Paediatrics Flashcards
Gross Motor Milestones
3 Months - head control 6 Months - rolls front to back, back straight when held sitting 7-8 Months - sits without support 9 Months - pulls to standing, crawls 12 Months - cruises, walks with one hand held 12-15 Months - walks unaided 18 Months - squats to pick things up 2 years - runs 3 years - rides a tricycle 4 years - hops on one leg
Gross motor milestones - when to be concerned (2 things)
Not sitting without support by 12 months
Not walking without support by 18 months.
Age at which continence usually achieved
3 to 4 years
Management of Nocturnal Eneuresis (4 things)
1) rule out other causes e.g. constipation, diabetes, UTI
2) advise on fluid intake, diet, toileting behaviour
3) give rewards for agreed behaviour i.e. toileting before bed
4) failing these measures, generally enuresis alarm for children under 7 or desmopressin for children over 7 years. (depending on family needs and preferences.)
Causes of Microcephaly
Normal Varient Familial Congenital Infection Perinatal brain injury FAS syndromes e.g. Patau craniocyntosis
Presentation of Heart failure in Infants (4)
Breathlessness worse on exertion e.g. feeding
sweating
poor feeding
recurrent chest infections
Causes of Heart Failure in Infants
< 2 weeks - duct dependant systemic circulations e.g. coarctation of the aorta
> 2 weeks - VSD as the pulmonary vasculature resistance falls
Risk assessment in febrile children -colour
Green - normal
Amber - pallor reported by care giver
Red - pale or mottled
Risk assessment in febrile children - Activity
Green - responds normally, content, easily rousable or awake, not crying or strong cry
Amber - not responding normally to social cues, no smile, takes time to wake, decreased activity
red - no response to social cues, appears ill, does not wake or does not stay awake when roused, weak, high pitched or continuous cry.
Risk assessment in febrile children - Respiratory
Amber - nasal flaring, tachyponea (>50b/m in 6-12 months or >40b/p in ae >12 months), 02 sats = 95% in air, Crackles in the chest.
red - grunting, tachyponea >60 bpm, moderate or severe chest indrawing
Risk assessment in febrile children - circulation and hydration
green - normal skin and eyes, moist mucous membranes
amber - tachycardia >160 b/m in <12 mnths, >150 b/m in 12-24 mnths, >140 b/m in 2-5yrs, cap refil >/= 3 secondsm dry mucous membranes, poor feeding, reduced urine output
red - reduced skin turgor
Risk assessment in febrile children - other
green - no amber or red signs
amber - age 3-6 mnths temp >39 degrees, fever for 5 days or more, rigors, swelling of a joint or limb, non-weight bearing or not using an extremety.
red - age <3 months temp >38, non blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal neurology, focal seizures.
management of febrile illness in infants
GREEN - supportive care at home, advice when to seek help
AMBER - safety net or paeds specialist review
RED - urgent referal to paeds specialist
What would these parameters be in early (compensated) shock in a child? BP, HR, Resp rate, appearance, urine output
BP - Normal HR - tachy RR - tachy appearance - pale or mottled UP - reduced
What would these parameters be in late (decompensated) shock in a child? BP, HR, Resp appearance, urine output
BP - hypo HR - Brady Resp - acidotic appearance - blue UO - absent
Fluid Bolus in children
20ml/kg (15ml/kg in neonates) in 10 mins of saline
initial management of duct dependent congenital heart disease
prostaglandins e.g. alprostadil as they maintain patency of the ductus arteriosus
Red flags for constipation (5) (and two amber)
reported from first few weeks of life
Meconium passed later than 48 hrs post birth
‘ribbon’ stools
previously undiagnosed leg weakness or locomotor delay
abdominal distension
Amber - safeguarding concern, faltering growth
Causes of Constipation in Children
Majority are Idiopathic dehydration low-fibre diet opiate medication anal fissure over enthusiastic potty training hypothyroidism hirschsprung's disease hypercalcaemia learning disability
what is Hirschsprung’s Disease?
the absence of ganglions in a segment of the bowel causing loss of peristalsis and ability to move stool through the intestine
What is perthes’ disease and who gets it?
degenerative condition of the hips, typically affecting boys (5:1) aged 4 - 8 years. It is due to AVN of the femoral epiphysis.
presentation of Perthes’
Hip pain, progressive over weeks
limp
stiffness and reduced ROM
radiographical changes in perthes’
widening of joint space, decreased femoral head size, femoral head flattening
management of perthes’
Cast and braces to keep femoral head in acetabulum
if older than 6 consider surgical management
What is Juvenile idiopathic arthritis
arthritis occurring in someone less than 16 years old lasting more than 6 weeks.
Types of JIA and their features (5)
Pauciarticular - most common, 4 or less joints effected, medium sized joints e.g. knees, shoulders elbows
Systemic-onset JIA -anaemia, thrombocytosis, lecucytosis and rasied ESR present
RF positive JIA - RF is positive, nodules on extensor surface of tendons
Polyarticular JIA - 4 or more joints effected
Ethesitis related JIA - inflammationof the entheses present (site of tendon and ligament insertion into bone.)
What is plagiocephaly?
parallelogram shaped head - normal in infants due to sleeping on back. usually resolves between 3-5 years. Reassure and recommend moving cot/ focus of attention, encouraging supervised supported sitting out during the day and supervised tummy time.
What is biliary atresia and when does it occur?
oliteration or discontinuity of the extrahepatic biliary system, resulting in obstructive jaundice. Usually presents in first few weeks of life.
