Growth & development Flashcards
What is the most reliable sign of dehydration in babies?
Weight loss
How is BMI calculated?
(weight in kg) / (height in meters)^2
What outcomes from the assessment of FTT would suggest inadequate nutrition or a growth disorder?
- Height more than 2 centile spaces below the mid-parental height centile.
- BMI below the 2nd centile.
List some causes of hypogonadotropic hypogonadism
Abnormal functioning of hypothalamus or pituitary:
- Previous damage to the hypothalamus or pituitary, for example by radiotherapy or surgery for previous cancer.
- GH deficiency.
- Hypothyroidism.
- Hyperprolactinaemia.
- Serious chronic conditions can temporarily delay puberty (e.g. cystic fibrosis or inflammatory bowel disease).
- Excessive exercise or dieting can delay the onset of menstruation in girls.
- Constitutional delay in growth and development.
- Kallman syndrome.
List some causes of hypergonadotropic hypogonadism
Due to abnormal functioning gonads:
- Previous damage to the gonads (e.g. testicular torsion, cancer or infections, such as mumps).
- Congenital absence of the testes or ovaries.
- Kleinfelter’s Syndrome (XXY).
- Turner’s Syndrome (XO).
Kallman syndrome is associated with…
A reduced or absent sense of smell (anosmia).
Outline the common causes of vomiting in childhood
- Gastro-oesophageal reflux.
- Gastroenteritis.
- Infection e.g. meningitis, UTI, pneumonia, otitis media, tonsillitis.
- Food allergy or milk intolerance.
- Appendicitis.
- Overfeeding.
- Accidental poisoning e.g. iron, alcohol, paracetamol.
- Congenital pyloric stenosis.
- Strangulated hernia.
- Intussusception.
- Volvulus/stenosis/atresia.
- Hereditary metabolic disorder.
- Space occupying lesions or head injury.
- Cyclical vomiting.
- Eating disorders.
- Intestinal obstruction.
Why do 90% of GORD cases resolve before 1 year of age?
- Increased length of oesophagus.
- Increased tone of lower oesophageal sphincter.
- Upright position and weaning.
X-ray finding in duodenal atresia?
Double bubble sign
In neonates or infants, bile stained vomit is an indication of what?
Bowel obstruction.
But can be dysmotility associated with prematurity.
Management of suspected intestinal obstruction?
NBM, NG tube, IV fluids and abdominal X ray. Refer to paediatric surgery.
X-ray of Hirschsprung’s disease shows what?
Dilated bowel loops and no gas in rectum.
What is the most common cause of gastroenteritis in children?
Rotavirus
List signs of dehydration in children
- Unwell.
- Irritable/lethargic.
- Reduced urine output.
- Pale or mottled skin (shock).
- Cold extremities (shock).
- Warm extremities.
- Sunken eyes.
- Dry mucous membranes/skin turgor.
- Tachycardia/tachypnoea/hypotension/delayed CRT/thready peripheral pulse.
- Unresponsive.
What is the mainstay of treatment for dehydration in children?
Oral rehydration supplements (ORS)
Name some causes of chronic diarrhoea in children
- Coeliac disease (most common).
- Lactose intolerance - primary and secondary.
- Functional GI disorders - toddler diarrhoea (increased transmit time) and IBS.
- Chronic bowel infection.
- IBD.
- Food allergy and intolerances.
- CF in babies with FTT.
- Small intestinal bacterial overgrowth.
- Malignancy of bowel (rare).
At what age is enuresis abnormal?
> 5
Why is there projectile vomiting in pyloric stenosis?
Due to increasingly powerful peristalsis in stomach as it tries to push food into the duodenum.
Cow’s milk intolerance vs. Cow’s milk protein allergy
Cow’s milk intolerance presents with the same gastrointestinal symptoms as cow’s milk allergy (bloating, wind, diarrhoea and vomiting), however it does not give the allergic features (rash, angio-oedema, sneezing and coughing).
Describe the process of desensitisation of the rectum in children leading to constipation
Children develop a habit of not opening bowels when they need to and ignoring sensation of a full rectum —> desensitisation —> retain faeces —> faecal impaction —> overflow incontinence.
Describe how you would assess acute diarrhoea in children
- How long?
- Blood in stool?
- Any other symptoms e.g. fever, abdo pain, vomiting, lethargy, responsiveness.
- Assess for dehydration: CRT, BP, HR, sunken eyes/fontanelles, skin turgor, mucus membranes, tears, urine output, cold extremities, pallor.
Outline the causes of chronic diarrhoea in infancy and childhood
- Coeliac disease
- IBD
- Functional GI disorders
- Food allergies and intolerances (e.g. cows milk protein or lactose)
- Small intestinal bacterial overgrowth
- Recurrent gastroenteritis
List some other differentials for septic arthritis
- Transient synovitis
- Perthes disease
- Slipped upper femoral epiphysis
- Juvenile idiopathic arthritis
- Osteomyelitis
Describe the pathogenesis of septic arthritis
Bacteria will ‘seed’ to the joint from a bacteraemia (e.g. recent cellulitis, UTI, chest infection), a direct inoculation, or spreading from adjacent osteomyelitis.
