paediatrics Flashcards
How does colic present in a child and what advice can you give to the parents?
Baby cries a lot for no obvious cause. If they cry more than 3 hours a day, 3 days a week for at least 1 week. Often will be very windy too and draw knees up to abdomen or arch back when crying
Reassure parents they will grow out of it about 6 months
Ask for support from friends, family or Cry-sis
Check not crying for other reasons like a milk allergy
If a parent presents with a child with an itching head due to headlice what advice can you give them?
Reassure it doesn’t mean they are dirty
Check everyone in the house and start treatment on the same day for everyone
Do wet combing on days 1, 5, 9 and 13 to catch any newly hatched head lice. Check again that everyone’s hair is free of lice on day 17. Lots of conditioner.
- Dimeticone 4% gel, lotion, or spray (Hedrin) Only treat if live lice found. Treat from root to tip of hair. Suffocates lice so not likely to form resistance. Safe for pregnant women
No need to keep child off of school or put clothes on a hot wash or use tea tree oil
What are some congenital and physical causes of constipation in children?
- Hirschsprung’s Disease: presents early in life with failure to thrive, no meconium in first 24 hours, swollen abdomen, constipation doesn’t respond to treatment
- CF
- Hypothyroidism
- Anorectal malformation: faeces coming out of urethra
Colonic atresia: often billous vomiting
How may a viral wheeze present in a child and how can we treat it?
Child may have SOB, recession and an expiratory wheeze
Wheeze can continue for some time after virus and reoccurs with viruses
Most common between 12 months to 5 years
Treatment: same as acute asthma with reliever inhaler and spacer
How does Osgood-Schlatter’s disease present in children?
- Small avulsion fractures of the patella tendon on the tibial tuberosity during forceful contractions of the quads. Happens before tibial tuberosity has undergone ossification
- Ossicles or enlarged tubercle may form so pain and swelling/lump occurs below kneecap which is worse on activity like running and jumping
- Develops slowly and severe exacerbations
Usually unilateral
More common in boys and with skeletal maturity it will disappear. Exacerbation usually settles after a few weeks to months
How can you distinguish Osgood Schlatter’s from the following:
Injury
Perthes
SUFE
Injury: pain suddenly starts after trauma not gradual. Often abdnormal exam such as ligament injuries
Perthes: Femur head loses blood supply so AVN and head collapses. Pain in hip/groin or referred to knee/thigh. Painful muscle spasms and limited abduction/internal rotation. X-ray to diagnose
SUFE: head of femur slips off backwards, more common in boys aged 11-17. Pain in knee, limp, leg appears shorter or turned outwards, limited movement, possible Trendelenberg gait
What is toddler’s diarrhoea and what advice can you give to parents about this?
Chronic diarrhoea usually in boys aged 1-5 years
3 or more loose stools a day that are often smelly, pale, bits of vegetable in and abdominal cramps
Reassure parent child will grow out of it by age 5-6
Encourage parent to increase fat, lower fibre, decrease amount of fruit juice in childs diet
What are the differentials for threadworms if looking at the symptom of perianal itching?
- Candida: white discharge, affected area may be tender, anti-fungal medication will work
- Dermatitis
- Pubic Lice
- Haemorrhoids
what’s the difference between GOR and GORD?
GOR: usually begins before 8 weeks and is normal physiological if symptoms not affecting child. 90% will resolve by 1st year
GORD: when the symptoms are affecting the child e.g discomfort, pain, oesophagitis. Consistent projectile vomiting, failure to thrive, dysphagia, fever, cough, retrosternal pain, irritability
How can you differentiate GORD from mesenteric adenitis, abdominal migraine, and psychological reflux?
Mesenteric adenitis: sore throat/cold precursor, fever, pain in abdomen usually RIF, nausea and diarrhoea. Self-limiting
Abdominal Migraine: ab pain, N+V, paroxysmal episodes>1h, symptom free between episodes, photo/phonophobia
Psychological: usually 5-14 years, stress, depression, anxiety, myalgia, head-aches, IBS like symptoms
What are some risk factors and complications of GORD in children?
Risk factors: premature birth, FH of heartburn, obesity, hiatal hernia, neurodisability
Complications: reflux oesophagitis, recurrent aspiration pneumonia, frequent otitis media (>3eps in 6 months), dental erosion
what is bronchiolitis
- Viral infection of bronchioles usually by resp syncitial virus, adenovrus or influenza
Usual onset less than 2
Subcostal recession/nasal flaring/grunting are serious signs
Fever
Cough
Wheeze
Tachypnea
Crackles
what is the treatment for bronchiolitis?
If the child does not require hospital admission:
Advise the parents self-limiting illness and that symptoms tend to peak between three and five days of onset. Advise of red flags like grunting, poor feeding, apnoea, lack of wet nappies etc
Advice parents not to smoke in the house
Hospital admission:
Give oxygen if sats <92%
If resp failure CPAP
how is croup managed?
If mild can be managed at home if not under 3 months or no immunodeficiency. Symptoms usually get better within 48 hours
Advise regular fluids, paracetamol/ibuprofen
Need single dose PO dexamethasone regardless of the severity
Why should ibuprofen not be taken when a patient has chicken pox?
Increases the risk of necrotising fascitis
