Paeds 1 Flashcards
1
Q
Common problems with breastfeeding
A
- 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
2
Q
Cause of sore/cracked nipples
A
- Usually happens if baby not latched on properly
- Get help from midwife, health visitor as soon as possible - can make pain worse otherwise
3
Q
Ways to overcome not enough breast milk perception
A
- 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
4
Q
Signs baby is getting enough breast milk
A
- 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
5
Q
Engorgement causes
A
- 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
6
Q
Signs of not latching on properly
A
- Painful
- Baby seems not satisfied after feed
*
7
Q
Sign baby is latched on well
A
- 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.
8
Q
When does thrush infection occur on breasts?
A
- If nipples become dry/cracked
*
9
Q
How does blocked milk duct occur?
A
- 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
10
Q
When does mastitis occur?
A
- 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
11
Q
What causes breast abscess?
A
- Unresolved mastitis
- May need surgery to drain abscess
12
Q
What is tongue tie How does it relate to breast feeding?
A
- Strip of skin that attaches tongue to floor of mouth - frenulum
- Sometimes can affect breastfeeding
- Sometimes doesnt
- Is easily treated
13
Q
Head lice advice
A
- 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
14
Q
When to suspect colic?
A
- 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
15
Q
Signs of colic
A
- 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
16
Q
Managing colic
A
- Hold/cuddle baby during cyring
- Gently rock them over shoulder
- White noise - TV etc can help
- Warm bath
- Wind after feeds
17
Q
Weaning - when and what advice?
A
- 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
18
Q
Signs baby is ready for solids
A
- 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
19
Q
Red flags alongside rash that suggest should go to A&E
A
- 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
20
Q
Cause of rash on cheeks with high temp
A
- 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
21
Q
Causes of blisters on hands and feet and mouth ulcers
A
- 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
22
Q
Scarlet fever rash
A
- 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
23
Q
Ringworm rash
A
Itchy round shaped rash
May be red, pink, silver or darker than rest of skin
24
Q
Who to speak to if your crying baby is making you struggle and you need to talk to someone?
A
- Cry-sis helpline
25
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
26
What is bow legs known as?
Genu varum
27
When is Genu varum normal?
* Normal in children under 2
* If not spontaneously gone by 2 need orthopaedic referral
28
What is knock knees known as?
Genu valgum
29
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)
30
Why does in-toeing occur?
* Lots of reasons
* Commonly caused by metatarsus adductus/varus deformity
* Moulding deformity which usually improves by 2yrs of age
31
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
32
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
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3 causes of in-toeing
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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)
35
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
36
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
37
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
38
Frequent falls can be a sign of...
* Duchenne muscular dystrophy in boys
* But it is normal for children to fall a lot under 3
39
Assymetry
* Any assymetry in posture/walking should be sent to physio for investigation
* Assymetric crawaling may be normal
* Leg length/hip movement concerns --> ortho
40
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
41
When is mature gait pattern established?
Not properly until 7yrs old
42
Fever, painful rash on upper body differentials
* Measles
* Scarlett fever
* Rubella
* Erythema infectiousum
* Roseola infantum
* Varicella (chicken pox)
43
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
44
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)
45
Rubella rash
* Non-confluent
* Maculopapular
* Rash begins primarily behind ear and spreads
46
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
47
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
48
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
49
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`
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