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MBChB IV Paediatrics > Growth charts and PEM > Flashcards

Growth charts and PEM Flashcards

1
Q

Why is it NB to plot patients

A

Opportunity to check growth
Idea of how well baby is doing
Opportunity counselling on feeding and development
High malnutrition rate in our country
Pick up poor growth early to intervene early

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2
Q

Criteria for SAM and MAM

A

SAM
Weight for height z score < -3 or
MUAC < 11.5cm or
Bilateral pitting oedema of nutritional origin

MAM
-3 < Weight for height z score < -2
11.5cm < MUAC < 12.5cm
NO bilateral pitting oedema of nutritional origin

AGE = 6m - 5 years

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3
Q

When to treat inpatient?

A

Pneumonia
Diarrhoea with shock
Sepsis
Metabolic - hypothermia or hypoglycaemia

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4
Q

When to worry

A 
Severe infection 
Hypothermia
Collapse due to dehydration 
Jaundice 
Hypoglycaemia
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5
Q

Features of Kwashiorkor

A

Flag sign
Moon face
Pot belly
Oedema
Dermatosis - dry scaly pigmentation, crazy paving, pseudopurpura - due decreased platelets, bullous desquamation, angular cheilitis
Decreased cell mediated immunity
Liver enlarged fatty changes
Hypokalaemia - ileus, anaemia, poor contractility
MEALS - malnutrition, oedema, anaemia, liver malfunction, skin lesions

Growth failure 
Oedema 
Dermatosis 
Immune suppression infections - measles, HSV, TB, gastroenteritis  
Other 
     Mental and neurological changes 
     Atrophic bowel - diarrhoea 
     Liver changes - fatty 
     Glucose intolerance - hypoglycaemia 
     Anaemia 
     Purpura due thrombocytopaenia
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6
Q

Step 1: Prevent and treat hypoglycaemia

A

Prevent - feed two hourly start straight way or if Necessary rehydrate first always give feed throughout night

Treat
1. conscious + destrostix < 3mmol/l
immediate feed of DF 75
OR 10% sugar solution oral 5ml/kg - 10ml/kg
OR dextrose 10% ivi bolus - 5ml/kg
2. monitor BG if this was low - repeat hourly, once treated most stabilise in 30min
3. Continue feeds
4. If BG remains < 3 mmol/L give ivi bolus 10% dextrose water 5ml/kg

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7
Q

Step 2: Prevent and treat hypothermia

A

axillary T < 36 or rectal T < 35.5
feed straight away
rewarm by
- clothing child including head
- cover warmed blanket and place a heater or lamp nearby
- pit child on mother bare chest - skin to skin and cover them
- do not use hot water bottle - scolding

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8
Q

Step 3: Prevent and treat dehydration

A

do not use IV route except in cases shock
1. Assume all children watery diarrhoea may have dehydration
2. SOROL 5ml/kg every 30min for 2 hours orally/NGT
3. 5-10ml/kg/h for next 4-10 hours
exact amount determines - child wants, stool loss, vomiting
oral rehydration safe - assume
4. replace SOROL doses at
4,6,8,10 Hours with F-75 if rehydration is continuing at these times
continue feeding starter F-75
5. observe half hourly for 2 hours then hourly for next 6-12 hours
= PR, RR, urine F, stool/vomit F

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9
Q

Signs of over hydration

A

increasing RR
increasing PR
increasing oedema
puffy eyelids

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10
Q

Step 4: Correct electrolyte imbalances

A

excess body sodium
deficiency potassium and magnesium
causes oedema = NOT diuretic
KCl 25-50mg/kg/dose oral 3x daily until oedema subsides
- < 10kg = 250 mg
- > 10kg = 500 mg
Mg 0.4-0.6 mmol/kg/d (0.2ml/kg of 50% IVI solution orally)

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11
Q

Step 5: Prevent and treat infection

A 
Infections often hidden 
Broad-spectrum AB 
- ampicillin AND aminoglycoside: gentamicin, amikacin 
ADD specific AB if appropriate 
antimalarial treatment 
GIT - metronidazole - flagyll 
Dysentery - cefotaxime or ceftriaxone
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12
Q

Step 6: Correct micronutrient deficiencies

A 
Vit A orally - > 12m = 200 000 IU 
6-12 m = 100 000 IU 
0-5 m = 50 000 IU 
MVT supplement 5ml daily - if not available additional Mg 0.2ml/kg 
FA - 2.5mg daily po 
Zinc - 2mg/kg/d 
Copper - 0.3mg/kg/d 
Iron 3-6 mg/kg/d - only when gaining weight or from second week in divided doses
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13
Q

Step 7: Start cautious feeding

A

begin feeding immediately
if hypoglycaemia or danger signs - 2 hourly
refused or no taken via NGT
DF-75 = lower fat and protein content
130ml/kg/day
monitor - amount offered and left over, vomiting, frequency watery stool, daily BW
increase up to 150ml/kg/day

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14
Q

Step 8: Achieve catch up growth

A

return of appetite
replace starter DF-75 with same amount catch-up formula DF-100 for 48 hours
increase each successive feed by 10ml until some feed remains uneaten
usually when about 30ml/kg/feed (200ml/kg/d)

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15
Q

Step 9: Provide sensory stimulation and emotional support

A

delayed mental and behavioural development
TLC
cheerful stimulating env
structured play therapy 15-30min/day
physical activity as soon child well enough
maternal involvement when possible

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16
Q

Step 10: Prepare for discharge and follow up

A 
ready for discharge when 
- no oedema 
- good appetite 
- good weight gain 
- no infection 
- playful and alert 
weight for age at least -2 Z score = considered recovered 
still low 
educate parents 
regular follow up - 2 weekly 
booster immunisations 
vit A - every 6m
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17
Q

When does major growth and development take place?

