Paeds Flashcards
What gross and fine motor skills should a child of 6 months be able to achieve?
Pushes up on arms in prone, can roll from front to back / transfers objects using palmar grasp
A weight on what centile corresponds to a child being obese?
98th centile
Which formula is best- whey or casein based?
Whey
What gross and fine motor skills should a child of 18 months be able to achieve?
Runs, climbs onto adult chair / builds tower of 3-4 blocks, develops hand preference
Other than general inspection, what should you do during assessement of the back and CNS in a newborn examination?
Palpate down the spine
Listen to the mid-scapular area
Check the anus is patent
Check the Moro and grasp reflexes
What defines precocious puberty in girls and boys?
< 8 years in girls, < 9 years in boys
What are some potential underlying causes of a delay in social skills?
Autism
Secondary to abuse or neglect
Other than general inspection, what additional test should you do during assessment of the legs and hips in a newborn examination?
Barlow and Ortolani’s test
What are some good ways to tell that a baby is taking enough milk during feeds?
They are gaining weight
They are having 6 wet nappies per day
They are passing 2 yellow stools per day
When is calculation of a child’s BMI required?
If the weight is above the 75th centile or if the weight and height centiles differ
What social skills should a child of 9 months be able to achieve?
Anxious around strangers
From 4 years to puberty, how much should a child’s height increase by each year?
5cm
What extra things should you always enquire about in a paediatric history?
Birth history, growth and developmental history, vaccination history
Explain how the grimace in response to plantar stimulation section of APGAR is scored?
Absent = 0
Grimace/feeble cry = 1
Strong cry/pull away when stimulated = 2
What language skills should a child of 24 months be able to achieve?
Joins two words together, follows simple instructions
What are some potential underlying causes of a fine motor/visual delay?
Squint
Refractory error
Cataract
Glaucoma
What happens to a baby’s weight in the first week after birth?
What is the reason for this?
The baby will lose 5-10% of its birthweight
Loss of extracellular fluid
What social skills should a child of 12 months be able to achieve?
Waves bye-bye, drinks from a cup
By what age should the majority of children have achieved day and night time continence?
3-4 years
What are some specific symptoms to ask about in a paediatrics systemic enquiry?
Cough/cold symptoms/difficulty breathing, vomiting, rashes, fever, any evidence of pain
When should routine examination of the newborn take place?
Ideally within 24 hours of birth, must be within 72 hours
What growth variables are plotted in children aged < 2 years?
Head circumference, length and weight
At what ages are childhood vaccinations usually given?
2, 3 and 4 months
12-13 months
3 years 4 months
What are some risk factors for child abuse that you should try to address in a history where this is suspected?
Was the child premature or does it have any physical/mental disability?
Are there any mental health or substance misuse issues with the parents?
Is there domestic violence or social deprivation?
Exclusive breastfeeding is recommended for how long?
6 months
A weight on what centile corresponds to a child being overweight?
91st centile
What social skills should a child of 6 months be able to achieve?
Friendly with strangers, plays with their feet
Explain how the activity (tone) section of APGAR is scored?
Absent = 0
Some flexion = 1
Flexed arms and legs that resist extension = 2
Explain how the pulse section of APGAR is scored?
No pulse = 0
< 100 = 1
> 100 = 2
What gross and fine motor skills should a child of 12 months be able to achieve?
Cruising, walking / bangs toys together
What extra question should you always ask in a social history in paediatrics?
Has social work ever been involved with the child?
A baby’s weight should double by when?
4-6 months
What are some potential underlying causes of a speech delay?
Hearing impairment
Autism
Part of a wider global developmental delay
What social skills should a child of 3 years be able to achieve?
Vivid pretend play, understands sharing
If a child who is in or completing puberty has a height measurement plotted within the shaded area, what action is required?
Referral to paediatrics (below 0.4th centile)
If a child who is pre-pubertal has a height measurement plotted within the shaded area, what intervention is required?
Compare with the mid-parental height- only consider referral to paediatrics if there is a significant discrepancy
At what age can a child drink full fat cow’s milk?
12 months
How do you gestationally correct on a growth chart?
