Paediatrics Flashcards
Define preterm birth
Less than 37 weeks
Epidemiology of preterm birth
8/100 babies
5 risk factors for preterm birth
Hx preterm labour, Smoking, Age, PROM, TVUS
6 signs of preterm birth
regular contractions, period pain, show, water breaking, back-ache, cervical dilation
4 investigations for preterm birth
VE, blood test, urine test, CTG
6 consequences of preterm birth
jaundice, hypoglycaemia, RDS, ventricular haemorrhages, cerebral palsy, NEC
4 ways to manage a preterm birth
Tocolytics (atociban, nifedipine)
Abx if suspected chorioamnionitis
Steroids if 24-35w
Cerclage (cervical suture before 24w if <25mm on US or hx of >/=3 preterm cervical dilation
Define low birth weight
Less than 2.5kg
Epidemiology of low birth weight
7%
10 RF for preterm birth
- prematurity and IUGR are most common causes
- substance abuse (smoking), malnutrition, black, diabetes, hypertension, infection, pre-eclampsia
Monitoring for low birth weight
monitored on US at antenatal screening – can do it more regularly if suspected
7 immediate and 4 late consequences of low birth weight
Immediate: RDS, intraventricular haemorrhage, PDA, NEC, ROP, jaundice, infection
Later: DM, HTN, cerebral palsy, metabolic syndrome.
2 ways to management low birth weight
Tackle risk factors and prevent prematurity
Define Sudden Unexpected Death in Infancy (SUDI)
Unexpected and initially unexplained death
What does a SUDI require?
Post-mortem and police enquiry
Epidemiology of SUID
Most common cause of death in first year of life
>200 babies die/year
5 causes of SUID
50% no cause is found
Infection, Genetic/metabolic; Accidental injury; Non-accidental injury (10%)
What happens to siblings following SUID
Sibling screen for sepsis/inborn errors of metabolism
5 RF and 3 PF for SUID
RF: Sleeping in prone position, smoking, premature, bed sharing, hyperthermia
PF: breast feeding, room sharing, use of pacifiers
6 ways to prevent SUID
- do put baby sleeps on back
- do keep babies head uncovered
- do breastfeed baby if possible
- don’t smoke in the same room
- don’t sleep in the same bed
- don’t let your baby get too hot (room temp 16-20)
Epidemiology of asthma in children
1/11 children have asthma
Increased in prevalence in 2d half of 20th century, now plateauing
We have highest rates in Europe
13% of carers give up work
3 costs of asthma to the NHS
consultations, hospital admissions and meds
Childhood vaccinations at 8 weeks
6 in 1: Diphtheria, Tetanus, Pertussis, Polio, Hib and Hep B
Men B
Rotavirus
Childhood vaccinations at 12 weeks
6 in 1
Pneumococcal
Rotavirus
Childhood vaccinations at 16 weeks
6 in 1
Men B
Childhood vaccinations at 1 year
Hib
Men C + B
MMR
Pneumococcal
Childhood vaccinations throughout childhood for elegible groups
Influenza annually
Childhood vaccinations at 3 years 4 months
Diphtheria, tetanus, pertussis and polio
MMR
Childhood vaccinations at 12-13 years
HPV
Childhood vaccinations at 14 years
Tetanus, Diphtheria and Polio
MEN ACWY
Vaccinations in the elderly
65 years: Pneumococcal then influenza annually
70-79: Shingles
Vaccinations in pregnant women
Influenza
Pertussis
Who gets the TB vaccine?
Infants in areas with a high TB incidence or who live with a parent/grandparent born in a high incidence country
Change in schedule to children born to hepatitis B infected mothers
At birth, 4 weeks and 12 months
Most common accident in babies and pre-school age
At home e.g. falling down the stairs/trapping fingers in doors
Most common accident in school age
Outside the home e.g. RTA
Most common accident in older children
Risk taking behaviour
Most common age and gender for accidents
6-9 year
Male
How many children die every year?
5000
What percentage of accidents are caused by cut injuries/lacerations
56%
What are the percentages for the highest causes of deaths?
