Others

Question 1

What is the most common cause of death in children aged 1 month to 1 year?

Answer 1

Sudden infant death syndrome (SIDS)

- “Cot death”

Question 2

What are some preventive measures/advice to give to parents to avoid SIDS?

Answer 2

• Supine sleeping position
• Avoid co-bedding
• Avoid smoking in the house
• Avoid over-heating
• Feet-to-foot position while sleeping
• Blanket not covering head

Question 3

What is the peak age for SIDS?

Answer 3

2-4 months

Question 4

What is the peak age of accidental poisoning in children?

Answer 4

30 months

Question 5

How do one manage a child with suspected poisoning?

Answer 5

1. Identify the agent.
2. Identify the toxicity of the named agent.
3. Decide if removal of the poison is indicated by
   &raquo_space; Activated charcoal: most effective
   &raquo_space; Gastric lavage: rarely used in children
   &raquo_space; Induced vomiting with ipecac
   &raquo_space; Little evidence this works if presentation is at more than 1 hour of ingestion
4. Investigations
   &raquo_space; BG for alcohol
   &raquo_space; Blood levels for:
   - Alcohol
   - Paracetamol
   - Salicylates
   - Iron
   - Digoxin
   &raquo_space; Toxicology screening
5. Clinical management
   &raquo_space; Admission
   &raquo_space; Specific antedotes
6. Assess social circumstances

Question 6

What are the features of non-accident injuries/physical child abuse?

Answer 6

Fractures

• In a non-mobile child
• Rib fractures
• Spiral fractures
• Multiple fractures of different ages

Bruising

• The shape of a hand or any object
• Around the wrists suggesting ligatures
• Around the neck suggesting strangulation
• On the buttock of a child > Look out for retinal hemorrhages and intracranial/subdural hemorrhages

Question 7

What are the advantages of breast-feeding?

Answer 7

For the infant

• Ideal nutrition for infants in the first 4–6 months of life
• Reduces the risk of gastrointestinal infection, and, in preterm infants, of necrotising enterocolitis
• Enhances mother–child relationship
• Reduces risk of insulin-dependent diabetes, hypertension and obesity in later life

For the mother

• Promotes close attachment between mother and baby
• Increases the time interval between children
• Possible reduction in premenopausal breast cancer

Question 8

What is the most common nutritional disorder affecting children and adolescents?

Answer 8

Obesity

Question 9

How do we define obesity in children?

Answer 9

> 91th centile: overweight
98th centile: obesity
3.5SD: very severe obesity
4SD: extreme obesity

Question 10

What are the causes of obesity in children?

Answer 10

Exogenous
- Over-eating

Endogenous
- Hypothyroidism
- Cushing’s syndrome
- Syndromal causes: Prader Willi syndrome (look for hypotonia, hypogonadism and dysmorphic facies with almond-shaped eyes and fair complexion)
- Leptin deficiency (> Over-eating children with obesity are typically also taller due to over-nutrition.
» Short obese patients should be investigated for endogenous causes.

Question 11

What are the complications of obesity?

Answer 11

Orthopedic

• Slipped capital femoral epiphysis
• Tibia vara
• Feet abnormalities

Metabolic conditions

• Type II DM
• Hypertension
• Abnormal lipid profile

Other medical conditions

• Idiopathic intracranial hypertension
• Polycystic ovarian syndrome
• Gallbladder disease

Psychosocial

• Low self-esteem
• Depression