Growth and development Flashcards
What are the differentials for failure to thrive?
GI: Coeliac disease, dietary protein intolerance (cow’s milk protein allergy), carbohydrate intolerance (lactose intolerance), pyloric stenosis, GORD/oesophagitis, cystic fibrosis, IBD, pernicious anaemia
Non-GI: Constitutionally small, nutritional neglect, not eating enough, emotional neglect, eating disorder, hypothyroidism/hyperthyroidism, anaemia
Other differentials: Prenatal - prematurity, IUGR, Chr abnormalities, toxins (alcohol, smoking, drugs)
Others - Poor feeding, inborn errors of metabolism, chronic infections, malignancy
What are the Ix for failure to thrive?
Bedside: Neonatal exam, looking for signs of neglect
Bloods: FBC, Blood film, iron studies, vit B12, Anti-TTG antibodies (Coeliac disease)
Other: Measure height and weight - plot on growth chart and track centile
Ask for maternal and paternal weight - plot on growth chart and calculate mid parental centile
CF blood test - pilocarpine sweat test?
What is the Mx for a constitutionally small baby?
Reassure parents
Safety net
Regular follow up with GP with possible referral to specialist paediatric doctor if concerns grow
What questions should you ask for failure to thrive?
HPC:
DOP
Associated Sx: vomiting, irritability, feeding - how? poor feeding, frequency dirty nappies? wet nappies? nature of stool? bloating? losing weight? lethargic/tired? pain? cough? seizure?
Diet and appetite - when you feed is he full or still hungry? What does he eat in a normal day? Do any of them seem to not suit him?
BINDS - Pregnancy and birth and neonatal period
Height and weight - is this normal?
Gross motor function, fine motor function, social function, vision and hearing, immunisation schedule remember social worker/social services!
RF during pregnancy? smoking, alcohol consumption, illness, use of medications and now??
PMH, PSHx, previous hospitalisation?
FHx - constitutionally small? any other health problems in the family?
Social history - parent jobs, siblings - same problems?, special dietary requirements, living accommodation, second hand smoke exposure?
ICE
If general advice and reward systems have not helped for a child who wets the bed, what is the first-line treatment?
Enuresis alarm
What is the tx if an enuresis alarm fails for bed-wetting?
Desmopressin
How does an enuresis alarm work?
A bedwetting alarm has a sensor attached to an alarm. The sensor is put onto child’s pajamas or beneath the child. If the sensor gets wet, it sets the alarm off and wakes your child up. Over time, the alarm should help your child to learn when they need to wee and wake up to go to the toilet.
How does desmopressin work for bed-wetting?
Desmopressin works by reducing the amount of urine produced in the body at night by the kidneys. This means that the bladder then fills with less urine during the night. Desmopressin is usually taken at bedtime.
The need for treatment should be assessed every 3 months as children often produce more vasopressin as they get older. After a week off, if the Desmopressin is still required, repeated courses can be used and can be continued as long as necessary.
What is the difference between desmopressin and vasopressin?
Desmopressin (1-deamino-8-O-arginine-vasopressin, DDAVP) is a synthetic analogue of arginine vasopressin. It has 10 times the antidiuretic action of vasopressin, but 1500 times less vasoconstrictor action.
A newborn baby has:
Cerebral calcification
Chorioretinitis
Hydrocephalus
What congenital infection is he likely to have contracted?
Toxoplasmosis
When is the MMR vaccine given?
12-13 months
3-4 years
When is the HPV vaccine given to girls?
12-13 years (secondary school)
Are bow legs normal in children?
In children under 3 years old, bow legging can be due to a normal variant (genu variant) and normally resolves by 4-5 years old.
How do we calculate corrected age in a premature baby?
The corrected age of a premature baby is the age minus the number of weeks he/she was born early from 40 weeks.
What is the cause of hydrocele?
Patent processus vaginalis