A

<5yo

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18
Q

What is the predictable amount of growth in children in 1st, 2nd and 3rd years?

A 
1st = 25cm/y
2nd = 12cm/y
3rd = 5cm/y -> puberty
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19
Q

What are the phases of growth and what do they depend on?

A

Intrauterine
Infantile (nutrition)
Childhood (GH)
Puberty (GH and sex hormones)

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20
Q

By how many years is the pubertal growth spurt of boys delayed vs girls?

A

2 years

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21
Q

Explain growth vs development

A 
Growth = incr in size, composition, distribution
Development = incr in complexity
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22
Q

What kinds of age are there?

A

Chronological
Corrected
Bone
Mental

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23
Q

When do you calculate corrected age and how?

A

<1500g or <37w

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24
Q

How do you measure bone age?

A

Osseous maturation in long bones (hand and wrist)

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25
Q

How do you measure mental age

A

Cognitive function performance

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26
Q

What factors influence growth?

A 
Genetics
Environment
Ethnicity
Psychosocial stress
Health
Nutrition
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27
Q

Name causes of a short stature

A

Familial delay
Constitutional delay
Endocrine

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28
Q

Name endocrine causes of a short stature

A 
Hypopituitarism (decr GH)
Hypothyroidism
Precocious puberty
CAH
Cushing's
Pseudohypoparathyroidism
Poorly controlled DM
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29
Q

Differentiate between familial and constitutional delay

A

Familial: skeletal = chronological age (family short)
Constitutional: skeletal < chronological (family normal)

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30
Q

What other delay will constitutional delay cause other than growth?

A

Delay in sexual maturation

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31
Q

Name causes of a tall stature

A 
Familial
Obesity
Thyrotoxicosis
Precocious puberty
Genetic (marfan's)
Chromosomal (klinefelter)
GH excess (pituitary adenoma)
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32
Q

What is the earliest finding in undernutrition?

A

Weight loss

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33
Q

Which measurement is affected last by chronic malnutrition?

A

Head circumference

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34
Q

What does MUAC measure?

A

Muscle bulk (chronicity)

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35
Q

What other charts can you get for anthropometry?

A

Turner
Down’s
CP

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36
Q

At what point do you stop using the corrected age of a premature child?

A

3yo

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37
Q

Which measurements are for a child <5yo

A 
Wfa
Lfa
Wfl
MUAC
HC
38
Q

Which measurements are for a child >5yo

A

Wfa
Hfa
BMI
HC if indicated

39
Q

When is it length vs height for age?

A 
Length = not walking
Height = walking
40
Q

How do you interpret length for age?

A

> 3 = very tall

41
Q

How do you interpret weight for age?

A

> 1 = possible growth problem

42
Q

How do you interpret weight for length?

A 
>3 = morbidly obese
>2 = obese
>1 = overweight risk
43
Q

How do you interpret BMI for age?

A 
>3 = morbidly obese
>2 = obese
>1 = overweight risk
44
Q

Define failure to thrive

A

Weight <3rd percentile
Weight falls across 2 major percentile curves
Weight <80% for height and age

45
Q

What is decreased weight, normal height and normal head circumference suggestive of?

A

Caloric insufficiency
Decreased intake
Hypermetabolic state
Increased losses

46
Q

What is decreased weight, decreased height and normal head circumference suggestive of?

A

Structural dystrophies
Endocrine disorder
Constitutional delay
Familial delay

47
Q

What is decreased weight, decreased height and decreased head circumference suggestive of?

A

Intrauterine insult

Genetic abnormality

48
Q

Name the clinical signs of FTT

A 
SMALL KID
Subcutaneous fat loss
Muscle atrophy
Alopecia
Lethargy
Lagging behind normal
Kwashiorkor
Infection
Dermatitis
49
Q

Name causes of failure to thrive

A
  1. Parent-child relationship
  2. Inadequate caloric intake
  3. Inadequate absorption
  4. Increased metabolism
50
Q

Which factors regarding the parent-child relationship can cause FTT?

