paediatrics Flashcards
what are the pre- requisites of child development (Gross Motor Control)
- physiological flexion
- midline orientation
- reflexes
- mobility
- balance
- weightbearing
- coordination
- tone
- strength
what is physiological flexion and its importance
- this is flexion at the hips, knees, ankles and rounded shoulders with hands close to the face
- if babies lack flexion they will remain in an extended position, which can hinder motor skills
what happens if a baby does not have physiological flexion
without it a baby will not develop core muscles and will rely on surfaces for support
what is midline orientation and its importance
- when a baby has symmetry (we want to promote symmetry)
- this allows babies to understand how to bring hands to midline which aids self-soothing via thumb sucking in stressful environments
what is a stressful environment for a neonate
- being in hospital
- being away from the mother
- visual and audible noise
what are some important reflexes
- rooting
- morrow
- suckling
- stepping
- reaching
- palmar and plantar grasp
- fencer response
pre term babies have reduced muscle mass preventing them reaching _____________ __________
developmental milestones
pre term babies would have breathing difficulty due to
- underdeveloped lungs
- reduced alveoli and surfactant
- cell walls being thicker than the normal 1cm which is optimum for gas exchange
what are some factors that can impact development
- scoliosis, limb loss, hip dysplasia, insufficient tummy time
- muscular dystrophy, tone, prematurity
- recurrent chest infections, smoking, mould
- long hospital stays and neglect
DHD stands for
developmental hip dysplasia
is pain a factor of DHD in babies
no, babies don’t often feel pain caused by DHD
how can you assess for DHD in babies
- assess ROM at the hips
- measure leg length
- lower limb tests : galeazzi (measuring femur leg length in crook lying), barlow (screens a dislocated hip by dislocating it) and ortalani (screens for an already dislocated hip by relocating it)
what is the galeazzi sign
when there is a femur discrepancy in leg length
what is the barlows test
this screens for a hip instability by dislocating the hip
what is ortalanis test
this screens for an already dislocated hip by relocating the hip
what is the latest age barlow and ortalani tests should be carried out
this is done on children under 3 months
what are the two main types of positional talipes
- equinovarus
- calcaneovalgus
what is the position of equinovarus talipes (foot)
plantarflexion and inversion
what is the position of calcaneovagus talipes (foot)
dorsiflexion and eversion
what is the most common orthopaedic condition in paeds
CTEV (congenital talipes equinovarus)
what is pes cavus
pes cavus is a condition where a baby has an abnormal arch in the foot. babies are not supposed to have an arch developed at this point
how does a vertcal talus present
this presents as a rocker bottom foot, where to sole of the foot is curved
how is CTEV treated
initially treated with serial casting over the course of 6-8 weeks then boots and bars until the age of 5
what is the outcome measure used for CTEV
the pirani score
what does a score of 0 on the pirani score indicate
0 = positional talipes
what factors does the pirani score asses
how many types does congenital muscular torticollis have
there are two types
what is type 1 torticollis
when it occurs during pregnancy due to foetal malposition
what is type 2 torticollis
when it occurs in early life due to perinatal trauma
what are some risk factors of torticollis and plagiocephaly
- neonatal stay
- unilateral stimulation
- Erbs palsy
- Dystonia
- resp issues
- visual/ vestibular issues
what is Erbs palsy
this is a condition that is caused by nerve damage during birth, causing paralysis of the arm
how is Erbs palsy treated
treated with exercises and typically recover within 6 months
what is Dystonia
this is a neurological movement disorder, people with this condition experience involuntary muscle spasms and contractions
dystonia can cause high tone leading to __(what condition)__
torticollis
as physios what can we look to assess in children
- assess independent movement of the baby and their response to stimulation
- assess AROM/ PROM in rotation and flexion
- baby’s strength
- complete the plagiocephaly scale
what are some red flags to look for
- macrocephaly
- high/ low tone
- scoliosis
- lump on palpation
- facial deformity
what is macrocephaly
this is where the baby has a large head circumference and query if a condition had caused it
what is DCD
developmental coordination disorder
what was DCD (developmental coordination disorder) previously known as
dyspraxia
what is DCD (developmental coordination disorder)
its a neurodevelopmental coordinator disorder that causes children to have delays in advanced gross and fine motor skills
what can developmental coordination disorder lead to
- motor learning disabilities
- delays in executive function
- reduced academic performance
- effects on socialism
- possible joint laxity
developmental coordination disorder can be assossiated with two conditions. _______ and _________
autism and ADHD
what are key questions that should be asked in a subjective Hx taking
asking about:
- developmental milestones
- type of birth
- any complications at birth
- if the child regularly attends school
What assessment should be used for evaluating a child’s movement?
