Paediatric differential Diagnoses + safeguarding Flashcards
Differentials for increasing sleepiness
Hypoglycaemia: poor feeding
Exhausted: WOB/feeding
Encephelopathic: infection/metabolic condition
Neurological: head injury/poor cerebral perfusion
Hypoxia
Hypercapnia
Differentials for tachycardia
Upset/anxiety pyrexia pain fear cardiac arrythmia/failure Increase WOB Sepsis/shock hypovolaemia Iatrogenic: salbutamol
Differentials of seizures
- febrile
- meningitis
- encephalopathy
- epilepsy
- sepsis
- brain tumour
- metabolic disorder
Differentials of a non-blanching rash
- Meningicoccal septicaemia if with fever MEDICAL EMERGENCY
- AI/NAI - bruising
- Henoch-Schonlein purpura
- Idiopathic thrombocytic pupura
Signs of heart failure
decrease feeding: SOB clammy when feeding Reasonable saturations Tachycardia Enlarged liver
Signs of an acutely unwell child
Abnormal breathing Increase HR/RR Sleepy pale Grunting Unclear heart sounds Hx of poor feeding Signs of HF Cold extremeties decreased sats
Differentials of difficulty breathing
Sepsis CHD/HF bronchiolitis meningoencephalitis NAI w hypovolaemia DKA Acute blood loss asthma UA obstruction Pneumonia Pneumothorax Metabolic acidosis
What is the triad of shaken baby syndrome
Retinal haemorrhages
subdural haematoma
encephalopathy
RIsk factors for Sudden infant death syndrome
prone sleeping parental smoking bed sharing hyperthermia and head covering prematurity
Causes of enuresis in a child
- Normal
- Stressors
- Constipation
- UTI
- Diabetes
Management of enuresis
- Reward charts for good behaviours like going for a wee before bed
- Adequate but not excessive intake over the day
- Restrict fluid intake just before bed
- Avoid caffeine
- Desmopressin >7
Advice for parents with children with enuresis
- NOT the child’s fault
- 99% will become dry over time
What does bile stained vomit suggest
Intestinal obstruction
What does haematemasis suggest
- Oesophagitis
- Gastric ulcer
- Oral/nasal bleeding
What does projectile vomiting suggest
pyrloric stenosis
What does abdo distention/tenderness suggest
Obstruction
strangulated inguinal hernia
surgical abdo
What does blood in stool suggest
Gastroenteritis
Salmonella
Campylobacter
Intussusception
What does a bulging fontanelle suggest
Raised ICP: Meningitis/hydrocephalus
What should you include in a feeding history
- Bottle or breast: mls vs how long on breast
- Volume before now
- Timescale of decline of feeding
- WHy does the baby stop feeding
- Any precipitating changes e.g. change formula
- ALWAYS CALCULATE FEED in mls/kg/day
Why may a baby stop feeding
- out of breathe
- pale
- clammy
- sleepiness (worrying)
Normal volume of feeds in babe
- <1 monthL 150mls/kg/day
- > 1 month 100mls/kg day
- 1-4 hourly 10-40 mins
- 8 or more feeds in 24 hours