Plot the measurements at the child’s chronological age, then draw a line back the number of weeks the infant was preterm
What language skills should a child of 3 years be able to achieve?
Knows name and sex, asks lots of questions
What are three questions to always ask as part of your systemic enquiry in paediatrics?
Is the child eating/drinking normally? Is the child still having wet/dirty nappies or going to the toilet as normal? Is the child acting like their normal self or are they out of character?
Short stature is defined as a height below what centile?
Tall stature is defined as height above what centile?
2.5th centile
98th centile
What language skills should a child of 12 months be able to achieve?
Responds to name, jargons
What are some investigations you may want to do in a situation where child abuse is suspected?
Blood tests
Skeletal survey
Head CT
Fundoscopy
Medical photography
How long should milestones and growth charts be corrected for premature babies?
2 years
What social skills should a child of 6 weeks be able to achieve?
Social smile
When do the primitive reflexes typically disappear?
5-6 months
How should you plot growth for a baby who was < 32 weeks premature?
Use an infant and neonatal close monitoring chart
What language skills should a child of 6 weeks be able to achieve?
Stills to voice
What social skills should a child of 24 months be able to achieve?
Puts on hat and shoes, developing symbolic play
Explain how the respiratory effort section of APGAR is scored?
No effort = 0
Weak, slow gasps = 1
Strong cry = 2
What are the 5 features of APGAR?
Appearance (colour)
Pulse
Grimace (response to stimulation)
Activity (tone)
Respiratory effort
A baby’s head circumference should treble by when?
One year
How should head circumference be measured?
Above the child’s ears, measure the head from midway between the eyebrows and hairline to the occipital prominence
What is one of the most important things to ask about in a history where abuse is suspected, in order to be safe?
Ask if there are any other children at home
A baby’s weight should treble by when?
1 year
What is the target height for a child based on mid-parental height?
Within two centile spaces above or below the mid-parental height
After the first few days of life, how much milk should babies be consuming?
How many feeds should this be spread over?
150ml/kg/day spread over 4-6 feeds
What are some things to ask for in a family history of a child where abuse is suspected to rule out potential differentials?
Bleeding disorders, ostoegenesis imperfecta
At what age should a baby begin to be weaned onto solid foods?
6 months
Describe how to perform Ortolani’s test?
Flex the hips and knees of the infant, place your index finger on the greater trochanter and apply pressure while abducting the hip- this relocates a dislocated hip
What social skills should a child of 4 years be able to achieve?
Dresses and undresses, understands turn-taking
When should a child have their length measured in a supine position as opposed to standing height?
If they are < 2 years old or they are unable to stand
When are APGAR scores calculated?
Routinely at 1 and 5 minutes after birth
Additional checks every 5 minutes until the score is > 6
What gross and fine motor skills should a child of 3 years be able to achieve?
Stairs with alternating feet, rides tricycle / copies a circle, cuts with scissors
How accurate is the adult height predictor section of growth charts?
4/5 children will be within +/- 6cm of this value
What gross and fine motor skills should a child of 4 years be able to achieve?
Runs up and down stairs / threads beads, draws man
What is a good way of explaining that you are going to refer their child to social services for assessment?
All children with these injuries are referred for further assessment. Some injuries like this are not accidental and it can be very difficult to tell, so we have to refer all cases in order to be safe.
(Explain the process and emphasise that you are doing this to keep the child safe and protected)
What are some specific milestones that are useful to ask about?
When did the child start to walk and talk?
What gross and fine motor skills should a child of 3 months be able to achieve?
No head lag / regards hands held in midline
What language skills should a child of 3 months be able to achieve?
Laughs and coos
What gross and fine motor skills should a child of 9 months be able to achieve?
Crawls, stands holding onto furniture / picks up objects between thumb and hand, points with index finger
What is the definition of faltering growth (failure to thrive)?
A sustained drop down 2 centiles on a growth chart
Before performing a newborn examination, what information should you obtain?
Information about the maternal health, pregnancy and delivery, family history
What would be your immediate management for a case where child abuse was suspected?
