General Paeds Flashcards
what age should you refer if the child isnt walking?
18 months
what happens at the 6-8 weeks review?
Identification data (Name, address, GP)
Feeding (breast/ bottle/ both)
Parental concerns (appearance, hearing; eyes, sleeping, movement, illness, crying, weight)
Development (gross motor, hearing + communication, vision + social awareness)
Measurements (Weight, OFC, Length)
Examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex))
Sleeping position (supine, prone, side)
healthy child programme
antenatal
birth - 1 week after
2 weeks
6-8 week review
1 year
2-2.5 years
5 years
how do you monitor physical growth in a child?
weight (grams and kgs)
length or height
head circumference
causes of failure to thrive in early life:
maternal
deficiency intake:
poor lactation
incorrectly prepared feeds
unusual milk or other feeds
inadequate care
causes of failure to thrive in early life:
infant
prematurity
small for dates
oro-palatal abnormalities (cleft palate)
neuromuscular disease
genetic disorders
causes of failure to thrive in early life:
increased metabolic demands
congenital lung disease
heart disease
liver disease
renal disease
infection
anaemia
causes of failure to thrive in early life:
excessive nutrient loss
gastro-oesophageal reflux
pyloric stenosis
gastroenteritis
malabsorption (food allergy, coeliac disease, persistent diarrhoea etc)
non medical causes of failure to thrive:
poverty/ socio-economic status
dysfunctional family interactions
difficult parent child interactions
lack of parental support (no family etc)
lack of preparation for parenting
emotional deprivation
child neglect
Primary care assessment tools when looking at children with special needs:
(know these!)
ASQ (ages and stages questionnaire)
PEDS (parents evaluation of development status)
M-CHAT (checklist for autism in toddlers)
SOGS-2 (schedule of growing skills)
William’s syndrome:
broad forehead
flat nasal bridge
short nose
full lips
wide mouth
aortic stenosis
What are some red flag signs a child may have a developmental syndrome?
loss of developmental skills
vision problems
hearing problems
floppiness
no speech by 18-24 months
asymmetry of movement
CASE 1
vomiting baby - what questions do you ask?
what does he weight?
what are his feed volumes?
what are his feed volumes/ how many per day?
common cause of baby vomiting and unsettled
overfeeding!
normal should be 120-140ml (4-5oz per feed)
what units do you measure children’s weight in?
kilograms and grams
how much is an ounce?
1/16th of a pound
A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ
Diagnosis?
Additional features of the history/ examination?
Management?
Diagnosis
Constipation +/- impaction
History
Stool frequency/ consistency/ size/ pain/ blood
Toilet training and use/ Soiling/ Withholding
Diet/ appetite/ fluids/ activity/ school routine
Examination Inspect lower spine and anus Check lower limb neurology Measurements and centile No rectal examination
constipation cycle:
pain or anal fissure
withholding of stool
constipation
large hard stool
how do you treat constipation in a child?
stool softeners/stimulants (senna, lactulose, movicol)
increase fluid intake
fruit, veg, fibre
reduce milk/ sweets
toilet routine and comfort
A 10 week old boy presents with 4 weeks of frequent post feed effortless vomits and distress (back arching and pulling up knees).
Examination showed a soft abdomen with no palpable masses.
Diagnosis and differential?
Other questions to ask?
Management and investigations?
Diagnosis and differentials:
Gastro-oesophageal reflux (GORD) (common in babies)
+/- Milk intolerance
Consider pyloric stenosis
Consider surgical causes if bilious
Other questions
Vomits: Bilious or not/ Volume/ Amount/ Blood
Feeding: Type/ Volume/ Frequency/ Position
General: Weight gain+ centiles/Development/ Cough
how do you manage GORD?
feeding advice (routine/ volumes/ reassurance)
medical (feeding thickeners - gaviscon), milk free feeding, acid reduction
surgery (uncommon - gastrostomy)
GORD is very common in
babies
GORD in babies is usually
self limiting
2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen
Diagnosis?
Diagnosis (differentials)
Coeliac disease!
2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen
investigations?
Coeliac serology
stool screen (culture, feacal elastase, electrolytes)
small bowel biopsy (duodenal)
IgA
2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen
treatment?
gluten free diet
A 2 week old baby present with a 2 day history of vomiting all feeds. The parents bring in one of his baby grows. Weight is down 30g.
He is unsettled on examination
(green vomit)
differentials?
this is bilious vomiting!! (should ALWAYS ring alarm bells!)
(due to intestinal obstruction until proven otherwise)
Causes:
malrotation
intussusception (usually older - in infants or toddlers)
crohn’s
intestinal atresia (newborns)
intestinal atresia only happens in
new borns
intussusception usually occurs in
older infants and toddlers
A 2 week old baby present with a 2 day history of vomiting all feeds. The parents bring in one of his baby grows. Weight is down 30g.
He is unsettled on examination
(green vomit)
management?
urgent surgical opinion
IV access
IV fluids
NG tube
(nothing by mouth)
A 2 week old baby present with a 2 day history of vomiting all feeds. The parents bring in one of his baby grows. Weight is down 30g.
He is unsettled on examination
(green vomit)
investigations:
abdominal x-ray
contrast meal
A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough.
Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o
diagnosis?
bronchiolitis
A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough.
Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o
investigations?
nasopharyngeal aspirate
A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough.
Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o
management
no proven role for any meds
Observation!
what is the most common LRTI?
bronchiolitis
symptoms of bronchiolitis
tachypnoea
poor feeding
nasal stuffiness
An 18m boy presents with a 4 hour history of barking cough and noisy breathing having been well the day before
Examination shows a runny nose, loud stridor, tracheal tug sub-costal recession, well perfused peripheries and temp of 37.8o
differentials?
Most likely is croup (laryngotracheitis)
foreign body
epiglottitis
An 18m boy presents with a 4 hour history of barking cough and noisy breathing having been well the day before
Examination shows a runny nose, loud stridor, tracheal tug sub-costal recession, well perfused peripheries and temp of 37.8o
management?
calm and avoid stress/ anxiety
oral steroid (dexamethasone, prednisolone)
symptoms of croup
child is usually WELL
barking cough!
hoarse voice
stridor
coryza ++
symptoms of epiglottis
stridor
DROOLING
how do you treat epiglottis?
intubation and antibiotics
how do you treat croup?
oral steroids
A 3y old girl presents with a 4 day history of increasing lethargy, cough, fever and tummy pain. She has vomited x4 in the last 2 days.
Examination showed temp 39.8o, resp rate 40, nasal flaring, intercostal recession, no focal chest findings, RUQ discomfort, soft abdomen.
Diagnosis and differential?
LRTI (is it right lower lobe penumonia!)
UTI
appendicitis
A 3y old girl presents with a 4 day history of increasing lethargy, cough, fever and tummy pain. She has vomited x4 in the last 2 days.
Examination showed temp 39.8o, resp rate 40, nasal flaring, intercostal recession, no focal chest findings, RUQ discomfort, soft abdomen.
Investigation and management?
check saturations
consider CXR so confirm signs
urine dipstick/ culture
Manage: oral amoxicillin or macrolide
pneumonia symptoms
fever
SOB
cough
grunting
if a child has a wheeze- what is less likely cause of it?
a bacterial infection
what bacteria are responsible for pneumonia?
pneumococcus
mycoplasma
chlamydia
What does HEADSS stand for in adolescent psychosocial interview
Home and environment
education and employment
activities
drugs
sexuality
suicide/ depression
