paediatrics Flashcards
what is difference in kids?
size, drug dose, fluid
larger head to body ratio
larger body: surface area( fluid)
difference in airway in children?
large occiput, short neck, big tongue, small mouth
difference in breathing in children?
higher RR(40-60)
Smaller immature airways
compliant chest wall
diaphragmatic breathing
difference in circulation in children?
RV=LV at brith until
pulmonary vascular resistance fall at 6 mo
circulating blood volume by body weight ( small losses significant)
high HR
normal HR in newborns
110-160bpm
skin difference in children
thin epidermis
increase absorption
MSK difference
bone not yet ossified( growth centre), growth plate not fuse yet,
fracture in kids
greenstick, Satter Harris ( around growth plates)
immune system in kids
less mature system immature BBB(more intracranial infection esp new born required LP)
Infectious disease in newborns
Group B strep, E.coli
metabolic system in kids
high BMR( higher requirement and expenditure)
4 domain in developmental in children
- motor
- speech language
- social
- cognition
4 things to ask in history in kids
- oral intake
- output
- sleep
- activity level
sleep time in kids?
longer than adults
3 aspects of history to ask
- ob and birth history
- developmental history
- immunisation history
adolescent history?
HEADS Screen home education activity drug sexuality, suicide. mood, safety
causes in irritability in children?
dehydration , sleep deprivation, hunger, pain or discomfort, behaviours, CNS infection, fever
pain rating scale
- Wong becker FACE pain rating scale
- numerical ratings cale
- FLACC scale( face, legs, activity, cry, consolability)
- neonatal pain ax tool
general observation
alert, active, playful, dysmorphisms, growth vital signs
how to measure growth
weigh, height and head circumference
wide pulse pressure in kids means
PDA or aorta regurgitation
narrow pulse pressure
aortic stenosis
signs of respiratory distress in children
intercostal, subcostal recession, tracheal tug and nasal flaring
gross motor function develop timeline
rolling (by 9mo) scrawling( by 12mo) sitting standing (18mo) walking(2yo)
language development timeline
babbling(6 mo) two part babble( 9mo) 1-3 words(1yo) 2 words together(2yo) understand 2 steps commands(2.5yo) understand sentence(3yo) understand complex sentence (5yo)
time range to look at in milestone
- 3rd and 97th percentile (beyond : worry about but still can be normal)
reach for objects in fine motor occur when
3-4mo
banging objects together, casting and pointing to objects
6-12mo
pincer grip in fine motor when
9-12mo
hand dominance occurs when
2 yo (should not occur before 12mo)
what can children do at 2 yo
walking, putting 2 words together, hand dominance, 2 steps commands, interaction with other children
2 parts of langue milstones
expressive and receptive
language milestone development
attention and listening skill–> social interaction and play skills–> understanding language–> expressive language– speech pronunciation and fluency skill
following commands in receptive language skill happen when
one step commands 1yo
two steps command 2yo
when will the children star to be understood by strangers
4 yo
social developmental red flag
smile by 6-8 mo
turn playing develops when
3yo
weight, height and head circumference at birth
weight: loss 5-10% in first few days(7-10d return to normal)
height: 50cm
head circumference: 35cm
risk factors to normal development
- Prematurity
- Low birth weight
- Birth injury
- Chronic illness
- Vision and/or hearing impairment
- Low parental education
- Parental mental illness
- Social isolation
- Poverty
- Lack of access to services
Developmental screening tests
Denver
Parent questionnaires
– PEDS, ASQ
Leading cause of death in children 0-14 years of age
injury
Boys > Girls (1.5 time)
Indigenous > Non-indigenous
common cause of injury in 0-14
<1: breathing, assault
1-14: transport and accidental drowning
causes of injury in Infants <12 months
- Drowning (75% bathtubs)
* Thermal injuries
causes of injury Children 1-4yrs
- Drowning (60% swimming pools)
- Thermal injuries
- Unintentional poisoning
- Falls (from playground equipment)
causes of injury Children Children 5-9yrs
• Falls
causes of injury Children 10-14yrs
- Unintentional transport injury
- Intentional self harm
- Assault
- Falls
cause of injury in adolescents
• Intentional self harm
ED presentation in children
<1: bronchiolitis
1-9: gastro
10-18: abdo pain
Developmental delay?
Develop fall outside 2 SD below expected range to achieve developmental milestone
Normal development with right succession with delayed compared to age
Global impairment
Delay or impairment in 2 or more area
Specific delay
Delay in one area only
Atypical development
Cerebral palsy, ADHD, trajectory very different
Primitive reflexes need to be lost before development
Loss by 6-8 wks
Stepping reflex
startle reflex
screening development in birth to 8 yo
PEDS
biological factors in development affecting Developmental myelination
Genetics Monogenic disorder Epigenetics Exposure to toxin Modification of genomic transcription, Trauma. Nutrition
psychosocial factors in development
temperament, availability of parent, parenting style, bullying, self-esteem
triad of ADHD
hyperactivity
impulsivity
poor concentration
presentation of autism
- social communication ( no reciprocal , non-verbal communication, relationship)
- repetitive restricted pattern of behaviours ( sameness, adherence, highly restricted, rigid)
- hyper or hypo-activity to sensory stimulus
M>F, 2-4yo
Ix for autism
ADOS, ADI-R
recognition of the serious ill children
Skin: mottle, cyanotic, petechiae, pallor
Activity: assistance, ambulating, responsive
Ventilation: retraction, head bobbing, robbing, nasal flaring, slow rate, fast rate, stridor, wheezing
Eye contract: glassy starte, fail to engage
Abuse: unexplained bruising or injuries/ inappropriate parent
Cry: high pitched, cephalic, irritable,
Heat: high fever(>41), hypothemia( <30)
Immune system: sick cell, AIDS, corticosteroids
Level of consciousness(irritable, lethargic, pain , consoling, unresponsive)
Dehydration( hollow eyes, cap refill, god and, voiding, D+V, bilious persistence,dry mucous membrane)
toxic appearance
poor interaction with parent eye contact poor person cyanosis irritable not constable
suspects sepsis
cyanosis, rapid breathing, poor perfusion, petechial rash, parental concern, clinician instincts, T>40
color in NICE guideline
pale, mottle/ ashen, blue
activity in NICE
no response, appears ill, no wake, weak, high pitched or continuous cry
resp in NICE
grunting, tachycardia, RR>60, chest indrawing
circulation/dehydration in NICE
reduced skin turgor
other red flag in nICE
Age<3. temp>38, non-bleaching rash, balding fontanelle, neck stiffness, status epileptics, focal near signs, focal seizures
things to consider in a sick chid
abuse, aortic stenosis, TGA, pulmonary atresia, malrotation, lactate, ketone,
CEWT scores
identify ill children in hospital
oxygen, resp rate
HR, BP
Common cause of cardiac arrest in children
fluid loss
fluid maldistribution
resp distress
resp depression
resp effort
stridor: upper airway pathology
wheeze: low airway pathology
grunt: airspace pathology or pneumonia
AVPU score
alert
response to voice
response to pain
unresponsive
