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Paediatrics 2 Flashcards

1
Q

Give some causes of wheeze in a child

A
  • Persistent infantile wheeze (small airways / smoking / viruses)
  • Viral episodic wheeze (no interval symptoms / triggered by infection)
  • Asthma (multiple trigger wheeze) -> persistent symptoms / FHx / atopic
  • Other
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2
Q

Describe the presentation of ‘viral episodic wheeze’.

A
  • No interval symptoms
  • No excess of atopy
  • Likely to improve with age
  • No benefit from regular inhaled steroids
  • Use bronchodilators
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3
Q

Describe the management of acute asthma

A
  • Oxygen, if needed
  • B-agonist
  • Prednisolone 1mg/kg
  • IV salbutamol bolus
  • Aminophylline / MgSO4 / Salbutamol infusion
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4
Q

Treatment approaches to asthma include preventer and reliever inhalers. What class of drugs are the preventers, and give some examples.

A

Preventers = inhaled steroids

  • Beclomethasone
  • Budesonide
  • Fluticasone
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5
Q

Treatment approaches to asthma include preventer and reliever inhalers. What class of drugs are the relievers, and give some examples.

A

B2 agonists eg.

  • Salbutamol
  • Terbutaline
  • Ipratropium Bromide
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6
Q

Preventer and reliever inhalers are used to manage asthma. List 5 Add-on therapies which may be used in adjunct to the preventers + relievers.

A
  • Long acting B2 agonists
    eg. Salmeterol, Formoterol
  • Leukotriene receptor antagonists eg. Montelukast
  • Theophyllines
  • Omalizumab (Anti-IgE)
  • Protect (High IgE)
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7
Q

On choosing a preventer inhaler for an asthmatic child, what considerations should you make?

What class of drugs are used as preventative medication in asthma?

A
  • Lowest effective dose
  • Minimise oral deposition
  • Minimise GI absorption

STEROIDS!

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8
Q

On choosing a reliever inhaler for an asthmatic child, what considerations should you make?

What class of drugs are used as reliever medication in asthma?

A
  • Age-appropriate device
  • Easy to use
  • Portable
  • Dosage not critical

Drug class: B2-agonists.

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9
Q

A child has mild, intermittent asthma. What’s the first line management? (Step 1)

A
  • Environment

- Inhaled short acting B2 agonist as required eg. Salbutamol

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10
Q

What is meant by ‘regular preventer therapy’ with regards to asthma control in a child? (Step 2)

A

Inhaled steroid eg. Beclametasone

200 - 400mcg / day

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11
Q

If regular preventer therapy fails to control a child’s asthma, what therapeutic option is recommended? (Step 3)

A

Add-on therapy:

  1. Add LABA eg. Salmeterol
  2. Assess control of asthma (is there a response to LABA)?
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12
Q

If a child has persistent poor control due to asthma, what therapeutic management can you recommend? (Step 4)

A

Increase inhaled steroid up to 800 mcg / day

eg. Beclametasone

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13
Q

If a child’s asthma is so poorly controlled that they are continuously / frequently using oral steroids, what action should you take?

A
  • Refer to respiratory paediatrician
  • Use daily steroid tablet in lowest dose providing adequate control
  • Maintain high dose inhaled steroid at 800 mcg / day
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14
Q

An asthmatic child does not respond to treatment. Give 5 reasons why this might occur.

A
  1. Adherence (compliance)
  2. Bad disease
  3. Choice of drugs / devices
  4. Diagnosis
  5. Environment
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15
Q

What are the possible side effects of inhaled steroids (when used in the management of asthma)?

A
  • May suppress the adrenals
  • Might cause brief slowing of growth
  • Oral thrush -> educate patient!
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16
Q

Give some examples of upper respiratory tract infections in children.

A
  • Rhinitis
  • Otitis media
  • Tonsilitis
  • Laryngitis
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17
Q

Give some examples of lower respiratory tract infections in children.

A
  • Croup
  • Epiglottitis
  • Bronchiolitis
  • Pneumonia
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18
Q

Acute stridor is seen in Croup. What is the causative organism of croup?

A

Viral -> Usually Parainfluenza

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19
Q

Describe the signs + symptoms seen in a child with croup.

A
  • Worse at night
  • Barking, seal-like cough
  • Stridor
  • Recession
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20
Q

Croup is usually caused by parainfluenza. Describe the course of the disease in children.