Admit to paediatrics for further investigation
Contact your senior and contact safeguarding lead
Refer to social services
Between the ages of 1 and 5, the average child should gain how much weight per year?
2kg
What are some potential underlying causes of a gross motor delay?
Cerebral palsy
Muscular dystrophy
Part of a wider global developmental delay
What language skills should a child of 9 months be able to achieve?
Polysyllabic babble, imitates adult sounds
For children up to the age of 5 who are walking, how much exercise should they be doing in a day?
For children aged 5-18 years, how much exercise should they be doing in a day?
180 minutes
60 minutes of moderate-vigorous intensity exercise
What is the triad of symptoms that forms shaken baby syndrome?
Retinal haemorrhages, subdural haematoma, encephalopathy
How should you plot growth for a baby that was premature, but more than 32 weeks gestation at birth?
Plot measurements on the preterm section until 42 weeks’ gestation
After this, plot on the 0-1 chart at the chronological age but with gestational correction
What should you do during assessment of the abdomen and external genitalia in a newborn assessment?
Check the umbilical stump and feel the abdomen, softly then firmly
Palpate the testes and inspect for hypospadias (boys)
Check the labia and introitus and warn patients to expect some spotting (girls)
What growth variables are plotted in children aged > 2 years?
Weight, height +/- BMI
What gross and fine motor skills should a child of 6 weeks be able to achieve?
Head control in vertical / follows torch with eyes
What are some benefits of breastfeeding to the mother?
Decreased risk of breast and ovarian cancer
Decreased risk of cardiovascular disease
Helps with post-natal weight loss
Improves bonding
More affordable
What defines pubertal delay in boys and girls?
13+ for girls, 14+ for boys
If a teenage child’s height is plotted in the shaded area, what further information do you need to acquire?
Pubertal status and mid-parental height centil
What are some benefits of breastfeeding to the child?
More proteins, antibodies and probiotics to prevent infection
Decreases risk of type 1 diabetes, obesity, SUDI and cardiovascular disease in adulthood
When should a skeletal survey be repeated?
After 11-14 days
What language skills should a child of 18 months be able to achieve?
5-20 words, points to body parts
A baby’s head circumference should double by when?
4-6 months
What language skills should a child of 6 months be able to achieve?
Screams when annoyed, babbles tunefully
What is the average age of puberty in boys and girls?
10 years in girls, 11 years in boys
What gross and fine motor skills should a child of 24 months be able to achieve?
Stairs two feet at a time / builds tower of 6-7 blocks, circular scribble
What does dropping centiles on a chart actually correlate to in terms of growth?
The child isn’t growing
What should be done as part of assessment of the head and skull during the newborn examination?
Examine the size and shape of the skull
Feel the fontanelles
Measure the head circumference
What should you do during assessment of the heart and peripheral pulses in the newborn examination?
Feel the femoral pulses (normally 110-160 bpm)
Palpate the four areas with bell and diaphragm
Feel for the apex beat and any heaves/thrills
Other than general inspection, what are some additional things you should do during the assessment of the face, eyes, ears, mouth during the newborn examination?
Check the red reflex
Feel the palate while assessing for the suckling reflex
What should you do during assessment of the lungs in the newborn examination?
Assess the respiratory rate (30-60) and pattern of breathing
Listen to air entry
What APGAR score would be considered normal?
8-10
What language skills should a child of 4 years be able to achieve?
Recount stories of recent experiences
What social skills should a child of 18 months be able to achieve?
Feeds with a spoon, imitates adult activities
From 1 to 4 years, how much should a child’s length increase by each year?
25cm
Explain how the ‘appearance’ section of APGAR is scored?
Blue/pale = 0
Pink body with blue extremities = 1
Pink = 2
A specialised growth chart is required for children with what condition?
Down’s syndrome
Before performing a newborn examination you should ask whether the baby has peed or pood- within what timeframe should each of these events occur?
Should urinate within the first 24 hours and pass meconium within the first 48 hours
Describe how to perform Barlow’s test?
Adduct the hip and apply posterior pressure through the knee, this may dislocate a hip (positive test)
What social skills should a child of 3 months be able to achieve?
React pleasurably to familiar situations
