Paediatrics in GP Flashcards
What are centile charts useful for?
Plotting change in height, weight, head circumference etc over time.
What is it important to do with growth charts?
Look at the pattern over time, not just assume that a low centile is always pathological.
What BMI centile suggests a child may be obese?
Above 91st centile is overweight, above 98th is obese.
What could a BMI below 2nd centile suggest?
Small build or undernutrition
A mother brings in a child with concerns that they are too small.
What questions should be asked in the history?
- Diet and eating habits
- Weight progression over time
- Parental height
- Medical history
- School performance
- Other symptoms
If a child is eating too much or too little, who could be fueling this?
Child themselves, or the parents
What factors contribute to childhood obesity?
- Dietary habits
- Exercise
- Sleep
- Genetics
- Socio-economic status
- Medication
- Concurrent health conditions
What is the worst dietary habit that leads to obesity in children?
Fast food that is high in fat and fast carbohydrates
How does sleep contribute to childhood obesity?
Sleep deprivation due to and causing reduced physical exercise, also causes increased hunger due to increased letin and ghrelin production.
What medications can contribute to childhood obesity?
- Antidepressants
- Anticonvulsants
- Antipsychotics
- Lithium
- Corticosteroids
What concurrent medical conditions can increase risk of childhood obesity?
- Hypothyroidism
- Cushing’s
- GH deficiency
- PCOS
- Spina bifida
What are growth and weight faltering defined as?
Weight or length/height crossing down through the centiles, weight low for height, or not catching up from low birth weight.
What age should be used for premature babies on growth charts?
Corrected age for degree of prematurity
When should a premature baby reach normal:
- Head circumference
- Weight
- Height
- 18 months
- 24 months
- 40 months
Which conditions use different growth charts to normal children?
Down’s syndrome and Turner syndrome
A parent brings their child in due to concerns that they are too small for their age.
What questions about pregnancy should be asked?
- Smoking
- Alcohol consumption
- Medications use
- Illness during pregnancy
A parent brings their child in due to concerns that they are too small for their age.
What questions should we ask about the eating habits of the child?
- How much, if it can be quantified.
- If they seem satisfied following feeding
- Frequency of wet and dirty nappies
- Stool nature
A parent brings their child in due to concerns that they are too small for their age.
What is the first assessment you should make?
Whether the child looks well in themselves, happy, active, and healthy.
When might a GP need to do the NIPE?
If the mother and baby are discharged from hospital soon after delivery, or if a home delivery occurs.
What hx should the GP enquir about if they need to do a NIPE?
Events in pregnancy, birth, and since birth.
Any concerns the parents have.
FHx
Interventions at birth e.g. vit K
Specifics inc passage of urine and meconium, feeding
Neoonatal screening
Which newborn check is the GP more likely to undertake?
6 week check
How does the 6 week check differ from the NIPE?
Problems with vision or hearing maybe be more apparent by this point
Motor responses e.g. holding head up without wobbling should be possible at 6 week check (although sometimes takes until 3mo)
Social behaviour differs ( child should be smiling)
Health education at this point - discuss vaccinations, sleeing positions, and recognition of illness.
What are the major orthopaedc conditions that a GP should screen children for?
Congenital dislocation of the hip
Soliosis
How is CDH screened for? (Name the tests)
Ortolani and Barlow maneurvres
At the 6 week check, what might indicate the infant has visual problems?
- Infant doesn’t fix on mothers face when breastfeeding
- Eye-wandering when awake and happy
- White spot (cataract ) seen in pupil
What signs at the 6 week check might indicate an infant has hearing issues?
-No startle response to noise
At what age would no response to their name cause concern about a child’s hearing?
8 months
What signs of birt trauma might a parnt be concerned about and bring their infant to the GP with?
- Caput succedaneum (swelling and bruising of presenting portion, resolves on it’s own)
- Cephalohaematoma (rare haemorrhage beneath periosteum, lump that resolves with some anaemia or jaundce possible)
- Depressed skull fracture (rare, usualy du to forceps delivery, needs neurosurgical elevation)
- Intracranial haemorrhage (rare, may cause fits, shock, IRD, need admitting urgently).
What minor problems might a parents bring their infnt to the GP with?
Skin changes/rashes Sneezing Sticky eye Possetting Colic
A parent bring their infant to the GP for a white rash. O/E, what would confirm a diagnosis of milia?
What should you tell the parent?
Tiny pearly white papules on nose/palate.
It is just blocked gland ducts, will resolve on its own.
A parent brings their newborn to the GP with peeling skin. They are otherwise well and were born at 41+4 weeks. What do wetell them?
Common problem for post-dates babies, nothing to worry about. Use olive oil or baby oil to prevent skin cracking and keep skin moist.
What is possetting?
Common regurgitation of 5-10mls of each fed by a baby with no signs of discomfort or effort.
As long as otherwise well, just slow downfeeds and feed upright.
A mother brings her newborn in to the GP because she cannot take how muh the child is crying. The child seems well and happy o/e with no signs of illness or causes of distress. What do we need to ask about?
Pattern of crying i.e. is it related to feeding?
Does mother feel connected to baby? Screening for post-natal depression.
What does the baby do when crying? (E.g. drawing feet up to abdomen suggests colic)
A parent brings in their infant, who was born at 30 week gestation. What problems are they at a higher risk of developing?
- Poor suck and swallow reflex
- Hypothermia and shivering
- Respiratory distress (v. Low threshold for readmission)
- Jaundice
- Infection
- Anaemia
- Intraventricular haemorrhage causing neuro issues
- Retinopathy o prematurity
- NEC
- Hearing problems
- Bonding isues
A mother comes to the GP wishing to discuss breast feeding. What can you tell her?
It is generally preferred from a medical standpoint - fewer GI and respiratory infections, decreased incidence of childhood obesity, strong bond created between mother and baby, and protective against breast cancer in mother.
However, means only mum can feed baby unless she expresses. Additional vitamin K may be needed. Some infectious diseases can be transmitted (HIV/Hep B), as can some medications, if breast fed alone past 6mo, supplementation of vitamns isneeded.
When should an infant start to be weaned from milk onto foods?
Around 6 months of age. Indicated by baby being hungry soon after feeding even when it was a big feed.
A mother wants to wean her 6mo ont purees. What can you tell her about homemade purees=?
They are usually preferred and cheaper to make that shop-bought.
Do not add salt or excess sugar.
If under 6mo, advised to continue sterilising equipment before feeding.
Start with 2-3 tsp of food per meal.
Start with one flavour then introduce more over time.