A
  • Self limiting

- Spring / Autumn

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21
Q

A child in A+E is diagnosed with Croup. What medication should you give them?

A

Steroids!

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22
Q

What is the causative organism of acute epiglottis?

A
  • Haemophilus influenza B

=> causes a severe, acute illness

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23
Q

List 2 diseases that might be caused by meningococcus.

A
  • Septicaemia

- Meningitis

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24
Q

List 3 diseases caused by Haemophilus influenza B.

A
  • Epiglottitis
  • Meningitis
  • Pneumonia
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25
Q

What is ‘pneumonia’?

A

A respiratory disease characterised by inflammation of the lung parenchyma (excluding the bronchi) with congestion caused by viruses or bacteria or irritants.

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26
Q

How is pneumonia diagnosed in children?

A
  • History of cough +/or difficulty breathing (<14 days duration) with increased respiratory rate (defined for age)

> 2 months: > 60 / min
2 - 11 months: > 50 / min
11 months: > 40 / min

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27
Q

What might be seen on an X-ray of a child who has pneumonia?

A

A dense or fluffy opacity that occupies a portion or whole of a lobe of lung that may or may not contain air bronchograms.

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28
Q

When should you consider bacterial pneumonia in a child under 3 years?

A
  • Fever > 38.5oC
  • Chest recession
  • Resp rate > 50 / min
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29
Q

What is the leading causative organism of bacterial pneumonia?

Name some other organisms that can cause pneumonia.

A

Most common: Pneumococcus

Other bacterial organisms that cause pneumonia:

  • H. influenzae type B (Hib)
  • S. aureus
  • K. pneumoniae
  • Mycobacterium tuberculosis
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30
Q

What is the most common cause of viral pneumonia in children?

Name some other causative organisms.

A

Most common: Respiratory Syncytial Virus

Other viral causative organisms:

  • Influenza A + B
  • Parainfluenza
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31
Q

Which organisms might cause pneumonia in a HIV-positive child?

A
  • Mycobacterium tuberculosis

Others

  • Pneumocystis jiroveci
  • Mycoplasma pneumoniae
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32
Q

What is meant by ‘oedema’?

What signs + symptoms might a patient with oedema have?

A

Increase in interstitial fluid

‘Swelling’, pitting oedema,
Fluid moves under the influence of gravity -> ascites, pleural effusions, pulmonary oedema.

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33
Q

Give 4 causes of increased interstitial fluid.

A
  1. Lymph drainage => lymphedema
  2. Venous drainage + pressure => venous obstruction
  3. Low oncotic pressure (low albumin / protein) => malnutrition, decreased albumin production (liver), increased loss (gut, kidney [nephrotic syndrome])
  4. Salt + water retention => kidney (impaired GFR), heart failure
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34
Q

What triad of signs indicates Nephrotic Syndrome?

A
  • Heavy proteinuria
  • Hypoalbuminaemia
  • Oedema
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35
Q

What are ‘normal’ albumin levels?

At what levels of albumin do fluid retention + oedema occur?

A

Normal: 35 - 45 g/l

Fluid retention + oedema: 25 - 30 g/l

=> Serum albumin is linked to fluid retention.

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36
Q

If protein loss occurs (eg. nephrotic syndrome), what other complications is a child susceptible to?

A
  • Infection

- Thrombosis

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37
Q

What are the 2 types of Nephrotic syndrome?

A
  • Steroid sensitive

- Steroid resistant

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38
Q

What would you see in steroid-sensitive nephrotic syndrome?

Think about: BP? Renal function? Histology?

A
  • Normal BP
  • Normal renal function
  • No features to suggest nephritis
  • Histology: “minimal change”
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39
Q

What would you see in steroid-resistant nephrotic syndrome?

Think about: BP? Renal function? Histology?

A
  • Elevated BP
  • Haematuria
  • May be impaired renal function
  • Features may suggest nephritis
  • Failure to respond to steroids
  • Histology: various, underlying glomerulopathy, basement membrane abnormality
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40
Q

What is the normal range for plasma glucose?

i) fasting
ii) post prandial

A

Fasting = 3.5 - 5.6mmol/l

Post prandial = <7.8mmol/l

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41
Q

Which test is used to diagnose diabetes?

