Paediatrics and Child Health Flashcards
What are the stages of childhood defined by age
Neonates: Birth -4 weeks
Infants: 4 weeks-<1 year
Toddlers: 1 year-2 years
Preschool: 2-4years
School: 5-16 years
Adolescence: onset of puberty-Adulthood
What Screening and Surveillance is done during various stages of childhood?
All important childhood information is recorded where?
The PCHR-Red Book
(PCHR: Personal Child Health record)
What is Positional plagiocephaly and why does it occur?
An asymmetrically shaped head - most common: positional plagiocephaly
Occurs due to external pressure on the malleable skull
What would you explain regarding Positional plagiocephaly to a concerned parent?
It is only of cosmetic significance and should becomes less noticeable once baby starts to roll and their hair grows to cover the back
Label the image
When does the anterior vs posterior fontanelle close?
- Anterior ~ 18 months
- Posterior ~ 2 months
Remains soft and palpable until closed
A newborn presents with a non-pulsatile bulging fontanelle, most likley Dx
Raised ICP
A newborn presents with a depressed fontanelle, most likley Dx
Significant dehydration
What measurement is used to monitor head/skull growth?
Occipitofrontal circumference (OFC)
What key examination of the eyes must be done on an infant?
At what age is this performed?
Red reflex - 6-8 weeks
What causes an abnormal red reflex
Abnormal red reflex caused by anything which impedes reflection of ophthalmoscope light from vascular ocular fundus
List the most common cause of an abnormal red reflex
Congenital cataracts:
- Preventable cause of blindness in children
- Requires surgical treatment in first 3 months
A mother is concered because her 2 month old has a squint (image below)
- What is the medical name the condition?
- What advice would you give to Mum
- Newborn strabismus
- Transient squint (misalignment) is common upto 3 months, if squint persists beyond this age we need investigate underlying cause
What is the most common underlying cause of a squint in a newborn
Refractive errors but other more serious ones need to be excluded
Are Pre-auricular skin tags on an infant (image below) concerning?
Yes, newborns with this congenital anomaly are at increased risk of hearing loss
Tags may be an isolated finding or associated with part of a recognisable syndrome
Describe the appearance of a healthy, normal eardrum
Appears transparent with a pinkish/grey colour and is approximately circular in shape
Inner ear bones and light reflection (shape of a cone) are easily visualised
How would a child with Acute Otitis Media present?
- Pulling of the ear in older infants
- Purulent discharge for ear canal
These are localised signs/symptoms
If a child with Acute Otitis Media becomes systemically unwell, how may they present?
- Pyrexia
- Irritability
- Vomiting
- Going off food
You examine an infant with suspected Acute Otitis Media, list 2 indicative findings on otoscopy
- Red bulging ear drum
- Loss of normal light reflection
What age group are most commonly affected by AOM?
6-12 months but can occur any time throughout childhood
A mother is concerned about a lesion on her babys face, what is the Dx
Describe the progression of this lesion
Infantile (Strawberry) haemangioma
- Lesion develops in first few weeks of life
- Gradually increases in size
- Eventually produces a raised red lesion with uneven surface (resembles a strawberry)
- Gradually shrinks and disappears in childhood
What is seen on the image below, what is this?
Pectus excavatum
Sternum is sunken so the middle of chest instead of being level with the ribs
Isolated finding OR part of a syndromic diagnosis
What is shown on the image below?
Pectus carinatum, Poland syndrome
Sternum raised above the ribs, middle of chest is more prominent
Usually a number of other congenital anomalies which collectively form a recognisable Syndrome
What is an Umbilical Granuloma?
Small amount of pink or lightly red tissue which remains on the navel after the umbilical cord falls off
Cause is unknown but it is related to the tissue healing process. Usually heals spontaneously, if not then salt treatment is effective
What is the name given to the flat light/dark brown patches seen on the image below?
Cafe au lait spots (birthmarks)
Can be present anywhere on the body upto 2 spots are commonly seen in children
When should we be concerned with Cafe au lait spots and why?
If there is 6+ (rare)
Suggestive of the Neuro-cutaneous condition → NeuroFibromatosis Type 1
What is the medical term for webbed or conjoined fingers or toes
Syndactyly
In majority the affected fingers are connected only by skin
Webbed fingers or toes may occur as an isolated finding or as part of many syndromes
What is the inherritance pattern of the isolated form?
Autosomal Dominant
Image below shows a ‘sacral dimple’, what must we check to exclude a possible underlying abnormality of the spine
- Is the floor of the dimple seen covered with skin?
- Are there any other features such as a lipoma, hairy tuft, discolouration of skin adjacent to the dimple?
If skin is not intact or other features are present → possible spinal abnormality
What is the flat blue/grey birthmark seen on the image below?
Which locations are they usually present and who do they most commonly affect?
Mongolian Blue Spot - no significance unless misdiagnosed as bruises
Located at the base of the spine, buttocks and occasionally on legs and arms
Commonly seen in babies with dark skin (can be present in Caucasian babies)
What is the medical term for club foot?
Can it be treated?
Bilateral Congenital Talipes Equinovarus
Appropriate and timely orthopaedic and physiotherapy treatment → pain free, normal looking feet
