Paediatric Histories Flashcards
What additional areas are important in a paediatric history?
Pregnancy and birth
Feeding
Development
Immunisations
What red flags should you ask about in a paediatric vomiting history?
Projectile vomiting <50% feeds taken No wet nappies Non-blanching rash Symptoms of UTI
What traffic light system questions can you ask in a paediatric history? (5*)
Colour: look paler than normal?
Hydration: feeding/drinking, wet nappies
Activity: playing as normal or more tired?
Respiratory & rashes: any difficulties? rashes?
Temperatures: felt hot/recorded temps
What are the differential diagnoses for paediatric vomiting? (6)
GORD Pyloric stenosis Interssusception Coeliac disease Meningitis Gastroenteritis
What is the presentation of GORD in a vomiting child?
Common in 1st year: immature LOS
Recurrent regurg and vomiting related to feeds
Distressed after feeds
RFs: Prem delivery & CP
What is the presentation of pyloric stenosis in a vomiting child?
Peak age: 2-7 weeks
Projectile vomiting straight after feed
Child remains hungry
Complications: dehydration, constipation and FTT
What is the presentation of interssusception in a vomiting child?
Peak age: 5-10 months
Paroxysmal colicky pain every 10-20 mins
Early: vomiting, bile stained
Late: Mucus and blood per rectum
What is the presentation of coeliac disease in a vomiting child?
Peak age: 9 months-3 years (after weaning)
Vomiting, pallor, steatorrhoea, abdo distension & FTT
What is the presentation of meningitis in a vomiting child?
Vomiting - won't take feeds Fever, irritable or lethargic Non-blanching purpuric rash Cold extremities Signs of raised ICP
What is the presentation of gastroenteritis in a vomiting child?
Diarrhoea and vomiting
Fever, irritable, unwell
Hx of recent travel
Someone else has similar problems
What red flags should you ask about in a paediatric failure to thrive history? (3)
Chronic diarrhoea
Developmental delay
Regression (inc weight loss)
What specific FH should you ask about in a paediatric failure to thrive history? (3)
Coeliac disease
Cystic fibrosis
Diabetes
What are the organic differential diagnoses for paediatric failure to thrive? (4)
Prenatal
Intake issues
Malabsorption
Metabolic disorders
What are the prenatal causes of failure to thrive? (5)
Prematurity Maternal malnutrition Congenital infections Toxin exposure in-utero Intrauterine growth restriction
What are the intake issues that cause of failure to thrive? (4)
Neuromuscular disorders = inability to suck/swallow (e.g. Cerebral palsy)
Cleft pallet
Long standing GORD/vomiting after feeds
What are the malabsorption causes of failure to thrive? (5)
IBD Coeliac Cows milk intolerance Cystic fibrosis Chronic diarrhoea
What are the metabolic disorders that cause of failure to thrive? (5)
Poor metabolism: - Hypothyroidism, - Diabetes Increased metabolic demand: - Hyperthyroidism, - Heart failure - Renal failure
What are the non-organic differential diagnoses for paediatric failure to thrive? (2)
Constitutional delay
Inadequate feeding
What red flags should you ask about in a paediatric convulsions history? (5)
Seizure lasting >15 mins Focal seizure Recurrent within same illness Otorrhoea Suspected meningitis
What differential diagnoses should you consider in a paediatric convulsions history? (5)
Febrile convulsions Reflex anoxic attack Breath holding attack Epilepsy Meningitis
What features would make you think of febrile convulsions in a convulsing child?
Age: 6 months - 5 years
High temp >38 at time of seizure, usually viral
Tonic and/or clonic, symmetrical, generalised seizure. Lasts <5 mins
No signs of CNS infection, focal neuro signs, or previous Hx of epilepsy
What features would make you think of reflex anoxic attacks in a convulsing child?
Triggered by fear, anxiety or pain Brief and spontaneous Lasts <1 min Pale and limp, briefly LoC, followed by involuntary tonic and/or clonic movements of limbs May have urinary incontinence Feels groggy after No tongue biting
What features would make you think of breath holding attack in a convulsing child?
Precipitated by emotion: anger, frustration, trauma
Crying episode
Breath held and pallor/cyanosis develops
LoC may occur
What features would make you think of epilepsy in a convulsing child?
RF: birth asphyxia, CP, trauma
Precipitants: TV, lack of sleep
Partial/generalised/absent
What features would make you think of meningitis in a convulsing child?
Unwell and drowsy child prior to convulsions with pyrexia
Non-blanching rash may be present
What should you consider if a convulsing child has a discharging ear?
