Paediatric differentials Flashcards
State some differentials for a child presenting with developmental delay (rough categories with examples, pre-natal perinatal and post-natal)
Pre-natal:
- Genetic disorders e.g. Down’s syndrome
- Maternal infections e.g. congenital rubella syndrome
- Toxins during pregnancy e.g. smoking, anti-epileptic drugs
- Abnormal brain development e.g. microcephaly
Perinatal:
- Prematurity / IUGR
- HIE
- Metabolic abnormalities e.g. severe jaundice
Post-natal:
- Infections e.g. meningitis / encephalitis
- Metabolic abnormalities e.g. hypernatraemia
- Trauma
- Stroke / haemorrhage
Other:
- Social / abuse
- Maternal mental health condition
Outline a ‘brief resolved unexplained event’ (BRUE), or ‘apparent life threatening event’ (ALTE)
- Description
- Symptoms which can be reported during episode
Brief resolved unexplained event (BRUE), or apparent life threatening event (ALTE)
- Defined as an event occurring in an infant < 1 year, where the caregiver reports a sudden, brief, and now resolved episode of one or more of the following symptoms:
- Cyanosis or pallor
- Absent / decreased / irregular breathing
- Change in tone (hypo or hyper)
- Altered level of responsiveness
- Often presents with a well looking child but a severely distressed parent, who has witnessed an event during where they thought their child was going to die
- 50% cases the cause is unknown
- GORD is most common (31% cases)
State some potential causes of a ‘brief resolved unexplained event’ (BRUE)
- GI
- Neurological
- Respiratory
- Cardiac
- Metabolic
- Infection
- Child abuse / ingestion
From most common to less common
GI:
- GORD
- Swallowing problems
Neurological:
- Head injuries
- Seizures
- CNS infection
Respiratory:
- URTI or RSV
- Whooping cough
- Breath holding spells
- Obstructive Sleep Apnoea (OSA)
Cardiac:
- Congenital heart disease
- Arrhythmias
- Prolonged QT interval
- Wolff Parkinson White (WPW) Syndrome
Metabolic:
- Inborn errors of metabolism
- Electrolyte disturbances (hypocalcaemia or hypoglycaemia)
Infective:
- Meningitis
- Sepsis
Child abuse / accidental ingestion of toxins/drugs:
- Suffocation
- Shaken baby syndrome
State some differentials for a child presenting with acute joint pain/swelling
- Trauma (accidental or non-accidental)
- Septic arthritis
- Osteomyelitis
- Haemarthrosis
- Cellulitis
- Arthritis, reactive synovitis, irritable hips
- Malignancy
- Rheumatological e.g. Kawasaki disease
State some red flags for a child presenting with acute joint pain/swelling
- High fever
- Systemically unwell
- Rash / peeling fingertips
- Unclear history / delay accessing help
- Unexplained bruising
Suggest some differentials for a unconsolable crying baby
Benign:
- Normal crying behaviour
- Hunger
- Tiredness
- Pain
Acute onset:
- Raised ICP
- Trauma e.g. clavicle fracture, non-accidental injury
- Incarcerated inguinal hernia
- UTI
- Hair tourniquet
- Corneal foreign body/abrasion
- Food intolerance e.g. non-IgE cow milk / soy protein allergy
- GORD
State some causes of infant feeding prblems
Anatomical abnormalities e.g. cleft lip/palate, tongue-tie, tracheo-oesophageal fistula, oesophageal stricture
Neurological / neuromuscular e.g. cerebral palsy, congenital myotonic dystrophy, neurodevelopmental disorders
Genetic conditions e.g. Down’s syndrome
GI disorders e.g. GORD, colic, cows’ milk protein allergy, coeliac disease, lactose intolerance
Prematurity and intrauterine growth restriction
State some differentials for a child presenting with a limp in the following age categories:
< 3 years old
3–10 years
10–19 years
All ages
< 3 years old:
