well nourished" children less (33% vs 6% underestimation_

What are the general criteria for discharge to be met for the safe discharge of a child for any general medical problem?

- Significant acute medical issues excluded - Responsible adult to care for child - Safe transport home (ie drunk parent cant drive them home) - Return advice given for the medical presentation - Discharge information and follow up as applicable - Time of day (generally not overnight) - Risk assessment performed ie home situation, NAI etc

What are the risk factors for SIDS?

Maternal - Young maternal age (<20) - Smoking during pregnancy - Late or no pre-natal care Infant - Low birth weight - Pre-term deilvery - Sibling had SIDS (x5 risk) Environment - Prone sleeping position - Bed sharing - Overheating - Loose accessories (blankets, pillows) - Sleeping on a soft surface

What are the preventative measures for SIDS?

- Smoking cessation - Pre-natal care - Supine sleeping - Firm sleep surface - Room sharing without bed sharing - Pacifier use - Prevent overheating - No loose objects in bed

If you are suspecting NAI how generally should this be approached?

What is the definition and crtieria for diagnosis of a BRUE? What investigations are performed for non-low risk BRUE's? How are BRUE's risk stratified?

Investigations - BSL - ECG - Urine - Basic bloods +/- culture - NPA for viruses + Pertussis - FBE and UEC Low risk - No concerning features oh Hx/Exam - Age >60 days - Born >32 weeks and currently >45 weeks corrected age - No trained healthcare professional CPR - 1st event - Lasted <1minute

When considering diagnosing rheumatic fever in indigenous patients, what is a general differential list?

- RA or JRA - Kawasakis disease - SLE - Sepsis/septic arthritis - Reactive/Gonococcal arthritis - Influenza/covid - EM Major/SJS/TEN

What factors form part of the general follow up for Rheumatic fever?

- Patient has access to and is educated on monthly IM injections - Patient has been educated on and has the times for their cardiology/echo follow up - Patients is readily contactable ie have their phone number, address or some other reliable way to contact

What is thought to be the most common cause of BRUE's?

Exaggerated airway reflexes in the context of feeding, reflux or increased upper airway secretions