Paediatric Health Flashcards
Slow weight gain (causes, expected average weight per week)
Causes
- Inadequate caloric intake/retention (low milk supply, breast feeding issues, maternal restricted diet, persistent vomiting)
- Psychosocial factors (maternal depression, parental substance abuse, attachment difficulties)
- Inadequate absorption (coeliac disease, cystic fibrosis, chronic diarrhoea, cow milk intolerance)
- Excessive caloric utilisation (chronic illness, UTI, DM, cystic fibrosis, hyperthyroidism)
Weight gain
- 0-3 months: 150-200 g/week
- 3-6 months: 100-150g/week
- 6-12 months: 70-90g/week
Epiglottitis
principle of management, treatment in hospital, differential
Principle: minimal handling, oxygen optimisation, comfort position, urgent transfer.
Treatment in hospital: airway support, ceftriaxone 25 mg/kg (max 1g) IV daily for 5 days
Differentials: tonsillitis, infection mononucleosis and bacterial tracheitis
Abdominal pain - paediatrics
key points, common time critical causes, important non-abdominal causes
Key points
● Analgesia should be used and will not mask potentially serious causes of pain
● True bilious vomiting is dark green and warrants urgent surgical input
Common and time critical causes
● Neonates: Hirschsprung, incarcerated hernia, intussusception, necrotising enterocolitis, volvulus
● Infants/children: abdominal trauma, incarcerated hernia, intussusception, Meckel’s diverticulum, ovarian/testicular torsion, volvulus
● Adolescents: abdominal trauma, ectopic pregnancy, ovarian torsion/rupture, pancreatitis, PID, testicular torsion.
Non-abdominal causes: DKA, Henoch Schonlein Purpura, Pneumonia, Sepsis, STI, UTI/pyelonephritis
Abdominal pain (differentials based on history)
- Sudden onset
- Episodic/colicky (blood diarrhoea, bilious vomiting, polyuria/polydipsia/weight loss, vomiting/diarrhoea, cough/fever, dysuria)
- Dull then increasing
Sudden onset - testicular/ovarian torsion, intussusception, volvulus, perforated viscus, incarcerated hernia
Episodic/colicky - constipation, gastroenteritis, intussusception, mesenteric adenitis, ovarian torsion
- blood diarrhoea: gastroenteritis, Meckel diverticulum, IBD
- bilious vomiting: volvulus, obstruction
- polyuria/polydipsia/weight loss: diabetic ketoacidosis
- vomiting/diarrhoea: gastroenteritis
- cough/fever: pneumonia
- dysuria: UTI, pyelonephritis
Dull then increasing - appendicitis
Bronchiolitis (key points, severity, management)
Key points
- Bronchiolitis is a clinical diagnosis
- No investigations should be routinely performed
- Management includes supporting feeding and oxygenation as required
- No medication should be routinely administered
Severity indicators
- Behaviour, RR, accessory muscles, oxygen saturation/requirement, apnoiec episodes, feeding
- Refer to page 74 of GP Study Notes
Management: Minimal handling, no investigations, supportive management, education on red flags and when to
re-present.
Collapse in children (syncopal causes, mimics)
Common conditions that cause syncope ● Vasovagal syncope ● Breath holding spells ● Orthostatic hypotension ● Other: toxic exposures, hypoglycaemia and arrhythmias
Common conditions that mimic syncope ● Seizure ● Migraine syndromes ● Hysterical faint ● Hyperventilation ● Intentional strangulation ● Narcolepsy
14M, brought in after an episode of collapse with LOC while he was sitting in the schoolyard eating his sandwich.
Witnessed, jerky movements on limbs noted with the episode lasting for 1 minute. Patient embarrassed after the
incident. Nil PHx.
What are the 4 likely differential diagnoses? 5 Feature in history that will help reach a diagnosis. Features on examination.
