Paeds 1 Flashcards
Common problems with breastfeeding
- Sore/cracked nipples
- Not enough breastmilk
- Breast engorgement
- Baby not latching properly
- Too much breastmilk
- Breasfeeding and thrush
- Blocked milk duct
- Mastitis
- Breast abscess
- Breastfeeding and tongue tie
Cause of sore/cracked nipples
- Usually happens if baby not latched on properly
- Get help from midwife, health visitor as soon as possible - can make pain worse otherwise
Ways to overcome not enough breast milk perception
- Offer baby both breasts at each feed
- Alternate which breast you start with each feed to stimulate supply
- Keep baby close with skin to skin - stimulates supply
Signs baby is getting enough breast milk
- Starts feed with few rapid sucks followed by long rhythmic ones
- Hear and see swallow
- Cheeks stay rounded
- Seem calm and relaxed during feeding
- Comes off breast on their own
- Mouth looks moist after feeds
- Appears content and satisfied
- Breasts feel softer after feeds
- Nipple looks same before and after feeds
- You can feel sleepy/relaxed after feeds
Engorgement causes
- Early days when you and your baby getting used to feeding
- Takes a few days for you to match babys milk demand
- Can also happen when baby starts having solids
Signs of not latching on properly
- Painful
- Baby seems not satisfied after feed
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Sign baby is latched on well
- Baby has a wide mouth and a large mouthful of breast.
- Baby’s chin is touching your breast, their lower lip is rolled down (you can’t always see this) and their nose isn’t squashed against your breast.
- You don’t feel any pain in your breasts or nipples although the first few sucks may feel strong.
- You can see more of the areola above your baby’s top lip than below their bottom lip.
When does thrush infection occur on breasts?
- If nipples become dry/cracked
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How does blocked milk duct occur?
- If breast engorgement does not reolve –> blocked duct
- Frequent feeding from affected breast may help
- If possible position baby with chin towards lump - feed from that part of the breast
When does mastitis occur?
- When blocked milk duct does not resolve
- Inflammation of breast
- Breast can be hot, painful and can get flu like symptoms
- Carry on breast-feeding, starting feed with tender breast can help
- If not better within 12-24hrs or feel worse –> GP
What causes breast abscess?
- Unresolved mastitis
- May need surgery to drain abscess
What is tongue tie How does it relate to breast feeding?
- Strip of skin that attaches tongue to floor of mouth - frenulum
- Sometimes can affect breastfeeding
- Sometimes doesnt
- Is easily treated
Head lice advice
- Do not need to keep child off school
- Can treat without seeing GP
- Can wash hair and apply lots of conditioner and comb through with nit comb
- Or can use chemical treatments from pharmacies which kill live lice and then you comb through dead ones out
When to suspect colic?
- All babies cry
- But may have colic if they cry more than 3 hours a day, 3 days a week for at least 1 week but are otherwise healthy.
- Can cry more in afternoon/evening
- Usually stops by 3-4months old, starts within first few weeks
Signs of colic
- it’s hard to soothe or settle your baby
- they clench their fists
- they go red in the face
- they bring their knees up to their tummy or arch their back
- their tummy rumbles or they’re very windy
Managing colic
- Hold/cuddle baby during cyring
- Gently rock them over shoulder
- White noise - TV etc can help
- Warm bath
- Wind after feeds
Weaning - when and what advice?
- Start around 6 months old
- Introdiced alongside formula/breastfeeds
- Can start to reach for adult foods
- Dont have to worry about amount at first - get nutrition from milk
- Start with single veg and fruits
- Then carbs, meat, yoghurts and cheese
- Don’t add salt, avoid ready made foods with added sugar/salt
Signs baby is ready for solids
- Can sit up and hold head steady
- Co-ordinate eyes hands and mouth
- Swallow food - more in mouth than around it
- Is usually around 6 months
Red flags alongside rash that suggest should go to A&E
- Stiff neck
- Bothered by lights
- High temp
- Difficulty breathing
- Rash that looks like small bruises under the skin
- Skin lips/tongue look pale, blotchy blue or grey
Cause of rash on cheeks with high temp
- Slapped cheek syndrome
- Usually have runny nose and sore throat
- Few days later can get itchy rash on chest arm and legs
- Can be treated conservatively at home - fluids, calpol, moisturise itchy skin
Causes of blisters on hands and feet and mouth ulcers
- Hand foot and mouth
- Sore throat, high temp, don’t want to eat
- Gets better on its own within 7-10 days - fluids, soft foods, paracetamol/ibuprofen
- Can get mouth ulcer gels/sprays/mouthwashes to help
Scarlet fever rash
- Rash of small raised bumps that feel rough like sandpaper
- Initally flu like sympotms and then rash 12-48hrs later
- Starts on neck then spreads
- Strawberry tongue with white coating
- Can get rheumatic fever if get better and then worse
- Need antibiotics - Penicillin
Ringworm rash
Itchy round shaped rash
May be red, pink, silver or darker than rest of skin
Who to speak to if your crying baby is making you struggle and you need to talk to someone?