24% malignancy
14% injuries/poisons
Order of external causes of deaths
1st RTA
2nd suffocation
3rd drowning
4th smoke/fire, poisons
Biggest cause of death in 10-18 year old
75% RTA
Most common cause of death in pre-term
Prematurity (age, smoking, socio-economic status)
Most common cause of death at term
Congenital
% of poisoning that occurs in under 5’s
50%
3 primary prevention mechanisms for childhood accidents
- modification of product: vehicle child design
- alter environment: speed limits
- educating children: public health service
1 secondary prevention mechanism to prevent childhood accidents
Rehabilitation for burns
secondary prevention is after the accident has occured
What age suffer 45% of burns and scalds?
How?
Children under 5
In the kitchen (hot water, irons, ovens)
3 methods to reduce the risk of burns
- consider sunburn (sunscreen, hat, out of sun)
- get smoke alarms, don’t smoke near bed/sofa
- keep hot objects out of their reach
6 specific causes of childhood accidents and methods to prevent them
Choking: hold them when feeding, cut food into small bits, sit with child
Suffocation: no loose bedding, dispose of plastic bags safely
Falls: careful carrying baby, strap a child in high chair
Poisoning: CO alarms, medicines out of reach
Drowning: never leave baby in bath alone
Road accidents: correctly fitting rear seat every journey
3 consequences of poor early health in children
Start life in poor health > LD + poor mental health, poor diet
Adolescents > leave school early, physically inactive
Adulthood: mortality risk, physical/mental health, social stigma
How many children die every week from cruelty
1 child
4 RF for child deaths
Poverty
Social isolation
Disability
Chronic disease
What is the toxic trio?
Domestic violence and abuse
Parental mental health
Parental substance abuse
What act safeguards children
What is its main motto
Children’s Act (1989 > 2004)
Every child matters
3 common causes of bruising in children
Coagulation disorders (haemophilia, VWD, liver disease, thrombocytopaenia (ITP, ALL,), HDN
Common site for bruising in children
Bony prominences
5 worrying signs of bruises in children
Excessive multiple bruises of different ages
Bruise patterns which indicate slapping, gripped tightly, belts
Face, ears, neck, buttocks, trunks, proximal part of lower limbs
Well demarcated/ burn injuries
Spiral/ metaphysis fractures
4 worrying signs for abuse in the Hx
no explanation, presented late, listen to the child, changing hx
How can you distinguish between a fabricated/induced illness
discrepancy between hx and presentation, range of symptoms, multiple presentations, exaggerating mild disease
7 signs of sexual abuse in children
- recurrent GU symptoms (enuresis, constipation, soiling)
- abdo pain
- self harm
- alcohol/drug misuse
- pregnancy
- emotional/behavioural problems
- sexualized behavior
Define neglect
Persistent failure to meet child’s basic physical and psychological needs
Poor interactions, poor growth, poor dental health, cleanliness, missed appointments
Define emotional abuse
Persistent emotional maltreatment such as to cause severe and persistent adverse effects on a child or young persons emotional development.
What must you do if you suspect neglect?
- recognize > document > report to senior > designated safeguarding specialist
- local authority social services by law have to investigate (NSPCCC, police)
- information can be concerned without consent if public interest/ law
- give child advice about where they can go for advice and support
Statutory responsibility when it comes to children
- must act on any concerns and be open minded
- learn different cultural/ religious background; make sure your own culture doesn’t distract you.
- listen to children
- keep clear records
4 critical conditions which might end in paediatric end of life care
1 Life threatening condition for which curative treatment may be feasible but can fail e.g. malignancy
2 Conditions where premature death is inevitable, long intensive treatment e.g. CF
3 Progressive conditions without curative options where treatment is palliative and may be go over many years e.g. Batten’s disease
4 Irreversible but non-progressive conditions causing severe disability leading to susceptibility to health complications and likelihood of premature death e.g. severe brain injury
Define the doctrine of double effect
risk of hastening death is accepted when intention of using the drug it to control symptoms when death in inevitable
3 things to consider in childhood palliative care
Pain
N+V
Anxiety
What does time off school affect in adolescents?
exams, social isolation, mental health, dependence on parents, impact employment
4 things that might make a child miss their medications
- poor thinking i.e. forgetful
- feel bulletproof – don’t think about long-term
- rejection of medical professional/ parental advice
- bad side effects
Define transition
purposeful, planned process that addresses psychological, education needs of adolescent with physical/mental condition as they move from child centered to adult centered health care systems
good transition improves outcomes, attendance
Talking with VS Talking to children
talking with is inclusive, encourages responsibility for themselves, discussion, respect
