Paediatrics

Question 1

How is treating a paediatric patient different from an adult?

Answer 1

• consider parents
• kids dont understand
• different dose limits and secondary malignancies
• tumour types different
• kids more at risk of late side effects
  neurocognitive effects
• muscle developement

Question 2

What are the symptoms of medulloblastoma? (8)

Answer 2

• headaches
• nausea and vomitting in the morning
• problems with motor skills (clumsiness or poor handwriting)
• tiredness
• tilting of head to one side
• walking difficulty and balance problems
• back pain
• inability to control bladder and bowel

Question 3

How do you diagnosis medulloblastoma?

Answer 3

• symptom history
• MRI with and without contrast
• lumbar puncture (to see if tumour has progressed down CNS)
• surgery/biopsy
• pathology report

Question 4

What is the classification of high risk Medulloblastoma?

Answer 4

• <3 yrs at diagnosis
• tumour remaining following surgery is more than 1.5cm^2
• M1-4

Question 5

What is M0-M4 classification of Medulloblastoma?

Answer 5

M0 - no evidence of mets
M1 - tumour cells in the spinal fluid
M2 - tumour spread within the brain
M3 - tumour has spread to the spine
M4 - tumour has spread away from brain or spine

Question 6

What are the survival rates of Medulloblastoma?

Answer 6

• M0- 70-80%
• if disease has spread to spinal cord, SR 60%
• children under 3 often lower SR due to more aggressive disease

Question 7

Who is involved in a paediatrics multi-disciplinary team?

Answer 7

• occupational therapists
• physiotherapists
• medical oncologists
• paediatric nurses
• GA team
• RT
• Dieticians
• Speech pathologists
• teacher

Question 8

What is play therapy?

Answer 8

• play-based procedural support and preparation refers to a specific child life intervention that aims to promote the child’s coping with new and unfamiliar medical experiences

Question 9

What does RT play therapy involve?

Answer 9

• delivery a social story by the OT
• practice making a mask and vacbag on toy or parent
• playing in the treatment room including using the controls
• watching parents on the monitor from outside the treatment room
• practice leaving the child in the room by themselves

Question 10

What type of child is likely to require GA?

Answer 10

• children under 3
• behavioural issues
• compliance issue due to condition (e.g. posterior fossa syndrome)

Question 11

What is posterior fossa syndrome?

Answer 11

• most commonly from surgery for posterior fossa tumours in paeds
• occurs in 8-24% cases
• absence of reduction in speech
• axial hypotonia and ataxia
• mild to completely disabling symptoms

Question 12

What if GA is not an option?

Answer 12

• get the child to be very hungry then feed and then will fall into a deep sleep and then set up with straps

Question 13

Should paediatrics receive tattoos?

Answer 13

• prefer not as it is a traumatic reminder of experience
• can use point guards instead
• take a lot of measurements from landmarks