Movement Assessment Battery for Children (Movement ABC)
This assessment helps identify movement difficulties in children.
What should be done with the results of the Movement ABC?
Results should be interpreted and the child should be referred to a paediatrician for diagnosis
This ensures proper medical evaluation and potential intervention.
what is joint laxity
describes an unstable joint as it can PASSIVELY move beyond normal limits, particularly during glides
what is joint hypermobility
this describes the increased ROM of a joint beyond normal range, and it is a full body connective tissue disorder
What tool is used to measure joint extension?
Goniometer
How is joint hypermobility classified?
- Generalized joint hypermobility
- Peripheral joint hypermobility
- Localized joint hypermobility
What is generalized joint hypermobility?
Joint hypermobility present in many different joints throughout the body.
What is peripheral joint hypermobility?
Joint hypermobility limited to the hands and feet.
What is localized joint hypermobility?
Joint hypermobility in a single joint or group of joints in the same area.
What scale is used to assess generalized joint hypermobility?
Beighton Score.
How many points is the Beighton Score based on?
9-point scale.
What joints are assessed in the Beighton Score?
- Base of the right 5th (pinky) finger
- Base of the left 5th (pinky) finger
- Base of the right thumb
- Base of the left thumb
- Right elbow
- Left elbow
- Right knee
- Left knee
- Lower spine
What is a positive Beighton score for adults?
Greater than or equal to 5/9 points.
What is a positive Beighton score for children before puberty?
Greater than or equal to 6/9 points.
What is a positive Beighton score for adults over age 50?
Greater than or equal to 4/9 points.
What occurs when joints are not just hypermobile but also unstable?
Joint instability occurs when the bones of a joint aren’t held in place securely.
What can joint instability lead to?
Joint instability can lead to:
- Joint subluxations
- Dislocations
- Sprains
- Other injuries
What types of pain can joint instability cause?
Joint instability can cause both acute and chronic pain.
How does joint instability affect daily life?
It can interfere with ADLs and make doing them harder
What are hypermobility spectrum disorders (HSD)?
Connective tissue disorders that cause joint hypermobility, instability, injury, and pain.
What symptoms are often associated with HSD?
Symptoms include:
- Fatigue
- Headaches
- GI problems
- Autonomic dysfunction
True or False: HSD only causes joint-related issues.
False
HSD can also lead to various other symptoms such as fatigue and gastrointestinal problems.
Fill in the blank: HSD can lead to joint ______, instability, injury, and pain.
[hypermobility]
HSD (Hypermobility Spectrum Disorder) is classified as a __________ ___________ disorder ?
Connective tissue disorders.
children with T21 have reduced tone where
they have reduced tone in the core, head and neck along with joint laxity
True or False: CT21 patients have different milestone trajectories
true
fill the gap:
babies with this condition can experience __________ pain due to early intervention for illnesses
chronic
True or False: toddlers cannot localise pain
true
what is JIA
juvenile idiopathic arthritis
what is the cause of JIA
the cause is unknown (idiopathic), however factors such as genetic and environmental play a role and lead to an abnormal immune response
how much more common is JIA in girls than boys
girls are twice is likely to get JIA
how is JIA diagnosed
- looking for stiffness
- pain
- swelling going on for 6 weeks
- elevated CRP
what are the symptoms of JIA
- pain
- swelling
- decreased ROM
- fever
- rashes
- delayed growth
- difficulty walking
myalgic encephalomyelitis (ME) is also known as
chronic fatigue syndrome (CFS)
what are the most common symptoms of chronic fatigue syndrome (CFS)
- extreme tiredness - feeling tired all the time
- sleeping problems, insomnia or the feeling of exhaustion or stiffness when waking up
- problems with thinking, concentration and memory (brain fog)
- exacerbated symptoms after physical or mental activity, requiring sometimes weeks to recover (post exertional malaise)
what is the cause of chronic fatigue syndrome (CFS)
the cause is unknown
Is there a specific test for ME/CFS?
No, there is no specific test
True or False: ME/CFS can be diagnosed with a standard laboratory test.
False
treatment of ME (Myalgic encephalomyelitis) / CFS include:
- energy management
- medicine to control pain and sleep symptoms
- cognitive behavioural therapy (CBT), works by changing how a person thinks and behaves
