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
