paediatric illnesses Flashcards
What are the key differences in the airway?
-shorter airway, proportionally and literally
-airway is narrower and trachea less rigid
-large tongue and epiglottis, epiglottis also floppier
-babies are predominantly nose breathers for the first 6 months. when the nose is clogged, they really struggle.
-babies have large heads in comparison to their bodies. The weight of the head may tilt too far back and hyperflex the airway narrowing/closing it
What are the results of airway differences?
-more prone to airway problems, blockages and stridor
What are the anatomical differences in and around the lungs?
-less developed accessory muscles
-heart takes up more space proportionally, less space in abdomen for movement
-ribs are more horizontal
What are the results of the anatomical differences in and around the lungs?
-rely more on diaphragmatic breathing
-can’t increase respiratory rate on accessory muscles alone
-use abdominal muscles to aid diaphragm
-ribs less able to expand
-higher respiratory rate to get the oxygen they need. higher hr, higher metabolism
-in respiratory distress can get fatigued very quickly
-can appear they are coping well, then suddenly stop coping
What are the circulatory differences?
-blood pressure is lower due to reduced cardiac output when younger, and gets higher as they get older
-may not be able to palpate pulse in all areas. Usually can find a brachial pulse, Carotid and radial can be very hard to find.
What are the disability and exposure considerations for children and how do these affect practice?
-loose heat quickly due to high surface area to volume ratio
-typically have low glycogen stores. tend to need to eat more regularly.
-check blood sugars unless obviously unnecessary
-expose patient enough for what is clinically appropriate
-babies especially need to be kept warm
What forms the paediatric assessment triangle?
appearance, work of breathing, circulation
What should you look for in a child’s appearance?
-muscle tone/movement: floppy is bad
-interactiveness with parents/objects. should want to engage
-consolable by someone they know.
-look/gaze. be mindful of neurodivergent children or what the child is normally able to do. eg follow pen torch with gaze. red flags: not looking at anything, fixed gaze off to one side
-speech/cry. withdrawn is bad, as is abnormal high-pitched cry
What should you look for in a child’s work of breathing?
-how hard they are working
-breath sounds: stridor, wheezing, grunting
-positioning/tripodding
-intercostal/tracheal recession
-prominence of abdominal breathing
-nasal flaring
What should you look for in a child’s circulation?
-presence of mottling, but not on its own an worrying, only with other signs and symptoms
-signs of cyanosis
-capillary refill time can be done on the sternum
How can you assess pain in a child?
- (Wong-baker) smiley/sad faces pain rating, surprisingly young children can understand
-for slightly older children there is some wording
-can use the ladder with the faces and words. also good for dramatic adults
What is the paediatric observation priority score?
-It uses age/obs to calculate a priority score
-takes longer than the assessment triangle
-similar traffic light system generating a colour off symptoms
What should you consider when history-taking a child patient?
-use the same model as for adults but some information may have to come from parents/carers
-previous contact with health services/immunisations up to date
-feeding/appetite: reduced in infection. Also logistics
-changes in sleep pattern
-pregnancy/birth complications/premature
-get the red book
What are considerations around consent for children?
-Children 16+ can consent. parents don’t get a say
-gillick competence if under 16. May be able to consent to some things but not others due to understanding
-in young children, the consent comes from the guardians. they can also be used to help explain things to the children.
What is the cause, presentation and treatment of croup?
-inflammation of the upper airway, particularly around the larynx
-usually caused by a viral infection causing swelling
-barking cough, stridor, gradual onset
-do a BM
-mild can often be left at home and gp referred
-keep pt calm, give oral dexamethasone, which reduces inflammation, unless they are severely distressed.
