GP Paediatrics Flashcards
What are the challenges of GP medicine?
Undifferentiated illness, lack of access to investigations, dealing with uncertainty, lack of team, 10 minutes to get it right
What is the GP approach to paediatric illness?
Look at the child and parent
Is it their first visit?
Detailed history
What should be covered in the history?
Presenting complaint, red flags, eating/drinking, bowels/urine, parental concern, PMH, medication/allergies, family history, immunisations
When is the neonatal period?
From birth to 4 weeks
What do neonates present with?
Jaundice, vomiting, failure to thrive, sepsis
What may cause jaundice in a neonate?
UTI, hypothyroidism, galactosaemia, breastmilk jaundice, biliary atresia
What are some causes of vomiting in a neonate?
Reflux, CMP intolerance, pyloric stenosis, duodenal atresia
How do children with respiratory problems present?
Have a “cold”, not feeding, cough, wheeze
What are common causes of respiratory illness in children?
Bronchiolitis, croup, viral URTI, asthma, acute tonsillitis
What are some rare causes of respiratory illness in children?
Cystic fibrosis, acute epiglottitis, foreign body, pneumonia, cardiac causes, malignancy
How are children with a respiratory complaint assessed?
Pulse oximetry, resp rate, percussion, auscultation, ENT exam
Look for = cyanosis, tachypnoea, nasal flaring, intercostal/subcostal recession, wheeze, stridor, cough
What are the normal respiratory rates for children?
Under I year old = 30-40 bpm
Age 1-2 years = 25-35 bpm
Age 2-5 years = 25-30 bpm
>12 years = 15-20 bpm
How do children with GI issues present?
Abdominal pain, vomiting, diarrhoea, nausea, constipation
What are common GI complaints in children aged birth to 1 year old?
Gastroenteritis, UTI, constipation, intussusception, volvulus, incarcerated hernia, infantile colic, Hirschprung’s disease
What are common GI conditions in children aged from 2 to 5 years old?
Gastroenteritis, UTI, constipation, intussusception, volvulus, appendicitis, mesenteric lymphadenitis, Hirschprung’s disease, DKA, sickle cell disease
What are common reasons behind GI complaints in children aged between 6 and 11 years old?
Gastroenteritis, UTI, constipation, appendicitis, trauma, testicular tortion, mesenteric lymphadenitis, abdominal migraine, Hirschprung’s disease, DKA, sickle cell disease, pneumonia, functional abdominal pain
What GI problems do children aged from 12 to 18 years old present with?
Gastroenteritis, UTI, constipation, appendicitis, trauma, ovarian/testicular tortion, dysmenorrhoea, DKA, Mittelschmerz, threatened miscarriage, ectopic pregnancy, PID, IBD, adrenal crisis
How do children with MSK problems present?
Painful joints, limp, trauma
What are some causes of joint pain in children?
Inflammatory arthritis, Perthes disease, slipped femoral epiphyses, Osgood-Schlatter’s, growing pains, bone tumours
What are some causes of a limp and trauma in children?
Limp = developmental dysplasia of hip, Perthes Trauma = sprain, fracture, NAI
What are some other paediatric areas that a GP may encounter?
Skin complaints, ENT conditions, ophthalmology, mental health issues, behavioural problems, haematology
How are GPs involved in paediatric public health?
Childhood vaccinations, disease notification, childhood 6-8 week developmental screening, obesity
What is looked at in the 6-8 week childhood developmental screening?
Red light reflex, hip examination (barlows/ortolanis), genitalia, femoral pulses
May also be carried out by health visitor
When do routine immunisations begin?
At two months old
End at 14 years old
What are some red flags in the paediatric age group?
Unresponsive to social cues/difficult to rouse
Weak, high pitched or continuous cry
Grunting respiration/apnoeic episodes (SpO2 <90%)
Severe tachypnoea or tachycardia
Bradycardia <60 bpm
No wet nappies/not passed urine in last 18hrs
Non-blanching rash or mottled/ashen/cyanotic
Temperature <36 degrees
Temperature >38 degrees if <3 months old
What are amber flags in paediatric patients?
Abnormal response to social cues/not smiling
Reduced activity or very sleepy
Moderate tachypnoea or tachycardia
Carer reports behaviour is abnormal
Capillary refill >= 3s
Reduced urine output
Pale of flushed, leg pain or cold extremities
What is classed as severe tachypnoea?
<1 year old is >=60 bpm
Age 1-2 years is >=50 bpm
Age 3-4 years is >= 40 bpm
What is classed as moderate tachypnoea?
<1 year old = 50-59 bpm
Age 1-2 years = 40-49 bpm
Age 3-4 years = 35-39 bpm
What is classed as severe tachycardia?
<1 year old is >= 160 bpm
Age 1-2 years is >= 150 bpm
Age 3-4 years is >= 140 bpm
What is classed as moderate tachycardia?
<1 year old = 150-159 bpm
Age 1-2 years = 140-149 bpm
Age 3-4 years = 130-139 bpm