A

OGTT

Diabetes:
Fasting = > 7.0 mmol/l
Post OGTT = >11.1mmol/l
HbA1c = > 6.5%

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42
Q

What is the pathophysiology of Type 1 Diabetes?

A

B-cell destruction leading to no insulin production.

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43
Q

What is the pathophysiology of type 2 diabetes?

A

T2DM due to:
- progressive insulin secretory defect => very low insulin production
OR
- Insulin resistance

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44
Q

What is the mainstay of treatment for type 1 diabetes?

A

Insulin

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45
Q

What is the mainstay of treatment for type 2 diabetes?

A

Treat with insulin and / or diet and exercise

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46
Q

Which 2 genes are associated with Type 1 diabetes?

A

HLA-DR3

HLA-DR4

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47
Q

What are the actions of insulin?

A
  • Stimulates glucose uptake from blood
  • Lowers blood sugar
  • Stimulates conversion of glucose to glycogen in the liver
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48
Q

How does Type 1 diabetes present?

A

Early:

  • Pre-symptomatic
  • Symptomatic

Late:
- DKA

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49
Q

Describe the pathophysiology of DKA.

A
  • Insulin deficiency + glucagon excess =>
  • Increased blood ketones + increased blood glucose
  • Vomiting, osmotic diuresis => Fluid + electrolyte depletion
  • Acidosis => cellular dysfunction, cerebral oedema, shock
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50
Q

How should you manage DKA?

A
  • Fluid
  • Insulin
  • Monitor glucose hourly
  • Monitor electrolytes, especially K+ and Ketones
  • Very strict fluid balance
  • Hourly neuro obs
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51
Q

What are the autonomic signs of hypoglycaemia?

A
  • Irritable / Anxious
  • Hungry
  • Nauseous / shaky
  • Sweaty / palpitations / pallor
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52
Q

What are the neuroglycopenic signs of hypoglycaemia?

A
  • Dizzy, headache
  • Drowsy
  • Visual problems
  • Problem concentrating
  • Convulsions
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53
Q

A child is having a mild hypoglycaemic episode. How should you manage them?

A
  • Check blood glucose to confirm
  • Give 3-5 glucose tablets or 60-100mls lucozade
  • Wait 10 minutes => if no improvement, repeat
  • Follow up with longer acting carb (bread / biscuit)
    => Check blood glucose in 15 minutes.
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54
Q

A child is having a severe hypoglycaemic episode. How should you manage them?

A
  • Do not attempt to give anything by mouth
  • Glucagon: Sub cut / IM injection
  • Wait 10 minutes
  • When conscious, give sugar
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55
Q

What ‘practical stuff’ needs to be considered for a newly diagnosed diabetic?

A
  • Injections
  • Dietary guidance
  • Carb counting
  • Advice on exercise
  • Hypoglycaemia education
  • Sick day rules
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56
Q

Who would be involved in the MDT for a newly diagnosed diabetic?

A
  • Liaison with school
  • Paediatric Diabetic Specialist Nurses
  • Frequent outpatient appointments
  • Diabetes UK / Local groups
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57
Q

What are the aims of paediatric diabetes management?

A
  • Normal growth and development
  • As normal a childhood as possible
  • Transition with optimal HbA1c to help prevent complications
  • Avoidance of XS or severe hypos
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58
Q

What are the main complications of diabetes in the paediatric population?

A
  • Reduced life expectancy
  • DKA kills :(
  • 30-40% develop microalbuminuria
  • May require laser treatment for retinopathy
  • Nephropathy
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59
Q

How is diabetes monitored in the paediatric population?

A
  • HbA1c => 3 month profile

- Blood glucose log book

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60
Q

A child with Type 1 diabetes presents for their check up. What examinations should you conduct?

A
  • Eyes
  • Urine
  • Feet
  • Blood pressure
  • Injection sites
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61
Q

What are important things to remember when managing a child with DKA?

A
  • Fluid before insulin
    BUT
  • watch the fluid => children get cerebral oedema => this can kill
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62
Q

Why does poor growth cause concern?

A
  • Illness / neglect / deprivation
  • Growth is a barometer of a child’s physical and emotional well being
  • social + economic circumstances
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63
Q

How should growth of a child be assessed?

A
  • Growth velocity charts

- Consideration for a variety of factors, including parental heights, social inequalities + ethnic background

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64
Q

When considering a child’s growth, disproportion can give clues to a diagnosis. What would you be considering if a child had short limbs?