Intracranial complications of otitis media
What red flags should you ask in a child with developmental delay? (7)
Loss of skill at any age Not fixing or following Can't sit unsupported at 12 months No speech by 18 months Not standing by 18 months Persistent toe walking Loss of hearing
What differential diagnoses should you consider in a child with delayed motor development? (5)
Normal variation Cerebral palsy Duchenne muscular dystrophy Metabolic: rickets, hypoglycaemia Environmental: e.g. bed-bound
What differential diagnoses should you consider in a child with delayed speech and language development? (6)
Normal variation Hearing difficulties e.g. OM with effusion Autism spectrum disorder Cleft palate Learning difficulties Environmental deprivation/neglect
What red flags should you ask in a child with pyrexia? (5)
Neck stiffness/photophobia Non-blanching rash Foreign travel Drenching night sweats Bruising/bleeding tendency
What questions should you ask in a systems review of a child with pyrexia? (7 areas)
Haematological: bleeding/bruising, recurrent infections, TATT
Chest: cough, wheeze, added sounds to breathing, sputum, chest pain
ENT: runny nose, sore throat, earache/discharge, change in hearing
GI: tummy ache, D/V
GU: burning pain on urination
NS: headache, neck siffness, rash
Constitutional: travel, bites, growth, weight loss
What differential diagnoses should you consider in a child with pyrexia? (10)
Meningitis URTI UTI Bronchiolitis Croup Kawasaki's disease Otitis media Tonsilitis Pneumonia Epiglotitis
What features would make you think of URTI in a child with pyrexia?
Coryzal symptoms
May develop earache + otitis media secondary to URTI
What features would make you think of meningitis in a convulsing child?
Unwell child, irritable, drowsy, headache, photophobia, weak/high pitched cry
Non blanching rash and seizures
Can present non-specifically
What features would make you think of UTI in a convulsing child?
Abdo pain
Dysuria, strong smelling urine
Irritability, poor feeding
What features would make you think of bronchiolitis in a convulsing child?
Common in 1st year
Raspy cough, wheeze, coryzal Sx, fever
Less wet nappies, poor feeding, grunting = severe infection
What features would make you think of croup in a convulsing child?
Viral illness causing barking cough + stridor and coryzal Sx
Commonest in 1st few years
Usually self limiting, worse at night
Can cause airway obstruction
What features would make you think of Kawasaki’s in a convulsing child?
Fever >5 days and four of:
- Injected pharynx/ Cracked lips/ Strawberry tougue
- Conjunctival infection
- Change in extremities
- Polymorphous rash
- Cervical lymphadenopathy
What features would make you think of tonsillitis in a convulsing child?
Sore throat + fever CENTOR: Cough absent Exudate Nodes (Tender ant cervical) Temp >38 Age: 3-14
What features would make you think of otitis media in a convulsing child?
Otalgia
Decreased hearing
What features would make you think of pneumonia in a convulsing child?
Productive cough, fever, unwell with grunting sounds
What features would make you think of epiglotitis in a convulsing child?
Drooling, unwell, soft stridor, severe sore throat, not had Hib vaccination
How do you manage URTI in a child?
Most self limiting Patental advice: - Monitor temp - Paracetamol - Fluids
How do you manage meningitis in a child?
Community: urgent 999 admission + IM benzylpenicillin
Hospital:
- >3 months: ceftriaxone,
- <3 months: cefatoximine + amoxicillin/ampicillin
How do you manage croup in a child?
Single dose of dexamethasone + admit if respiratory distress
What red flags should you ask in a child with behavioural issues? (4)
Developmental delay
No symbolic play by 2y
No interactive play by 3y
Lack of meaningful speech in short sentences by 3y
What questions should you ask about environment for a child with behavioural issues?
How are they at home/school/social?
Are they the same at school/home?
Can you take them to public places?
What features of ADHD should you ask in a child with behavioural issues? (3)
Hyperactivity: restless, fidgety, constantly talking?
Impulsiveness: takes turns, interrupts conversations?
Inattention: concentration, distracted?
What features of autism spectrum disorder would you ask in a child with behavioural issues? (3)
Communication difficulties
Social impairment: friends, play with others, imaginary play
Repetitive behaviour: strict routines, what happens if its changed
What features would make you think of ADHD in a child with behavioural issues?
Age range: 3-7 Inattention Hyperactivity Impulsiveness Symptoms present >6 months across >=2 environments
What features would make you think of conduct disorder in a child with behavioural issues?
Age range: >7
Violence, bullying, theft, vandalism, cruelty to animals
Problems at school, truancy, expulsion
Disobedience, lack of respect for authority
Precipitated by bullying, abuse, situation at home, parental addiction, family conflict
What features would make you think of ASD in a child with behavioural issues?
Social impairment
Communication
Repetitive behaviour
RF: gestational age <35 weeks, FH, chromosomal disorders, CP
What differential diagnoses should you consider in a child with behavioural issues? (6)
ADHD ASD Conduct disorder/opositional defiant disorder Hearing/visual impairment Learning difficulties Tic disorder
