Paediatrics - General Flashcards
IV fluids - What are the daily maintenance fluid requirements for children
Bolus dose?
In adults it is 2.5L / 24 hours
In children it is based on weight:
1st 10kg - 100ml/kg
2nd 10kg - 50ml/kg
>20kg - 20ml/ kg
For example, for a 22kg boy - 1000ml + 500ml + 40 (2x20) = 1540ml /day
Bolus:
Background- Adults - 500ml standard
Children:
10ml/kg
DIVIDE BY 24 to get the hourly infusion rate
KEY NOT GIVEN IN THE EXAM:
Paediatric RR and HR values
THESE ARENT EXACT AND VARY BETWEEN SOURCES
Just remeber three groups - start at
Resp Rate:
<1 year - 40
1-4 - 30
4-12 - 30 repeat
12< - 25
HR - drop by 20
<1 year - 160
1-4 - 140
4-12 -120
12< - 100
History taking - What to include in a systems review
- dietary and fluid intake
- stool normal?
- urine output
- vomitting
- fever
- rash
- coryzal symptoms
- cough
- work of breathing
- weight change
- behavoir change
- pain
Additional components in a paediatric history (vs adults)
The generic structure of the paediatric history is the same as for adult medicine with a few additions. These can be remembered using the BLINDS mnemonic shown below, with the various areas covered in more or less depth depending upon the age and presentation.
Presenting Complaint and History
Past Medical History
Drug History and Allergies
Family History
Social History - Including social care invovlement!
Ideas, Concerns and Expectations
BLINDS
Birth and Antenatal History including
Looking for risk factors for neonatal sepsis
Immunisations
Nutrition
Developmental History
Screening for Mental Health/social care invovlement
The HEADSSS assessment is an internationally recognised tool used to structure the assessment of an adolescent patient (10-20), encompassing Home, Education/Employment, Activities, Drugs, Sex and relationships, Self harm and depression, Safety and abuse. The assessment starts with simple and easy questions about life to allow a rapport to be built, before delving into more personal and embarrassing aspects.
Get a chapperone:
Home - who lives at home? fight with anyone? who to turn to when upset?
Education & employment - what do you enjoy at school? who are your friends? bullying?
Activities - spare time?
Drugs- smoking and alcohol, some people your age try drugs smoking or alcohol?
Sex and relationships - are you seeing anyone at the moment? with a boy or a girl? sex?
Self harm - how is your mood? sad or stressed? self harm?
Safety - do you ever feel unsafe?
How to approach a CXR
- Why are we doing the x-ray?
- Medical Devises? Correct positions
- needs to be on a good inspiratory breath
- A→E approach
- Airway - central
- Breathing - too white or too black?
- Cardiac
- Diaphragm and Pleura - constophrenic angle, trace the pleura up
- Everything else - A→ E or evil areas - apices, bones - ribs and scapulae, cardiac, diaphragm - below the diaphragm, edges - soft tissues
High Yield Developmental Milestones - up to 1 year (5)
Child development is huge topic in itself, but remembering a few key milestones is really useful for most consultations (2):
Social smile at 6 weeks
Reaches for toys at 4 months
Sits unsupported at 6 months
Takes first steps unsupported at 12 months
First words at 12 months
Gross Motor Developmental milestones
Newborn - Limbs flexed, symmetrical pattern. Marked head lag on pulling up
6 – 8 weeks - Raises head to 45 degrees in prone (tummy-time)
**6 – 8 months Sits without support **(initially with a round back, then eventually with a straight back by 8 months), Limit age: 9 months
8 – 9 months - Crawling
10 months - Stands independently, Cruises around furniture
12 months Walks unsteadily – a broad gait, with hands apart, Limit age: 18 months
15 months Walks steadily
2.5 years Runs and jumps
Vision and Fine Motor developmental milesteones
6 weeks - fixing and following a moving object/face
4 months - reaches for toys, limmit 6 months
4-6 months - palmar grasp
7 months - transfer toy from one hand to another
10 months - mature pincer grip, limmit 12 months
Brick building - 4 by 18m, 12 by 2.5y, bridge by 3y, steps by 4
Pencil skills - 12 months - marks, line 2y, circle 3y, cross 3.5y, square 4y, triangle 5y
What is development and what are the domains
- Development describes the acquisition of functional skills between birth and approximately age 5
- 4 domains
o Gross motor
o Vision and fine motor
o Hearing, speech and language
o Social, emotional and behavioural - Milestones are median and then limit (two standard deviations away from the mean age of acquisition, which requires further tests). For instance, when considering the milestone of walking – the median age is 12 months, with a limit age of 18 months
Hearing, Speech and language developmental milstones
newborn - startled by loud noises
3-4 months - “aa-aa”
7 months - polysyllabic bable - bababababa
7 - 10 months - dada and mama (discriminately at 10 months)
**12 months - “drink”, says 2/3 more words - first words by 12 months
**18 months - where is your nose?
20-24 months - give me teddy
2.5 years - 3/4 word sentences - push me fast daddy
Social, emptional and behavoiral developmental milestones
**6 weeks - social smile
**10-12 months - waves bye-bye
12 months- drinks form a cup with two hands
18 months - can use a spoon without spilling
18 months - symbolic play (limmit 2.5 years) - immaginative play
2 years - nappy tained, dry by day
2-5 years - takes turns, interactive play, parralel play
High yield - Red flags for development for each domain (2 each)
Regression/lost milestones
Gross motor
Not sitting unsupported at 12 months
Not standing independently at 18 months
Not walking independently at 2 years
Not running at 2.5 years
Others
No clear words at 18 months
No interest in others at 18 months
Hand preference before 18M (shows weakness of the opposite)
What diseases are screened for in the newborn blood spot test - name 4/9
9 serious health conditions:
- sickle cell disease
- cystic fibrosis
- congenital hypothyroidism
- inherited metabolic disease
- beta thalasemia major is also picked up, but the main screening is during prengancy to check is the mother has the trait
When doing a developmental assessment of a child it is important to appreciate that children develop at different rates, and there is flexibility in the milestones. However, a child who is very slow to achieve all milestones or lags behind on a specific developmental domain may have underlying pathology.
List 4 causes of global developmental delay?
List 2 causes of each of the specific developmetal domains? - 8 marks
Global developmental delay refers to a child displaying slow development in all developmental domains. This could indicate an underlying diagnosis such as:
Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
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Gross Motor Delay
A delay that is specific to the gross motor domain may indicate underlying:
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
Fine Motor Delay
A delay that is specific to the fine motor domain may indicate underlying:
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia (rare)
Language Delay
A delay that is specific to the speech and language domain may indicate underlying:
Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
Hearing impairment
Learning disability
Neglect
Autism
Cerebral palsy
Management of language delay involves a referral to speech and language, audiology and the health visitor. Referral to safeguarding is required if neglect is a concern.
Personal and Social Delay
A delay that is specific to the personal and social domain may indicate underlying:
Emotional and social neglect
Parenting issues
Autism