- Cry-sis helpline
Devlopment of normal gait in children
- 6 months - supported walking, foot flat with no heel strike, stiff knees, poor ankle control
- 12 months - stiff knees, little knee flexion so circumducts at hip to bring leg through, start of heel strike, still wide base
- 18 months - increased knee flexion so less circumduction
- 3 yrs - hip and knee control mature but not foot and ankle
- 5-7yrs - maturing of ankle and foot control
What is bow legs known as?
Genu varum
When is Genu varum normal?
- Normal in children under 2
- If not spontaneously gone by 2 need orthopaedic referral
What is knock knees known as?
Genu valgum
When is genu valgum normal/not need referral?
If child between 3-4 (only need referral though if under 2 or over 7, or if assymetrical, or intermalleolar distance more than 10cm)
Why does in-toeing occur?
- Lots of reasons
- Commonly caused by metatarsus adductus/varus deformity
- Moulding deformity which usually improves by 2yrs of age
Other causes of in-toeing
- Internal tibial torsion can cause in-toeing prior to and during walking
- Walking can cause tibia to rotate into more normal alignment and should resolve by 5yrs of age
By age of 3, what causes in-toeing?
- Femoral anteversion
- Continues to correct until age 8-9
- In-toeing persistting after these ages needs referral
3 causes of in-toeing
When is out-toeing normal?
- Usually improves spontaneously when gait is matured
- Due to external rotation of hip when first walking (contraction of external rotator cuff muscles)
Common foot problems
- Flat feet - normal in pre-school and not a problem if mobile, refer if feet stiff/painful
- Cavus feet (high arch)- cause for concern, investigate neuromuscular disorders before referring
Common toe deformities
- Overriding/curly toes are common and usually improve with weight bearing
- If causing pain, difficulty finding foorwear or hard skin developing, podiatry may need to help
When is toe walking normal?
- If before age of 3yrs old
- If persistent could be caused by baby walkers - discontinue use
- Referral if absolutely cannot walk on heels down, could be tight hamstrings, NM disorder or tight achilles tendon
Frequent falls can be a sign of…
- Duchenne muscular dystrophy in boys
- But it is normal for children to fall a lot under 3
Assymetry
- Any assymetry in posture/walking should be sent to physio for investigation
- Assymetric crawaling may be normal
- Leg length/hip movement concerns –> ortho
Problems with fine motor/gross motor skills
- If gross motor skills - physio
- If fine motor eg handwriting –> paediatric occupational therapy or outreach teaching via school
When is mature gait pattern established?
Not properly until 7yrs old
Fever, painful rash on upper body differentials
- Measles
- Scarlett fever
- Rubella
- Erythema infectiousum
- Roseola infantum
- Varicella (chicken pox)
Measles rash
- Erythematous, confluent
- Dark red colour
- Begins behind ears
- Disseminates to rest of body
- Rash on palate
- Kopliks spots - clusters of white lesions in mouth of patient
- Also have conjuctivitis
Scarlett fever
- Fine, light red maculopapular rash (flat and raised)
- The develops into scarlett coloured confluent rash after 1-2 days
- Begins on neck and spreads to rest of body
- Most pronounced under armpits/groin arreas
- Non-blanching petichieae (pastias lines) may be present
- Patients face is usually red with perioral pallor
- Bright red tongue with enlarged papillae (strawberry tongue)
Rubella rash
- Non-confluent
- Maculopapular
- Rash begins primarily behind ear and spreads
Erythema infectiousum rash - AKA slapped cheek
- Do not necessarily develop a rash
- Red papules can emerge on extrematies and trunk that eventually become lace like reticular appearance
- Blotchy red rash may appear on cheeks - group together within hours to form red, slightly swollen warm plaques with nasal and peri-oral sparing
Roseola infantum rash (aka exanthem subitum or three day fever)
- Patchy, rose pink
- Most pronounced on torso
- Before exanthem phase have feverish phase of 3 days, followed by sudden decrease in temperature
Varicella rash
- Widespread
- Whole body affecting inc scalp and oral mucosa
- Starts with small red bumps that develop into fluid filled blisters and pustules that then form scabs
- Starry sky can be used to describe how different stages appear all at once on someones body
Stages of learning to walk
- 7 months - expert crawler
- 8 months - puller upper
- 9 months - Standing
- 10 months - first steps and wheeled walker
- 11 months - wobbly but wanders
- 12 months - pro`