Paediatric A&P Flashcards
Anatomically speaking, children are basically little adults with very similar anatomy and physiology. True or false?
False. Their anatomy varies in many ways.
NEONATE refers to a child aged between birth and how many days?
28 days. (Irrespective of any degree of prematurity).
Define In-Utero.
In the uterus / Before birth.
Define Newborn.
From delivery until first few hours after birth.
Define Infant.
First 12 months from birth (including neonatal period).
Define Child.
From first birthday to age of 18.
Infants and young children rely on the diaphragm to breathe more than adults do. True or false?
True.
Children have proportionately smaller heads than adults. True or false?
False. They have proportionately larger heads.
Infants are obligate mouth breathers. True or false?
False. They are obligate nose breathers.
Do Children have a larger and more flaccid tongue than adults?
Yes.
Define Occiput.
The back of the head. (Posterior).
Define Cephalid.
Towards the top of the head.
Is the epiglottis more or less cephalid as a child than it is as an adult?
More.
Is the epiglottis more or less elongated and flexible as a child, compared to an adult?
More.
Which anatomical structure is the narrowest part of the funnel-shaped airway?
Cricoid cartilage.
Are the mucous membranes attached loosely or tightly within the Larynx and Trachea?
Loosely.
Name 6 anatomical differences that may cause problems maintaining airway patency.
- Narrow nostrils
- Large tongue
- Loose teeth
- Compressible floor of mouth
- Horseshoe shaped epiglottis
- High anterior larynx
As a result of infants being obligate nasal breathers, obstruction of their narrow nostrils will cause severe respiratory what?
Respiratory distress.
Why is it better to use a straight bladed laryngoscope during intubation in infants?
Because of the position of the higher anterior positioning of the larynx and the large horseshoe shaped epiglottis.
Is the airway smaller or larger in infants, compared to adults?
Much smaller.
Infants have a soft palate that is more compressible, pliable and what else?
Highly vascular.
Relative to the oropharynx, the tongue in an infant is smaller compared to an adult. True or false?
False.
The larynx in infants and toddlers is relatively what in position?
Cephalad. (Anterior)
The epiglottis in infants and toddlers is short and narrow. Is it angled away or toward the long axis of the trachea?
Angled away.
Do the vocal cords have a lower or higher attachment anteriorly?
Lower.
In adults, the larynx is triangular shaped. What shape is it for children 10 years and younger?
Funnel shaped.
Compared to adults, are the upper and lower airways larger & laboriously obstructed or smaller and easily obstructed?
Smaller and easily obstructed.
Is the trachea in children long and hard or short and soft?
Short and soft.
The relatively equal incidence of right and left-sided aspiration of foreign bodies in smaller children (as opposed to adults) is predominantly due to what factor?
Symmetrical bronchi. (They are symmetrical until the age of roughly 15).
Infants rely on what type of breathing method?
Diaphragmatic. (Therefore their muscles tire earlier than adults).
Do children have a higher or lower metabolic rate?
Higher.
Do children consume more or less oxygen.
More.
Do children produce more or less CO2 production?
More.
Does the respiratory rate increase or decrease throughout childhood to adulthood?
It decreases.
What is the approximate respiratory rate for an infant aged <1 years?
a) 25-35
b) 30-40
c) 35-45
b) 30-40.
What is the approximate respiratory rate for a child aged 1-2 years?
a) 25-35
b) 30-40
c) 35-45
a) 25-35
What is the approximate respiratory rate for a child aged 2-5 years?
a) 15-20
b) 20-25
c) 24-30
c) 24-30
What is the approximate respiratory rate for a child aged 5-12 years?
a) 15-20
b) 20-24
c) 24-30
b) 20-24
What is the approximate respiratory rate for a child aged >12 years?
a) 15-22
b) 16-24
c) 12-20
12-20
If airflow resistance increases, what is the effect on the work of breathing?
It increases / becomes more difficult
Posterior displacement of what anatomical structure may cause severe obstruction to the airway?
The tongue
Define Acute.
Present or experienced to a severe or intense degree.
If the airway is obstructed, active inspiration often results in paradoxical chest movement with sternal and Intercostal retractions, rather than what?
