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.
What is the most common cause of hip pain in children aged 3-10 years?
Transient synovitis
A child presenting with joint pain and fever should have urgent management for what?
Septic arthritis
What is the most common type of arthritis in children < 16?
Juvenile idiopathic arthritis
Describe the clinical features of juvenile idiopathic arthritis
- Joint pain
- Limp
- Joint swelling
- Joint stiffness
- Fever
- Lymphadenopathy
- Rash on trunk
Aetiology of juvenile idiopathic arthritis?
Autoimmune
What are the complications of juvenile idiopathic arthritis?
- Eye inflammation
- Growth problems
- Joint damage
Outline the treatment for juvenile idiopathic arthritis
- NSAIDs
- Corticosteroids e.g. prednisolone
- DMARDs e.g. methotrexate
- Tocilizumab (inhibits IL-6 inflammation)
- Adalimumab or etanercept (TNF alpha inhibitor)
- Abatacept (inhibits T cell activation)
- Tofacitinib (JAK inhibitor)
A 5 year old boy presents with vague symptoms of muscle weakness and you notice them using their hands on their legs to help them stand up. What’s the most likely diagnosis?
Duchennes muscular dystrophy
What’s the genetic inheritance of Duchennes muscular dystrophy?
X-linked recessive
Hyperactivity and short stature are associated with which paediatric orthopaedic condition?
Perthes disease
Management for children below 0.4th centile for height
- Reviewed by a paediatrician
- TFTs and IGF tests
Can aspirin be given to a child?
No because it can cause Reye’s syndrome (encephalopathy and liver damage).
What is the investigation of choice for intussusception?
US
Which movement is restricted in slipped capital femoral epiphysis?
Internal rotation of the leg in flexion.
Parents bring their 4 week old formula fed infant to the short stay paediatric ward. They are concerned because he has persistent non-bilious vomiting and is becoming increasingly lethargic. Despite this, his appetite is substantial. On examination, he appears pale and you can see visible peristalsis in the left upper quadrant. What is the most likely diagnosis?
Pyloric stenosis
Describe the vomiting in pyloric stenosis
Projectile, non-bilious vomit
For malrotation and duodenal atresia, is the vomiting bilious or non-bilious?
Bilious
Name some risk factors for DDH
- Female
- Breech from 36 weeks
- FHx
How might an older child with missed DDH present?
Trendlenberg gait and leg length discrepancy.
US is generally used to confirm diagnosis of DDH in children <4.5 months. However in a child >4.5 months which imaging method would be first line?
X-ray
Which drug is first line for nocturnal enuresis?
Desmopressin
Describe the typical volume of fluids a baby should receive in the first week of life
- 60mls/kg/day on day 1
- 90mls/kg/day on day 2
- 120mls/kg/day on day 3
- 150mls/kg/day on day 4 and onwards
First line treatment for infant with suspected cow’s milk protein intolerance/allergy?
Extensively hydrolysed formula
What is the definite management of intestinal malrotation?
Ladd’s procedure
What is the definitive diagnosis for Duchenne’s muscular dystrophy?
Genetic testing
What is the metabolic abnormality associated with pyloric stenosis?
Hypochloraemic, hypokalaemic metabolic alkalosis
What is the first line treatment for GORD in babies?
- Alginate (e.g. Gaviscon) if breastfed.
- Feed thickener if bottle-fed.
What is the first line treatment for nocturnal enuresis if general advice has failed?
Enuresis alarm
Outline features of growing pains
- Never present at the start of the day after the child has woken.
- No limp.
- No limitation of physical activity.
- Systemically well.
- Normal physical examination.
- Motor milestones normal.
- Symptoms are often intermittent and worse after a day of vigorous activity.
What is the most common cardiac pathology associated with Duchenne muscular dystrophy?
Dilated cardiomyopathy
What is the gold standard investigation for the diagnosis of Hirschsprung’s disease?
Rectal biopsy
A 13-year-old girl presents to clinic with right knee pain. She is a keen hockey player but has had no recent injuries. On examination there is a painful swelling over the tibial tubercle. What is the most likely diagnosis?
Osgood-Schlatter disease
A two-week-old child is brought to the emergency department by his parents. He was slow to establish on feeds but was discharged home three days following delivery. During the past 7 hours he has been vomiting and the vomit is largely bile stained. On examination, he has a soft, distended abdomen.
Intestinal malrotation
A 4-week old baby is developing well and develops profuse and projectile vomiting after feeds. He has been losing weight and the vomit is described as being non-bilious.
Pyloric stenosis
Bilious vomiting on the first day of life is likely due to…
Intestinal atresia.
Malrotation usually presents on the 3rd day of life.
A 16-year-old female presents with chronic left knee pain. The pain is typically felt after jogging. There is also intermittent swelling and locking of the same joint. What is the most likely diagnosis?
Osteochondritis dissecans