A

Hypochondroplasia

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65
Q

When considering a child’s growth, disproportion can give clues to a diagnosis. What would you be considering if a child had a short back and long legs?

A

Delayed puberty

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66
Q

Why might a head circumference measurement be unreliable?

A

Inaccuracy

  • Faulty technique
  • Faulty equipment (wrongly positioned or calibrated)
  • Un-cooperative children
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67
Q

What does an orchidometer measure?

A

Testicular size

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68
Q

At what age is ‘delayed puberty’ considered in i) girls and ii) boys?

A

Girls: > 13 years
Boys: > 14 years

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69
Q

At what age is puberty considered to be early in i) girls and ii) boys?

A

Girls: < 8 years
Boys: < 9 years

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70
Q

In normal puberty, what are the first signs of puberty in i) girls and ii) boys?

A

Girls: Breast buds
Boys: Testicular enlargement

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71
Q

Name 3 common problems associated with puberty / delayed puberty.

A
  • Poor growth => failure to thrive
  • Psychosocial deprivation
  • Stretch marks / overweight
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72
Q

List 5 factors that affect birth weight.

A
  • Maternal size + weight
  • Parity
  • Gestational diabetes
  • Smoking
  • Paternal size
73
Q

Describe a baby’s growth after birth.

A
  • A third show catch-up growth
  • A third maintain birth weight centile
  • A third show catch-down growth
74
Q

What is the purpose of ‘thrive lines’ on growth charts?

A

Help to differentiate pathology from normal ‘catch-down’ growth.

75
Q

If a child is failing to thrive, what factors should you consider which may be indicative of why this child is FTT?

A
  • Vomiting
  • Dysmorphic features
  • Diarrhoea
  • Poor social circumstances
  • Actual weight loss
  • Weight > 2 major centiles below height.
76
Q

List 6 causes of short stature.

A
  • Constitutionally small => small parents
  • Idiopathic short stature => usually small at birth
  • Psychosocial
  • Delayed puberty
  • Chronic disease
  • Endocrine causes => Striae => ? Cushing’s
77
Q

Obesity drives growth. How would you differentiate between a child who has an endocrine problem vs a child who has nutritional obesity?

A

Nutritional obesity: Tall + fat

Endocrine problem: Short + fat

78
Q

Define ‘failure to thrive’.

A

Failure to gain adequate weight or achieve adequate growth at a normal rate for age
OR
suboptimal weight gain in infants and toddlers.

79
Q

What would be seen on a growth chart if a child is failing to thrive?

A

The child falls across 2 major centile lines

at least 2 growth measurements are needed; 3-6 months apart

80
Q

List some causes of ‘Failure to Thrive’ in children.

A
  • Inadequate calorie intake
  • Inadequate calorie absorption
  • Excessive calorie loss
  • Excessive calorie requirements
  • Failure of utilization of absorbed calories
81
Q

List some organic causes for inadequate calorie intake (which may lead to failure to thrive).

A
  • Impaired suck / swallow
    => neurological disorder eg. cerebral palsy
    => cleft palate
  • Chronic illness
    => chronic renal failure
    => liver disease
82
Q

List some non-organic / environmental causes for inadequate calorie intake (which may lead to failure to thrive).

A
  • Inadequate availability of food
  • Psychosocial deprivation
  • Neglect or child abuse
83
Q

List some causes for inadequate calorie absorption, which may lead to failure to thrive.

A
  • Enteropathy eg. coeliac, giardia
  • Food intolerance eg. Cow’s milk protein allergy, Lactose intolerance
  • Short gut syndrome
  • Pancreatic disease
84
Q

List some causes for excessive calorie loss, which may lead to failure to thrive.

A
  • Vomiting eg. gastro-oesophageal reflux, pyloric stenosis

- Protein losing enteropathy

85
Q

List some causes which require excessive calorie requirements, and which may lead to failure to thrive.

A
  • Chronic illness eg. cardiac, renal, respiratory, GI, chronic infection (immune deficiency)
  • Thyrotoxicosis
  • Malignancy
  • Abnormal movement disorder.
86
Q

List some causes of ‘failure of utilisation of absorbed calories’, which may lead to failure to thrive.