Chest and lung expansion
The lack of lung support makes the tidal volume of infants and toddlers almost totally dependent on the movement of what?
Diaphragm
When the diaphragm movement is impeded by high intrathoracic pressure (e.g. pulmonary hyperinflation, such as what occurs in asthma) or by gastric distension, why would respiration be compromised?
Because the Intercostal muscles cannot lift the chest wall
Upper airway obstruction e.g. epiglottitis, croup, or presence of a foreign body – may cause the trachea to do what during inspiration?
Collapse. (Tracheal collapse)
Airflow is turbulent, e.g., crying creates a resistance to airflow. For this reason, the infant or child with airway obstruction should be kept as what and what possible to prevent the generation of turbulent airflow, increased airway resistance and markedly increased work of breathing?
Calm and quiet
How many nerves are contained within the umbilical cord?
Zero. There are no nerves in the placenta.
What is the per KG blood volume of infants?
80mls
What is the per KG stroke volume of infants?
1.5mls
How can cardiac output be increased?
Increasing the heart rate.
Are heart rates in infants and small children higher or lower than in older children?
Higher.
What also increases with age, causing BP to eventually normalize?
Systemic vascular resistance.
Does BP decrease or increase with age?
Increase.
Does heart rate increase or decrease with age?
Decreases.
Paediatric pulse rates 0-3 months?
85-205
Paediatric pulse rates 3 months - 2 Years?
100-180
Paediatric pulse rates 2-10 Years?
60-140
Paediatric pulse rates >10 Years?
60-100
Paediatric BP 0-1 months?
> 60
Paediatric BP 1-12 months?
80
Paediatric BP 1-10 Years?
90+
Paediatric BP >10 Years?
120
What is the formula for calculating BP?
80 + (age in years x2)
Generally, do children have life-threatening arrhythmias?
No
In infancy, is the left or right ventricle relatively large (compared to later in life)?
Right ventricle
After 4-6 months, does the left ventricle or right ventricle become more dominant?
Left ventricle
ECGs reflect RV dominance in infancy, which diminishes with age. True or false?
True
The P wave, QRS complex, and P-R interval all decrease with age throughout childhood. True or false?
False. They increase.
What two basic physiological changes increase proportionally during childhood?
Weight and Height.
Drug doses, fluid volumes, DC shock and tube size are based on what in infants?
Weight.
If age is not known, weight can be calculated in children 1-12yrs based on what formula?
(Age +4) x2
After what period of time after birth does a child’s weight reach double (x2) that of when they were born?
5 months.
After what period of time after birth does a child’s weight reach treble (x3) that of when they were born?
1 year.
What type of tape is the best known for measuring a child’s height and weight?
Broslow.
In terms of thermoregulation, do children have smaller or larger surface area proportionally?
Larger.
Do children cool quickly or slowly?
Quickly.
Small babies become hypothermic easily when ill due to what factor?
They have poorly developed heat regulation.
Children (and particularly babies) are prone to hypoglycaemia, when sick or injured. This may be exacerbated by what condition?
Hypothermia.
Infants have minimal reserves of what in their liver?
Glycogen.
Glycogen stores in the liver get used up more slowly or rapidly than an adult?
More rapidly.
Any child with a disturbed conscious level will have a good or a poor blood sugar estimation?
Poor blood sugar estimation.
Diabetic children will become hypoglycaemic for the same reason as adults. True or false?
True.
In infants, what is contra–indicated when treating choking? Back slaps or abdominal thrusts?
Abdominal thrusts.
The Liver and Spleen are less well protected in children, and may extend below where?
The Costal margin.
The bladder also extends higher out of the pelvis. Does this decrease or increase the possibility of damage in trauma?
Increase.
Why are the Liver and spleen more at risk of injury in infants?
Because they are not as protected by the rib cage.
Infants and small children have an easier transmission of forces to internal structures due their compliant chest wall. Therefore you may see no external evidence of fractures ribs. True or false?
True.
You should always lie to a child even if a procedure is going to hurt. True or false?
False. Never lie as trust will be lost forever and will have a knock on effect in the future.