A 
Dietary intake, feeding knowledge, improper formula mixing
Environment
Interaction and attachment
Child behaviours
Postpartum depression
Social
51
Q

Name causes of inadequate caloric intake that can result in FTT

A

Inadequate milk supply
Mechanical (cleft)
Oromotor dysfunction
Toxin-induced anorexia

52
Q

Name causes of inadequate absorption that can result in FTT

A 
Biliary atresia
Coeliac disease
IBD
CF
IEM
CMPA
Pancreatic cholestasis
53
Q

Name causes of increased metabolism that can result in FTT

A 
Chronic infection
CF
Lung disease of prem
Asthma
Hyperthyroidism
IBD
Malignancy
Renal failure
54
Q

How do you calculate midparental height?

A 
Boy = (father + mother + 13)/2
Girl = (father + mother - 13)/2
55
Q

Name causes of increased upper to lower segment ratio

A

Achondroplasia
Short limb syndromes
Hypothyroid
Storage disease

56
Q

Name causes of decreased upper to lower segment ratio

A

Marfan’s
Klinefelter’s
Kallman’s
Testosterone deficiency

57
Q

What are the caloric needs of a child <10kg?

A

100kcal/kg/d

58
Q

What are the caloric needs of a child 10-20kg?

A

100cal + 50kcal/kg/d for each kg >10

59
Q

What are the caloric needs of a child >20kg?

A

1500cal +20kcal/kg/d for each kg>20

60
Q

What is a z score?

A

Deviation of value for an individual from median value of reference population divided by standard deviation of reference population

61
Q

Differentiate kwashiorkor and marasmus

A

Kwashiorkor (oedematous malnutrition) vs marasmus (wasting syndrome)
All kwashiorkors = SMA

62
Q

How can you qualify kwashiorkor oedema?

A

+1 feet/lower legs
+2 arms/upper body
+3 face

63
Q

Which group of children are at highest risk for marasmus?

64
Q

Which group of children are at highest risk for kwashiorkor?

65
Q

Name features of marasmus

A 
Head large relative to body
Emaciated arms, thighs, buttocks
Baggy pants
Thin, dry skin
Thin, sparse hair
66
Q

What is NAIDS?

A

Nutritionally acquired immunodeficiency syndrome
Cell mediated immunity affected -> atrophy of T cell lymphoid tissue -> decr IgA
B cells normal -> normal IgG

67
Q

Give examples of immunosuppressed infections

A 
TB
Measles
Gastroenteritis
HSV
Gardia lambdia
Gram - septicaemia
Infective mononucleosis
68
Q

Name the IMCI danger signs

A 
Lethargy
Shock
Bleeding
Respiratory distress
Weeping skin lesions
Jaundice
Dehydration
Hypothermia
Convulsions
Hypoglycemia
Vomiting all feeds
Feed refusal
69
Q

What are the heart rate reference ranges for all ages?

A 
Neonates 100-160
Infant 90-120
2-5y 95-140
5-12y 80-120
>12y 60-100
70
Q

What are the SBP reference ranges for all ages?

A 
Neonates 60-90
Infant 80-100
2-5y 80-120
5-12y 90-110
>12y 100-120
71
Q

What are the respiratory rate reference ranges for all ages?

A 
Neonates 30-60
Infant 30-40
2-5y 20-30
5-12y 15-20
>12y 12-15
72
Q

Which nutrient deficiency(s) cause hair colour changes?

A

PEM

Selenium

73
Q

Which nutrient deficiency(s) cause quality and hair texture changes?

74
Q

Which nutrient deficiency(s) cause alopecia?

75
Q

Which nutrient deficiency(s) cause skull deformities?

A

Vitamin D

Calcium

76
Q

Which nutrient deficiency(s) cause mouth bleeding?

A

Vitamin C

Vitamin K

77
Q

Which nutrient deficiency(s) cause angular stomatitis?

A

Riboflavin B2
Niacin B3
Iron
Zinc

78
Q

Which nutrient deficiency(s) cause tongue pallor, thrush, atrophy and hypertrophy?

79
Q

Which nutrient deficiency(s) cause glottis?

A

Riboflavin B2

80
Q

Which nutrient deficiency(s) cause cardiomyopathy?

A

Thiamine B1

Selenium

81
Q

Which nutrient deficiency(s) cause pallor?

A 
Microcytic - iron
Macrocytic - folate
Megaloblastic - B12
Haemolytic - vitamin E
Sideroblastic - copper
82
Q

Which nutrient deficiency(s) cause koilonychia?

83
Q

Which nutrient deficiency(s) cause rachitic rosary, scoliosis, lordosis, genu valgus?

A

Vitamin D
Calcium
Copper

84
Q

Which nutrient deficiency(s) cause hepatomegaly?

85
Q

Which nutrient deficiency(s) cause xeropthalmia and bitot spots?

86
Q

Which nutrient deficiency(s) cause ataxia?

87
Q

Which nutrient deficiency(s) cause peripheral neuropathy?

A

Vitamin E

Pyridoxine B6

88
Q

Which nutrient deficiency(s) cause polyneuritis?

A

Thiamine B1

89
Q

Which nutrient deficiency(s) cause dementia?

90
Q

Which nutrient deficiency(s) cause dermatitis?

A 
PEM
Riboflavin B2
Niacin B3
Zinc
EFA
91
Q

Which nutrient deficiency(s) cause pruritis?

MBChB IV Paediatrics (81 decks)

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