A
  • Chromosomal abnormalities
  • Prenatal growth failure
  • Metabolic abnormalities eg. hypothyroidism, glycogen storage disease, etc
87
Q

When taking a history for a child ?failure to thrive, what should you ask about?

A
  • Feeding Hx / Dietary Hx
  • Systemic Hx: cough, lethargy, vomiting, diarrhoea
  • Birth Hx: gestation + birth weight
  • Pregnancy Hx (smoking)
  • Development
  • Family Hx
  • Psychosocial Hx
88
Q

When examining a child ?failure to thrive, what examinations should you conduct?

A
  • Weight, height, head circumference => plot on a growth chart
  • Heights of parents
  • General examination
  • Developmental assessment
89
Q

Who would be involved in the MDT managing a child ?failure to thrive?

A
  • Primary Care (Health Visitor)
  • Dietician
  • SALT
  • Clinical psychologist
  • Social services
90
Q

What are the main drivers of growth in infancy?

A
  • Nutrition
  • Insulin + IGF
  • Thyroxine
91
Q

Why are infants vulnerable to malnutrition?

A
  • High energy requirements => rapid growth
  • Low density diet (milk)
  • Higher morbidity
  • Dependence on others for all food.
92
Q

Why might faltering growth occur?

A 
- Infant factors:
> low appetite
> minor or serious illness
> subtle neurodevelopmental delay 
- Maternal factors
- Pre- and perinatal factors 
- Social factors
93
Q

List some adverse effects of faltering growth.

A
  • Cognitive delay
  • Feeding + behaviour problems
  • Low maternal self-esteem
94
Q

What interventions might be put in place for a child who is ?failure to thrive?

A
  • Meal time organisation

- Behaviour management

95
Q

Describe the composition of breast milk from Day 1 to 7 post partum.

A 
Days 1 -3: Colostrum
Days 3 - 7: Transitional
Day 7+: Mature
=> foremilk
=> hindmilk

*initial weight loss will be seen.

96
Q

What is the expected weight gain of a child aged 0 - 3 months?

A

200g per week

97
Q

What is the expected weight gain of a child aged 3 - 6 months?

A

150g per week

98
Q

What is the expected weight gain of a child aged 6 - 9 months?

A

100g per week

99
Q

What is the expected weight gain of a child aged 9 - 12 months?

A

75g per week

100
Q

What foods should babies under 6 months avoid?

A
  • Wheat + gluten
  • Nuts + seeds
  • Eggs
  • Fish + shellfish
  • Citrus fruit
  • Liver + unpasteurised cheeses
101
Q

What is the recommended feeding for children aged 6 - 9 months?

A
  • Milk: 500-600mls daily (over 4 feeds)
  • 3 meals a day => all food groups
  • Textures and finger foods
102
Q

When should you consider vitamin supplementation for a child under 5 years?

A

0-6 months: if exclusive breastfeeding + poor maternal diet

6-12 months: if breast fed or formula fed and <500mls formula milk daily

Children under 5 years

103
Q

Which 2 vitamin deficiencies are common in children?

A
  • Iron deficiency

- Vitamin D deficiency

104
Q

List 3 common problems associated with infant feeding.

A
  • Colic
  • Posseting
  • Gastro-oesophageal reflux disease
105
Q

Why is hearing important?

A
  • Primary measure of communication
  • Hearing is a prerequisite for speech development
  • Hearing loss can result in developmental delays + academic underachievement
106
Q

When is a child’s hearing tested?

A
  • Universal newborn screen
  • Follow on from newborn screen (targeted follow up)
  • School entry
  • If concerns are identified
  • In accordance with treatment protocol
    eg. Chemotherapy, Cystic Fibrosis, Head trauma affecting temporal region (skull fracture).
107
Q

What are the aims of a hearing test?

A
  • Measure hearing threshold (dB)
  • be frequency specific (Hz)
  • obtain single ear information (if possible)
108
Q

What are the 4 different levels of hearing loss?

A
  • Mild
  • Moderate
  • Severe
  • Profound
109
Q

How do we test hearing? What are the 2 modalities?

A
  • Objective testing

- Behavioural testing

110
Q

Objective testing forms part of a child’s hearing assessment. What is the audiologist looking for when conducting this test?

A
  • Otoacoustic emissions

- Auditory brainstem response

111
Q

Behavioural testing forms a part of a child’s hearing assessment. What does this assess?

