Paediatric: SDL and mental health Flashcards
National child measurement programme
In reception (4-5y)
In year 6 (10-11y)
Trained staff weight and measure the height of the child. If outside a healthy weight, support will be offered. Participation is not mandatory
What are the two components of the new-born hearing screening programme
0-5w (done either in hospital or in community)
- 1-2 in 1000 babies in the UK are born with a permanent HL or deafness in one or both ears.
- 90% of babies with HL are born to families with no history of deafness.
- There are separate protocols for screening babies who have been in NICU or SCBU.
2 tests are carried out as part of the newborn hearing screening:
1) Automated otoacoustic emissions test (all)
2) Automated auditory brainstem response test (some)
Referrals are given a full audiological assessment
Preschool hearing and vision screening
Vision screen: between ages 4-5- Visual acuity in both eyes
Hearing screen: usually in y1 or y2 at school- Behavioral test
Paediatric sepsis 6
Complete within 1 hour:
- Give high flow oxygen
- Obtain IV/IO access and take blood tests: cultures, BM (treat if low), gas (+ FBC, lactate/CRP as available)
- Give IV or IO antibiotics (broad spectrum per local policy)
- Consider fluid resus (titrate 10 ml/kg bolus, then re-evaluate and repeat as needed)- Careful of fluid overload – examine for crepitations and hepatomegaly
- Involve senior clinicians/specialists early
- Consider inotropic support early
What to do after the paediatric sepsis 6
If normal physiological parameters arent restored after 40ml/kg fluids or more. NB adrenaline or dopamine may be given via peripheral IV or IO access
Newborn resus algorithm
- Following birth, dry the baby (maintain temp) and start the clock.
- Following this you assess tone breathing and heart rate.
- If gasping or not breathing, open the airway to give 5 inflation breaths.
- Then reassess for an increase in HR.
- If there no increase HR, ensure the inflation breaths are adequate by checking chest movement.
- If chest is not moving, assume the inflation breaths are inadequate and recheck head position, consider 2-person airway control and other maneuvers, and repeat inflation breaths then look for a response.
- If the chest is moving but the HR is still undetectable or <60, you start chest compressions at a ratio of 3:1 inflation breath.
- Reassess HR every 30s, and if still undetectable or very slow, consider IV access and drugs.
What are the red flag features in the NICE traffic light system for evaluating unwell children
Pale/mottled/ashen/blue
No response to social cues
Appears ill to a healthcare professional
Does not wake or if roused does not stay awake
Weak, high-pitched or continuous cry
Grunting
RR >60
Moderate or severe chest indrawing
Reduced skin turgor
Age <3 months, temperature >=38°C
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures
Developmental dysplasia of the hip risk factors
The Department of Health advises that:
- all babies that were breech at any point from 36 weeks (even if not breech by time of delivery)
- babies born before 36 weeks who had breech presentation
- all babies with a 1st degree relative with a hip problem in early life
should be referred for ultrasound of the hips (at 6w).
If one of a pair of twins is breech, both should be screened. Some trusts refer babies for other reasons
APGAR score- 2
Pulse >100
Respiratory effort- strong/crying
Colour- Pink
Muscle tone- active movement
Reflex irritability- cries on stimulation/sneezes, coughs
Apgar score 1
Pulse <100
Respiratory effort- weak, irregular
Colour- body pink, extremities blue
Muscle tone- limb flexion
Reflex irritability- Grimace
Apgar score- 0
Pulse- absent
Colour- blue all over
Muscle tone- Flaccid
Reflex irritability- Nil
Apgar score- meaning
A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state
Newborn Baby Assessment (NIPE) 1/2
- Performed within 72 hours of birth by a qualified practitioner
- Record weight and check on a weight chart: if baby is small, plot head circumference and length to check if its symmetrical/asymmetrical growth restriction’
- General inspection: jaundice
- Tone: move the limbs passively
- Head: record head circumference, inspect cranial sutures and fontanelles
- Skin: colour, bruising
- Auscultate lung and heart
- Pulse oximetry
- Lower limbs: tone, movement and palpate both femoral pulses
- Hips: Barlow and Ortolani tests
NIPE 2/2
- Face: appearance, symmetry, trauma, nose
- Eyes: appearance, fundal reflex (preferred over red reflex)
- Ears
- Mouth and palate: look for cleft lip or palate and tongue tie
- Neck and clavicle: look for webbing, neck lumps, clavicle fracture
- Upper limbs: symmetry, inspect fingers and palms. Palpate brachial pulse in both arms
- Observe the chest especially for respiratory rate and work of breathing
- Abdomen: palpate
- Genitalia: inspect and palpate scrotum to ensure both testes are present
- Back, spine, reflexes
Basic life support: positioning the childs heag
- Infant: in the neutral position (avoid over extending), cover the mouth and nose and blow steadily for one second
- Child: in the sniffing position, cover mouth and pinch nose and blow for one second
Infants: reflexes
1) Rooting reflex
2) Sucking reflex
3) Moro reflex: when a baby is dropped, they open their arms wide
4) Grasping or palmar reflex
5)Babinski or plantar: stroking the foot it curls in
6) Walking or stepping reflex: when a baby is held upright an their feet brush a surface they take a step
7) Tonic neck: when a baby is on their back and turn to one side they make the fencing posture
8) Galant: stroke one side of the spine and the pelvis swings towards the stimulated side
Psychosocial poor growth
Growth disorder caused by extreme emotional deprivation or stress, despite adequate nutrition
- Pathophysiology: decreased growth hormone
- Presents: short stature, low weight for height, immature skeletal age
- Management: removal of source of stress foster/care home if appropriate
If under 0.4th centile for height review by paediatrician
Classifying learning disability
Mild: IQ less than 70
Moderate: IQ less than 50
Severe: IQ less than 35
Learning disability
Definition: IQ two standard deviations below the mean
Common causes: Autism, downs
Genetic: Downs, Prader willi, Fragile X, DiGeorge
Cause of global development delay
genetic syndromes (Down’s, Prader Willi, fragile X, DiGeorge)
autism
cerebral palsy
congenital infection or injury (rubella, alcohol, hypoxic brain injury)
