Lecture Day One Flashcards
What is growth?
An increase in height and weight and a failure to grow normally is abnormal
What are the four phases of growth?
- Intra-uterine/Pre-natal
- Infantile
- Childhood
- Adolescents (Puberty)
What impacts on fetal growth the most?
The uterine environment
What impacts on infantile growth?
- Nutrition
- Good health and happiness
- Thyroid hormones
What impacts on childhood growth?
- Growth hormone
- Thyroid hormones
- Good health and happiness
- Genes
What impacts on growth during puberty?
- Testosterone/oestrogen
2. Growth hormone
What is the average birth weight?
7lb-7.5lbs or 3-3.3kg
What is the average head circumference at birth?
35cm
When do teeth first appear?
6 months
How do you calculate expected weight in kg in a child aged 1 - 10 years?
2 x (age + 4)
What is the normal requirement of feed per day for babies?
150mls/kg/day
So if a baby weights 5kg, what is the normal requirement of feed for them?
150 x 5 = 750mls per day
How many mls are there in an oz?
30mls per oz
So how many oz per day if 750mls per day?
25oz per day
Up to what age is it recommended that children have full fat milk?
5 years of age
How are maintenance fluids calculated in children?
1st 10kg = 100mls/kg/day
2nd 10kg = 50mls/kg/day
3rd and subsequent kg = 20mls/kg/day
Freddie is 28kg and is vomiting, requiring maintenance IV fluids, calculate his hourly IV fluid requirement?
10kg - 100mls/kg/day = 1000 / day
10kg - 50mls/kg/day = 500 / day
8kg - 20mls/kg/day = 160 / day
1000 + 500 + 160 = 1660/24 to get hourly = = 70mls per hour
How is BMI calculated?
Weight/Height(squared)
What are the 4 areas of development?
- Gross motor
- Fine motor
- Speech and language (hearing)
- Social
At what age is the median for learning to crawl?
8-9 months
At what age is the median for walking unsteadily?
12 months
At what age is the median for walking steadily?
15 months
What may be a reason an 18 month old isn’t walking, and it is not a cause for concern?
They may be a bottom shuffler - find they get around a lot faster doing this, so less inclined to walk
How would you test an 18 month old who isn’t walking to see if there are more worrying signs?
Lie them supine and see if they roll over to prone and get themselves off the floor
What is important when looking for developmental warning signs? - what can you do to test/find out more?
- Family history
- Maternal concern
- Persisting primitive reflexes
- Discordant development (one area slower in development than others)
- Regression (very concerning)
What is the moro reflex?
Holding baby carefully, move baby downwards (as if pretending to fall) and see if they splay both arms outwards - looking forward asymmetry in this action
What other primitive reflexes can be tested in a baby?
Palmar reflex - finger in their palm, they will hold your finger
Finger in mouth - suck finger
At what age do primitive reflexes disappear?
3 months
Which primitive reflex develops from 9 months and stays for life?
Parachute reflex - put hands forward to stop falling on face
What screening procedures are done in a baby - eyes?
Looking for red reflex: loss of this can mean…
Retinoblastoma
Cataracts
What is the 1 week Guthrie screening procedure for? (5)
- PKU
- Hypothyroidism
- CF
- Haemoglobinopathies
- Acylcarnitine
What is enuresis?
Inappropriate voiding of urine after the age at which bladder control should have been achieved
What is encopresis?
Passage of fences into the clothes by day or night (after the age of 4 years is abnormal)
What are the causes of encopresis after the age of 4?
Chronic constipation/faecal impaction
What is concerning about a 2 year old with a history of asthma has a RR of 12 and a heart rate of 80?
They should have a RR and HR higher than those given - sign they may be suffering from hypoxia, and exhaustion
What % of babies will have passed meconium within 48 hours?
95%
What are the possible causes of delayed passage of meconium?
- Hirschsprungs
- Anal atresia/stenosis
- Meconium ileus
- Volvulus
What % of babies will micturate within 24 hours?
95%
What % of birthweight loss is worrying?
10% or more
What % of babies should sleep through the night by 6 months?
90%
How many hours sleep do babies at birth require?
16 hours per day
How many hours sleep do babies at 6 months old require?
14 hours per day
At what age range does ‘sudden unexplained death’ occur in children?
1-12 months
What is the difference in cardiac arrest in children compared to adults?
Childrens cardiac arrest is not often of cardiac origin - more commonly respiratory, whereas with adults it is normally cardiac
What are the respiratory failures that can lead to cardiac arrest? (6)
Obstructive causes: 1. Foreign body 2. Asthma 3. Croup Respiratory depression causes: 1. Convulsions 2. Poisoning 3. Raised ICP
What are the circulatory failures that can lead to cardiac arrest? (6)
Fluid maldistribution: 1. Septic shock 2. Anaphylaxis 3. Cardiac failure Fluid loss: 1. Vomiting 2. Burns 3. Blood loss
How do you open a children’s airway?
0-8 years - ensure head is just looking straight up (if lying supine for example)
8+ years - hyperextend head, but not as much as in adults ‘sniffing the morning air’
What signs in children are there of respiratory distress? (6)
- Subcostal/intercostal recession
- Tracheal tug
- Grunting
- Nasal flare
- Head bobbing
- Exhaustion - increased effort may be absent!
How do you test for breathing efficacy? (4)
- Chest expansion
- Auscultation - air entry ok?
- Pulse oximetry (>94%)
- Blood gas - high CO2?
What is the response to breathing if there is a problem? (6)
- If not breathing - ventilate with a bag-valve mask device
- Give 02 15l/min via a non-rebreathe mask with reservoir bag
- Aim 02 saturations 94-98%
- ABG
- CXR
- Site an NG tube (especially if used a BVM)
What is the response in circulation for emergency response in children? (4)
- IV/IO acccess
- Blood gas, glucose stick, laboratory tests (FBC, U&Es, LFTs, CRP, blood culture, cross-match)
- 3-lead cardiac monitoring or 12-lead ECG
- Fluid bolus 20mls/kg
Why is hypotension in a child worrying?
It is a pre-terminal sign! Childrens blood pressures do not drop until the very last minute
In the disability category for RRAPID for children, what is important to recognise? (5)
- AVPU - patient alertness
- Pupils - size and reaction to light
- Posture
- Blood glucose
- Evidence of seizure?
What is important to assess in exposure in RRAPID? (4)
- Rashes
- Temperature
- Injuries (fractures/bruising/burns)
- Smells (ketones/poisons)