A
  • Distraction testing
  • Visual reinforcement Audiometry
  • Performance testing
  • Pure tone audiometry
  • Speech discrimination testing
112
Q

What are the 3 types of hearing loss?

A
  • Conductive hearing loss
  • Sensori-neural hearing loss
  • Mixed hearing loss
113
Q

Give examples of behavioural changes which might occur with temporary hearing loss.

A
  • Appears to daydream => more ‘with it’ when nearer the teacher
  • Asks for repetitions of instructions, or watches other children.
  • Withdraws and does not mix well.
  • Irritability or atypical aggression.
114
Q

How might conductive hearing loss be managed?

A
  • Most conductive losses resolve themselves over time, or are operable.
  • Hearing aids may be offered for persistent losses
  • In the case of permanent conductive losses, Bone Anchored Hearing Aid (BAHA) may be fitted.
115
Q

How might sensori-neural hearing loss be managed?

A
  • Hearing loss usually permanent
  • Managed by hearing aids
  • Aim to raise the level of hearing so that as much speech is as audible as possible
  • In the case of profound hearing losses, cochlear implants may be recommended.
116
Q

How might mixed hearing loss be managed?

A
  • The conductive element will be addressed first

- A hearing aid will be issued to help make all parts of speech audible, especially the high frequencies.

117
Q

What conditions warrant a referral to Audiology?

A
  • Any suspicion of hearing loss
  • Speech delay
  • Behaviour issues
  • Meningitis
  • Head injury
  • Chemotherapy
118
Q

Why have the incidence of twin pregnancies increased since the late 1970s?

A

Due to the introduction of IVF

119
Q

A baby’s cardiovascular system has to adapt to life ex-utero. How does it do this?

A
  • Closure of fetal shunts
  • Perfusion of the lungs
  • Fall in pulmonary artery pressure
  • Increase in cardiac outpit
  • Foetal lung fluid removed
120
Q

A baby’s respiratory system has to adapt to life ex-utero. How does it do this?

A
  • Lungs filled with air
  • Surfactant released
  • Gas exchange
121
Q

Besides cardio-respiratory adaptation, what other adaptations does a baby have to make such that it can survive ex-utero?

A
  • Control of own movements
  • Independent hormonal responses
  • Thermoregulation
  • Feeding
  • Immunocompetence
  • Conversion to adult Haemoglobin
122
Q

When does implantation happen?

A

Weeks 1 - 2 following missed period

123
Q

A baby is classed as ‘very low birth weight’. How much do they weigh?

A

Less than 1500g

124
Q

A baby is classed as ‘extremely low birth weight’. How much do they weigh?

A

Less than 1000g

125
Q

A baby is classed as ‘incredibly low birth weight’. How much do they weigh?

A

Less than 750g

126
Q

A premature baby’s lungs are immature. Describe the structure of the lungs.

A
  • Little or no surfactant (it’s retained in type 2 pneumocytes)
  • Alveoli are absent at 24 weeks (then exponential increase towards term)
  • Lung damage is made worse by: oxygen, sepsis, ventilation.
127
Q

How is a diagnosis of ‘Chronic Lung Disease of Prematurity’ made?

A

Needing oxygen at 36 weeks corrected age.

128
Q

What is the pathophysiology of chronic lung disease of prematurity?

A
  • Reduced lung volume
  • Reduced alveolar surface area
  • Diffusion defect
129
Q

What are the health implications of Chronic Lung Disease of Prematurity?

A
  • Increased mortality
    > SIDS rate increased x7
  • Recurrent admissions
130
Q

What are the neurological consequences of prematurity?

A
  • Brain cells still developing + migrating
  • Not all synapses are formed
  • Brainstem not yet myelinated
  • Changes in cerebral blood flow
  • Changes in oxygen + carbon dioxide levels
131
Q

What is the pathophysiology of ‘Apnoea of prematurity’?

A
  • Brainstem not myelinated fully until 32 - 34 weeks.
  • ‘Forget’ to breathe (frequently associated with bradycardia)
  • Made worse by sepsis.
132
Q

What are the treatments options for Apnoea of prematurity?

A

Physical: NCPAP, Stimulation

Drugs: Caffeine(!)

133
Q

What are the ‘early years’ implications of prematurity?

A
  • Increased need for special schooling

- Increased need for learning support

134
Q

What are the benefits of breastfeeding for the infant?

