Paeds Flashcards
How old is a neonate, infant, toddler, pre-schooler, school age and adolescent child?
<28 days, 1-12 months, 1-3 years, 3-5 years, 5-12 years, >13 years
Features in HPC?
Explode every symptom- time-frame (when started, acute/ gradual onset, duration, progression, intermittent or continuous,) symptom- specific questions e.g. SOCRATES for pain
Paeds systems review- general: fever, behaviour, activity/ apathy/ alertness, rashes, growth+ weight
CR: cough, noisy breathing, dyspnoea, cyanosis
GI: vomiting, abdo pain, diarrhoea/ constipation
GU: wetting/ nappies/ toilet trained, dysuria, frequency
NM: seizures/ fits, headaches, abnormal movements
ENT: sore throat, snoring, noisy breathing, earache
Birth hx features?
Pregnancy- problems, maternal illness/ drug use
Birth hx- POB, gestation & birth weight, mode of delivery and birth complications, neonatal problems e.g. jaundice, fits, fevers, bleeding, feeding problems
Feeding hx?
Diet+ appetite- breast/ bottle milk< 12 months, which formula milk
Weaning 6-12 months
>12 months= solid meals and cow’s milk
Toileting- toilet training 2-4 years, dry by day 2 years, dry by night 3-4 years, frequency- wet nappies? (usually 5 soaking wet nappies per day and 3 yellow stools)
Growth hx?
Weights- ‘the Red Book’ from birth to 5 years
Puberty if older
Development hx?
Concerns, school progress& attendance
Screen if< 5 years: smiling by 6 weeks, sitting by 9 months, turns by sounds by 6 months, first words by 18 months, walking by 18 months, talking 3 word sentences by 3 years
Other aspects of paeds hx?
Past medical hx- illness, surgery, accidents, hospital/ A&E visits
Drug hx- immunisations up to date, current meds- dose, route, compliance, relevant recent meds, allergies
Family hx: relevant to HPC, anyone else ill
Social hx: family unit (tree,) smokers- inside/ outside, social services involvement, housing situation, playgroup 2-5 years, nursery 3-4 or school 5-16 years, other- hobbies, travel, pets
ICE
ABCDE assessment for child?
Wash hands, intro, patient ID, DOB, explain
Airway: stridor, secretions
Breathing: RR, recession, oxygen SATs, auscultate inspirations
Circulation: colour, radial pulse, hydration signs- wet nappies, mucous membranes, skin turgor, CRT, heart sounds, BP if unwell
Disability (neuro): alert and behaviour, AVPU score/ GCS, Fontanelle- bulging= raised ICP
Pupils w/ torch if unwell, limb tone and movement, joint swelling, RASH- look all over, capillary glucose measurement if decreased alertness
Everything else: ENT, temperature
Normal HR and RR in <1 y/o? 1-2 y/o? 2-5 y/o? 5-12 y/o? >12 y/o?
30-40 and 110-160 25-35 and 100-150 25-30 and 95-140 20-25 and 80-120 15-20 and 60-100
Amber flags?
Nasal flaring, tachypnoea, SATS<95%, pallor, tachycardia, reduced CRT, reduced UO, dry mucous membranes, reduced activity, not responding normally to social cues
Rigors, fever in 3-6 month old
Red flags?
Stridor
Resp distress= RR>60, pale/ mottled/ blue, reduced skin turgor, unresponsive/ won’t stay awake, non-blanching rash/ neck stiffness, seizures
Fever< 3 month old
Intro to developmental assessment?
Wash hands, intro, patient ID, explain exam, consent
Observe for 30 seconds
Do 3 areas before gross motor with child on parent’s lap
Ask parents questions to fill in any gaps/ anything cannot get them to demonstrate
Gross motor skills?
Put child on play-mat on floor
Lie on back- see if can roll
Lift shoulders to sitting position- look for head control (3 months)
See if can sit unaided (6 months)- curvature of spine and sitting reflexes
Pull to stand- see how much support needed (9 months)
Walk if able (15 months) or run (2 years)
Place prone- if lifts head, chest or crawls (10 months)
Fine motor and vision?
Get child to take a toy and observe- transfers (6 months), type of grip (palmar grasp 6 months; pincer grip 9-10 months)
Offer bricks- 3-cube tower= 18 months, bridge= 3 years
Paper and pen- scribbles at 18 months
Vision- wave toy, fixes and follows (3 months)
Hearing and language?
Click fingers/ use rattles- startles to noise= newborn, turns to sounds= 7 months, turns to name= 12 months
Talk to child and ask parents what the child can say or noises- babble by 6 months, single word by 9 months, Mummy and Daddy by 12 months, name and colours by 3 years
Commands- brick in cup by 2 years
Social skills?
Smile by 6 weeks, laughs by 3 months, stranger anxiety at 9 months, peek-a-boo by 9 months, waves bye at 12 months, solids by 6 months, fork and spoon at 2 years
Presenting a developmental assessment?
Looking at growth charts and measuring weight, height and head circumference, take a full history
Estimate developmental age if age unknown, if age known- comment if dev is appropriate for age
Qs along with diarrhoea and vomiting? For soiling/ enuresis?
Hydration- wet nappies, drinking
Primary/ secondary, full account of toilet training, school toilet behaviour, protest behaviour: stressful life, soiling- faces consistency& painful anal conditions, secondary: urinary/ GI infection symptoms, spinal cord compression symptoms- neuro sys review
Failure to thrive/ weight loss Qs?
Growth chart, input: dietary hx, feeding hx, hunger, use: energy, activity level, exercise, anorexic?, output: wet nappies, stools& GI symptoms, others: behaviour, general, happiness, parents health
Signs of resp distress?
Cyanosis, tracheal tug, subcostal/ intercostal recessions, hypoxia, tachypnoea, wheeze on auscultation, stridor, head bobbing
DDx for wheeze?
Asthma, bronchiolitis, viral induced wheeze, pneumonia
DDx for stridor?
Croup, epiglottitis, bacterial tracheitis, diphtheria, laryngomalacia, inhaled foreign body, angiodema/ anaphylaxis
Red flag features for a vomiting child?
Bile-stained= intestinal obstruction, haematemesis= peptic ulceration, gastritis, oesophageal varcies,
projectile vomiting= pyloric stenosis
Abdo pain on movement= appendicitis
Blood in stool= intussusception, gastroenteritis, severe dehydration= severe gastroenteritis, DKA, systemic infection, headache/ seizures= raised ICP, failure to thrive= gastro-oesophageal reflux disease, coeliac disease
DDx for vomiting?
GORD, cow’s milk protein intolerance, intestinal obstruction, infection
Symptoms, invest and managements for GORD?
Recurrent regurg, feeding difficulties, arching of back and neck, sore throat
pH impedance study, 24-hour probe
Smaller and more frequent meals, feed thickeners, optimise position
Symptoms, invest and managements for cow’s milk protein intolerance?
Abdo pain, eczema, flatulence, bloody stools, diarrhoea/ constipation
Skin prick/ specific IgE antibody testing
Cow’s milk elimination diet, hypoallogenic infant formula, mothers to avoid cow’s milk
Symptoms, invest and managements for intestinal obstruction?
Acute on chronic, billious vomiting, constipation, abdo pain
USS, abdo XR, contrast study
Surgical intervention
Symptoms, invest and managements for infection?
D&V and abdo pain (gastroenteritis,) isolated vomiting (UTIs,) altered responsiveness (meningitis)
Find source: cultures, urine dipstick, LP
Treat source of infection