What are the 4 likely differential diagnoses? ● Seizure ● Pseudoseizure ● Conversion disorder ● Substance withdrawal ● Hyperventilation attack ● Vasovagal syncope ● Narcolepsy What are the 5 features in history that would help you reach a diagnosis? ● History of similar attacks ● Urinary or faecal incontinence ● Particular trigger immediately preceding the attack ● Warning symptoms prior to the attack ● Substance use ● Recent head injury ● Family history of seizures What key features would you seek on examination to help you reach a diagnosis? ● Smell of alcohol ● Track marks ● Pupil size and reaction ● Rash ● Meningism ● Bitten tongue ● Fever
CAP - paediatric (key points, Ix, Tx)
Key points
● Can be diagnosed clinically (fever, cough, tachypnoea when other causes of wheezing syndromes are ruled
out)
● CXR not required for routine diagnosis (unless severe or complicated pneumonia is suspected)
● For non-severe pneumonia, high dose oral amoxicillin is recommended (even for inpatient care)
● Viruses are the most common cause of CAP in children 2 months or older.
Investigations
● CXR is only recommended for patients who require admission or if there is severe/complicated pneumonia
suspected.
● Follow up CXR is not required for patients that recover well
Treatment
Low-severity
Definition: minimal tachypnoea, absence of tachycardia, SatO2 >95% on RA.
Medication:
● Amoxicillin 25 mg/kg up to 1 g PO, 8 hourly for 3 days
● Cefuroxime 15 mg/kg up to 500 mg PO, 12 hourly for 3 days (nonsevere allergy)
● Azithromycin 10 mg/kg up to 500 mg PO, daily for 3 days (severe allergy)
Constipation (key points, background, treatment)
Key points
● Common cause is often functional
● Diagnosis is made clinically, imaging is not required
● Medications are often required
● Treatment is required for several months
Background
● Affects a third of children
● Healthy infants (<6 months) can strain and cry before passing soft stools
○ Only worry if the stools are hard
Treatment
Behaviour modification
- Position - footstool to ensure knees are higher than hips
- Toilet sits - up to 5 mins, three times a day, after meals
- Chart or diary
- Encourage exercise
- Review toilet access
- Delay toilet training until child is painlessly passing soft stools
Dietary modification - Not adequate alone in treating constipation
Medications
First line = oral laxatives
● < 1 month: coloxyl drops
● 1-12 months: Movicol or lactulose
● Children: paraffin oil
Disimpaction regime
● Indicated in children with severe constipation
● Oral medication is effective and preferred
● If suppository or enema needed then patient should be referred for
sedation
Tip: Reassure parents that it is safe and does not produce a lazy bowel. Advise
that early cessation can cause recurrence. Anal fissures can be treated with topical petroleum jelly.
Croup (epidemiology, assessment, severity, Ix, treatment)
Background:
● 6 months to 6 years
● Often worse at night
104
Assessment: Minimal examination. Do not examine the throat or upset the child further.
● Barking cough
● Inspiratory stridor
● Hoarse voice
● +/- widespread wheeze
● Increased work of breathing
● +/- fever with no signs of toxicity
Assessment of severity: (common KFP topic)
● Behaviour
● Stridor (loudness is not a good indicator of severity of obstruction)
● Respiratory rate
● Accessory muscles
● Oxygen saturations (hypoxia is a late sign, indicates life-threatening croup)
Investigations: not indicated. Can distress the child further and cause worsening of symptoms.