A
  • Fewer infections
  • Less immune-driven / allergic disease
  • Reduced risk of NEC
  • Reduced risk of SIDS
  • Higher IQ + better cognitive development
135
Q

What are the maternal benefits of breastfeeding?

A
  • Reduces risk of breast, uterine, ovarian and endometrial cancers
  • Promotes postpartum weight loss
  • Optimum child spacing
  • Less medical expense
  • More ecological
  • Delays fertility
136
Q

Prem babies can’t suckle. How can we help them to feed?

A
  • Support prem babies with IV fluids / parental nutrition
  • Start small volumes of expressed breast milk
  • Steadily build to full feeds
  • Monitor growth
  • Suck and swallow starts from 32 - 34 weeks
137
Q

What are the 2 types of jaundice? (in prem babies)

When does jaundice require investigation?

A

Unconjugated
Conjugated

Jaundice lasting more than 3 weeks needs investigation.

138
Q

What are the causes of unconjugated jaundice?

A
  • Haemolysis
  • Prematurity
  • Sepsis
  • Dehydration
  • Metabolic disease
139
Q

Give a complication of unconjugated jaundice.

A

High levels can cause kernicterus.

140
Q

How is unconjugated jaundice treated?

A
  • Phototherapy (blue light, 450nm)

- Exchange transfusions

141
Q

What might cause conjugated jaundice? Is this worrying?

A

Caused by:

  • Prolonged parenteral nutrition
  • NEC
  • Sepsis
  • Metabolic / anatomical problems

High levels of conjugated bilirubin are not a worry.

142
Q

Premature babies may develop sepsis due to an immature immune system. Which infective agents might cause this sepsis?

A
  • Group B Strep
  • Pseudomonas
  • Coagulase negative staphylococcus
143
Q

Why are prem babies more susceptible to developing sepsis?

A

During the last 3 months of gestation, there is active IgG transfer.

  • the more premature you are, the less IgG you get
  • Cell-mediated immunity is less active, as well.
  • Multiple invasive procedures
  • Plastic tubes are not patrolled by the immune system :(
144
Q

Describe the pathophysiology of retinopathy of prematurity.

A
  • Hyperoxic insult
  • Arrest of normal vascular growth
  • Fibrous ridge forms
  • Vascular proliferation
  • Retinal haemorrhages
  • Retinal detachment
  • Blindness
145
Q

What is the treatment for retinopathy of prematurity (ROP)?

A

Laser therapy (if there are high-risk changes seen).

146
Q

What should you NEVER forget about when working with prem babies?

A

THE PARENTS

  • Antenatal counselling
  • Post delivery counselling
  • Prognostic counselling
  • Regular updates
  • Palliative care / bereavement counselling
147
Q

What is the law regarding the treatment of prem babies?

A
  • You have a duty of care to treat patients + the parental wishes are paramount BUT
  • They cannot force you to administer therapy that you believe in ineffective
  • INDEED forcing treatment upon someone could be assault. BUT
  • as you have a duty of care, you may want to treat when the parents do not wish the same.
148
Q

Which pathogens cause Acute Otitis Media in children under 5?

A

Respiratory pathogens:

  • S. pneumoniae
  • H. influenza
  • M. catarrhalis
  • S. progenies
149
Q

Give some symptoms of a child presenting with acute otitis media.

A

Pain
Pyrexia
Unwell
Otorrhoea (discharge from the ear(s))

150
Q

What features in a paediatric history would point you towards a diagnosis of acute otitis media?

A
  • Otalgia (ear ache)
  • URTI
  • Ear tugging
151
Q

List 2 extra cranial complications of acute otitis media.

A
  • Mastoiditis: presents with ear protrusion and post-auricular swelling and redness
  • Tympanic membrane perforation
152
Q

List 5 intracranial complications of acute otitis media.

A
  • Meningitis
  • Extradural abscess
  • Subdural abscess
  • Cerebral abscess
  • Lateral sinus thrombosis
153
Q

What is the treatment for acute otitis media?

A
  • ? Viral: short period of observation (24-48h)
  • Analgesia
  • Antibiotics use is contentious!
154
Q

What is the management for recurrent acute otitis media?

A
  • Analgesia
  • Repeat antibiotic courses
  • Abx prophylaxis
  • Grommet insertion
155
Q

What is the common name for ‘Otitis media with effusion’?