- Fracture or soft tissue injury (toddler’s fracture or maltreatment)
- Developmental dysplasia of the hip
3–10 years:
- Fracture or soft tissue injury (stress fracture or soft tissue injury)
- Transient synovitis
- Perthes’ disease
10–19 years:
- Fracture or soft tissue injury (stress fracture or soft tissue injury)
- SUFE
- Perthes’ disease
- Osgood-Schlatter disease
- Sever’s disease
All ages:
- Septic arthritis / osteomyelitis
- Malignancy e.g. osteosarcoma, leukaemia, lymphoma
- Non-malignant haematological disease e.g. Sickle cell disease
- Rickets / metabolic disturbances
- Inflammatory muscle or joint disease
Outline a toddler’s fracture
A ‘toddler fracture’ is subtle undisplaced spiral fracture of the tibia typically seen in pre-school children
Usually caused by a sudden twist, often after an unwitnessed fall
State some differentials for a child presenting with oedema
- Nephrotic syndrome
- Heart failure (? secondary to congenital heart defect)
- Allergic reaction
- Malnutrition (Kwashiorkor)
State the most common mechanisms of injury in the following ages groups
- Infants
- Preschoolers
- School age
- Older children / adolescents
Infants:
Reach and grasp for objects / cruise around furniture
- Inhaled foreign bodies (majority at home)
- Falls (majority at home)
Pre-schoolers (1-4 years):
Increased mobility and curiosity, without awareness of hazards or dangers
- Falls
- Burns
- Unintentional ingestion
School age children (5-9 years):
Developing skills such as cycling, climbing etc.
- Falls from playground equipment / trampolines
Older children / adolescents:
Engage in risk-taking behaviours
- RTA
- Assault
- Deliberate self-harm
- Intoxication
State some differentials for a child presenting with apnoea
- Idiopathic / brief resolved unexplained event (BRUE)
- Premature poor development of mechanisms of respiratory control (apnoea of prematurity)
Central apnoea:
- Infection e.g. meningitis
- Head trauma
- Toxin exposure
- Whooping cough
- Infant botulism
- Inborn errors of metabolism
- Metabolic imbalances
- Congenital anomalies
Obstructive apnoea:
- Obstructive sleep apnea
- Infections (pneumonia, croup)
- Vocal cord paralysis
- Congenital upper airway anomalies
Mixed apnoea (central and obstructive):
- GORD
- Whooping cough
- Bronchiolitis
State some differentials for a child presenting with breathlessness
Respiratory:
- Acute respiratory infections e.g. pneumonia, viral
- Asthma
- Viral induced wheeze
- Bronchiolitis
- Cystic fibrosis / bronchiectasis / ciliary dyskinesia
- Allergic rhinitis
- Epiglottitis / enlarged adenoids
- Foreign body aspiration
- Chest wall deformations
- Tracheomalacia
Cardiovascular:
- Cardiac disease e.g. heart failure
- Anaemia
Systemic:
- Neuromuscular conditions e.g. Duchenne muscular dystrophy
- Anxiety
- Drug induced hypoventilation
State some differentials for a child presenting with a cough
Respiratory:
- Acute respiratory infections e.g. pneumonia, viral
- Asthma
- Allergic rhinitis
- Viral induced wheeze
- Bronchiolitis
- Cystic fibrosis / bronchiectasis / ciliary dyskinesia
- Croup
- Foreign body aspiration
- Post-nasal drip
GI:
- GORD / pharyngitis
Cardiovascular:
- Heart failure (pulmonary oedema)
State some differentials for a child presenting with cyanosis
Respiratory distress:
- Hypoventilation e.g. neuromuscular
- Pulmonary causes leading to ventilation-perfusion mismatch and impaired alveolar-arterial diffusion e.g. pneumonia, asthma
Cardiovascular:
- Cardiovascular shock e.g. hypovolaemia
- Right to left shunts / cyanotic heart disease
- Hemoglobinopathies e.g. methemoglobinemia
- Polycythaemia
- Local vasoconstriction e.g. hypothermia