Treatment:
1. Minimal handling
2. Keep with carer to reduce distress
3. Leave in the position of comfort that the child adopts
4. Consider if steroids are required
● Prednisolone 1 mg/kg PO STAT and repeat the same dose in the evening OR
● Budesonide 2 mg nebuliser if oral not tolerated
5. Give adrenaline if persistent or worsening of symptoms.
Developmental milestones - newborn
GM - flexed limbs, symmetrical posture, head lag
L - startled by large noises
Developmental milestones - 6 week to 2 months
GM - raises head in prone (2 months)
FM - following moving objects (with eyes)
S - smiles responsively
Developmental milestones - 3 to 4 months
GM - head control, rolls from prone to supine
FM - reaches out for toys
L - laughs and coos
Developmental milestones - 4 to 6 months
GM - sits with support
FM - palmar grasp
Developmental milestones - 6 to 8 months
GM - sits without support (7 months), rolls from supine to prone
FM - transfers from hand to other (7 months), puts food in month
L - turns to soft sounds out of sight
S - stranger anxiety
Developmental milestones - 8 to 10 months
GM - crawling (9 months), stands (10 months)
FM - mature pincer grip (10 months)
L - different sounds to call parents
Developmental milestones - 10 to 12 months
GM - walks unsteadily
FM - drinks from a cup with 2 hands (12 months)
L - 2-3 words
S - waves goodbye, plays peekaboo
Developmental milestones - 15 months
GM - walks steadily
Developmental milestones - 16 to 18 months
FM - makes marks with crayon builds a tower of 3 cubes, holds spoon and eats safely
L - 6-10 word, shows 2 parts of body
Developmental milestones - 18 to 24 months
L - join 2-3 words to make simple phrases
S - symbolic play
Enuresis (key points, normal milestones, classification, examination, investigations)
Key points
● Most children have no significant underlying physical or emotional problem but many will feel embarrassed
as they get older.
● Generally only present for issue if it is interfering with their ability to socialise with friends.
● If the episodes are not frequent or distressing then treatment is not indicated.
Normal milestones:
● Daytime bladder control by 4 years
● Nighttime bladder control by 5-7 years
Classification: primary and secondary.
Potential pathogenesis: nocturnal polyuria, detrusor overactivity and increased arousal threshold.
Examination:
● Height, weight, BP - poor growth/loss of weight/hypertension
● Abdomen - distended bladder, faecal mass
● Inspection of external genitalia (and perianal area if constipation also present)
● Lower back/spine - exclude occult spinal dysraphism or tethered cord (asymmetric gluteal fold)
● Assessment of lower limb neurology.
Investigations: Generally not required in primary enuresis. Consider if there are red flags.
Enuresis (management)
Management:
1. Education
2. Avoid constipation
3. Regular fluids and toileting throughout the day and before bed
4. No fluid restriction but avoid caffeinated beverages in the evening
5. Non-pharmacological
● Bedwetting alarms - good long-term success and fewer relapses, recommended from 6 years of
age.
6. Pharmacological (generally last line)
Desmopressin
Indication:
● Alarm therapy has failed or is not suitable
● Requiring rapid or short-term improvement
Disadvantages:
● Relapse rates are high when withdrawn
Routes:
● Sublingual (> 6 years, 120 microg at bedtime)
● Oral (> 6 years, 200 microg at bedtime)
General advice: Both parent and child must be motivated before starting behavioural interventions
Febrile child - <28 days (corrected)
Management: Needs referral to ED
Hospital management:
● Should be assessed promptly and discussed with a senior doctor
● FBE, CRP, blood culture, urine (SPA), LP CXR
● Admit for empiric antibiotics
Febrile child - 29 days to 3 months (corrected)
** Refer to page 159 of GP Study Notes
Febrile child - > 3 months (corrected)
** Refer to page 160 of GP Study Notes
Food allergies (key points, ASCIA advice)
Key points
● Allergy to one food may increase the risk of allergies to other foods
● Testing can lead to unnecessary avoidance of foods which may lead to increased risk of children developing
an allergy to that food
ASCIA advice
● Egg, dairy (in the form of cheese or yoghurt) and peanut (in the form of a smooth paste) can be introduced
at around 6 months of age but not before 4 months.
○ The early introduction of peanuts before 6 months, in children with eczema and/or egg allergy, can significantly reduce the risk of peanut allergy at 12 months.
4 month old boy with history of atopic dermatitis and family history of anaphylaxis to eggs (father). When should eggs be introduced?
6 months