A

Glue ear

156
Q

Who is affected by glue ear? What can glue ear cause?

A
  • Children aged 2 - 5 years

- Glue ear can cause hearing loss

157
Q

List some predisposing factors to glue ear.

A
  • Older sibling
  • Male sex
  • Parental smoking
  • Immune deficiency / allergy
  • Anatomical abnormalities eg. cleft palate
158
Q

What is the treatment / management for glue ear?

A
  • Watch and wait for 3/12
  • 50% will get better
  • No medical treatment
  • Ventilation tubes
  • Adenoidectomy
  • Hearing aids
159
Q

How might a child with hearing loss present?

A
  • Parental concern
  • Speech development
  • Behaviour
  • Education
  • Screening
160
Q

Why is hearing screening so important for speech development?

A
  • Limited time for speech development
  • Outside of this window, no scope to develop speech
  • Children discovered having been deprived of contact with speech - never develop speech
161
Q

When are screening tests for hearing loss conducted?

A
  • At birth
  • Health visitor distraction test
  • School entrance
162
Q

List 4 risk factors of sensorineural hearing loss (SNHL).

A
  • Family Hx
  • SCBU (Special Care Baby Unit)
  • Consanguinity
  • Syndromic
163
Q

Give 4 ways in which deafness rehabilitation is conducted.

A
  • Grommets
  • Amplification Hearing Aids
  • Bone Conduction Hearing Aids
  • Cochlear Implantation
164
Q

What are the indications for a tonsillectomy?

A
  • Recurrent acute tonsillitis (more than 7 episodes per year)
  • Biopsy
165
Q

List 3 causes of snoring in children.

A
  • Simple snoring
  • Sleep disordered breathing
  • Obstructive sleep apnoea
166
Q

How are snoring disorders diagnosed in children?

A

Clinical assessment + sleep studies

167
Q

What are the anatomical causes for snoring in children?

A
  • Tonsils / adenoids
  • Lingual tonsil
  • Macroglossia
  • Enlarged inferior turbinates / deviated septum
168
Q

List some complications of a tonsillectomy.

A
  • Pain
  • Bleeding
  • No evidence to suggest more prone to other infections
169
Q

List the types of chronic diarrhoea presenting in childhood.

A
  • Spurious: over / underfeeding; constipation
  • Chronic, non-specific diarrhoea
  • Malabsorption
  • Enteric infection
  • Inflammatory bowel disease
  • Drug induced
  • Non-intestinal pathology: neuroblastoma, thyroid disease
170
Q

A child presents with diarrhoea. What points should you consider?

A
  • Is it really diarrhoea?
  • Is dietary intake enough to gain weight?
  • Description of the stools
  • Frequency, time of day
  • General health - resp symptoms??
  • Drug Hx
  • Family Hx
  • PMH / Surgery
171
Q

What is Cow’s Milk protein allergy associated with?

A
  • Atopic diseases
172
Q

What percentage of infants show symptoms suggesting adverse reactions to cow’s milk?

A

5 - 15%

Note: estimates of CMPA vary from 2 - 7.5%

173
Q

What are the symptoms of a child who has CMPA?

Cow’s Milk Protein Allergy

A
  • Vomiting / Diarrhoea
  • Abdo pain
  • Intestinal bleeding (gross or occult)
  • Malabsorption
174
Q

How is CMPA treated?

Cow’s Milk Protein Allergy

A

Formula feeds

175
Q

Who gets Toddler’s Diarrhoea?

A
  • Children aged 6 - 20 months

- 90% have normal stools by 3 years of age

176
Q

Describe the symptoms of Toddler’s Diarrhoea.

A
  • Normal growth
  • 3 - 4 stools / day
  • 1st stool of day large; others small
  • Stools contain mucus + undigested food
  • Diarrhoea recurrent or persistent
  • No relation to diet
  • FHx of functional bowel symptoms
177
Q

Describe the pathophysiology of Giardiasis infection.

A

Protozoan: cystic form in stool; motile trophozoite in small intestine
- Villous atrophy, esp. with IgA deficiency

178
Q

How is Giardiasis diagnosed?

What’s the treatment?

A

Diagnosis: cysts in stool or motile forms in jejunal juice

Treatment: 3/7 high dose metronidazole

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