PAEDS Flashcards
What are the milestones in a rapid development screen?
Smiling - 6 weeks
Sounds (turns to) - 6 months
Sitting - 9 months
Standing - 12 months
Words - 18 months
Talk - 50 words by 2.5 y, 3 word sentence by 3 y
Friends - pre-school
What are 3 primitive reflexes and when would their presence suggest cerebral palsy?
Moro reflex
- sudden extension of head leads to symmetrical extension and abduction followed by adduction of arms
Palmar grasp
- flexion of fingers when object placed in palm
Rooting
- head turns to stimulus when touched near mouth
Persists past 3-6 months
What stage of development would you expect a baby of 6 wks to be at?
GM - lift head off flat surface
FM/V - follow an object horizontally
HSL - startled by loud noises
SEB - smile
What stage of development would you expect a child of 3 months to be at?
GM - lift head and chest off flat surface
FM/V - follow object horizontally
HSL - turn to sounds, vocalising
SEB - recognise mother
What stage of development would you expect a child of 6 months to be at?
GM - sit supported, roll over
- absence of primitive reflexes
FMV - reach out, transfer object between hands
HSL - laugh, scream, babble
should be vocalising
SEB - expresses likes/dislikes, starting to wean at 6m
What stage of development would you expect a child of 9 months to be at?
GM - crawling/bum-shuffling
- pull to stand at 10 m
should sit unsupported
FMV - should be able to transfer between hands
HSL - responds to name, says mama, dada
SEB - clap, wave, play peek-a-boo
What stage of development would you expect a child of 1 year to be at?
GM - stand unsupported, pull upright, unsteady gait
FMV - scribble with crayon, mature pincer grip
should have pincer grip
HSL - use a few words
SEB - stranger anxiety
- drink from cup using 2 hands
What stage of development would you expect a child of 18 months to be at?
GM - walk backwards, walk upstairs with one hand held
- pick up object, recover
should be walking independently
FMV - build a tower of 3-4 bricks
- turn book pages
HSL - point to eyes, nose, mouth
- should be able to say at least 6 words with meaning
What are the red flags for gross motor development?
- Poor head control or floppiness at 6 months
- Unable to sit unsupported at 9 months
- Not weight bearing through legs at 12 months
- Not walking at 18 months
- Not running at 2 years, or persistent toe walking
What are red flags for speech development?
- No double syllable babble at 1 year
- <6 words or persistent drooling at 18 months
- No 2 – 3 word sentences by 2.5 years
- Speech remains unintelligible to strangers by 4 years
What are the key features of autism?
- impaired social communication and interaction
- repetitive behaviours, interests and activities
What is the criteria for diagnosing attention deficit hyperactivity disorder?
6 features of inattention, hyperactivity and/or impulsivity + evidence of developmental delay
How is ADHD managed?
- 10 week watch-and-wait period before referring to secondary care
- education and training programmes
- 6 week trial of methylphenidate
What do you need to be careful of when prescribing methylphenidate?
- monitor height and weight every 6 months
- perform a baseline ECG as it is potentially cardiotoxic
How would you manage a child who has stopped breathing?
- shout for help
- open airway
- look, listen, feel for breathing
- FIVE RESCUE BREATHS
- check femoral pulse
- 15:2 chest compression + rescue breath
What is the management for Patent ductus arteriosus?
PDA with no cyanosis - Indomethacin
PDA with cyanosis - prostaglandins
What is the management for asthma in children aged 5-16?
- SABA
- SABA + low dose ICS (budesonide)
- SABA + low dose ICS + LTRA (Montelukast)
- SABA + low dose ICS + LABA (salmeterol)
- SABA + MART
When would intussusception typically present?
boys aged 3m - 18 months
How does intussusception present?
- colic pain
- pallor
- vomiting
- draws knees up to chest
- red currant jelly in stools
- sausage shaped mass in RUQ
How would you investigate a child with suspected intussusception and what would it show?
US abdomen - target shaped/donut mass
How is intussusception treated?
rectal air insufflation
When would malrotation typically present?
first 1-3 days of life (but can be any age)
How does malrotation present?
- bilious vomiting (if volvulous)
What are risk factors for developing malrotation?
- Exomphalos
- Congenital diaphragmatic hernia
- Intrinsic duodenal atresia
How is malrotation investigated and treated?
Ix = upper GI contrast study and USS
Mx = laparotomy (Ladd’s procedure)
Who typically gets pyloric stenosis?
boys, 2-8 weeks, family history!!
How would pyloric stenosis present?
projectile, non-bile stained vomiting
How do you investigate someone with possible pyloric stenosis?
Test feed = olive in RUQ and USS
How is pyloric stenosis treated?
Ramstedt pyloromyotomy
What biochemical picture would you get with pyloric stenosis?
low Na, K and Cl
What reassuring things could you say to parent of child with GORD?
- v common
- usually begins before 8 weeks
- becomes less frequent over time (normally resolved by 1yr)
What is the initial treatment for a child with GORD?
- small meals
- sit upright
- burp
What is the pharmacological treatment for GORD?
- feed thickener e.g. alginate therapy
- trial of PPI e.g. ranitidine
- refer to paediatrician
What are red flags for GORD?
- bile
- blood
- projectile
- faltering growth
What is Hirschsprung’s disease?
Absence of ganglion cells in myenteric/submucosal plexus
How would Hirschsprung’s disease present?
Delayed passage of meconium
Abdo distension
Vomiting
How is Hirschsprung’s disease diagnosed?
Suction rectal biopsy
How is Hirschsprung’s disease treated?
Initially rectal washouts then anorectal pull through procedure
How would necrotising enterocolitis present?
abdo distension
bloody stools
What are risk factors for developing necrotising enterocolitis?
Prematurity !
antibiotics >5 days
How is necrotising enterocolitis treated?
total gut rest
TPN
- laparotomy if perforated
How would you investigate for necrotising enterocolitis and what would you find?
X-ray
- pneumatosis intestinalis and evidence of free air
How does coeliac disease present in infants? (4)
- diarrhoea
- faltering growth
- muscle wasting
- abdo distension
How is coeliac disease diagnosed?
- IGA TTG (if low THEN anti endomyseal antibodies)
- endoscopic intestinal biopsy
What would you find on biopsy of someone with coeliac?
- villous atrophy
- crypt hyperplasia
- lamina propria infiltration with lymphocytes
What is the most likely causative organism of meningitis in neonates?
Group B Strep
What is the most likely causative organism of meningitis in children?
N meningitidis
Strep pneumoniae
What would you see on LP sample of bacterial meningitis?
cloudy
- raised protein
- raised neutrophils
- low glucose
What would you see on LP sample of viral meningitis?
clear
- normal/raised protein
- raised LYMPHocytes
- normal glucose
Give 4 contraindications to LP in suspected meningitis?
- focal neurological signs
- papilloedema
- significant bulging of the fontanelle
- signs of meningococcal septicaemia
What is the treatment for bacterial meningitis?
GP = IM benzyl penicillin
<3m = cefotaxime + amox
>3m = ceftriaxone
+ dexamethasone if >3m and super infected
When would you do an LP on a child?
<3m with fever
<1yr and unexplained fever
What are the signs of meningococcal septicaemia?
same as meningitis + NON-BLANCHING RASH
What is the prophylaxis for meningitis and who should get it?
- people who have had close contact within the 7 days before onset
- oral ciprofloxacin
How would scarlet fever present?
high fever+sore throat -> strawberry tongue -> rough SANDPAPER rash on cheeks, chest and tummy
Which organism is responsible for scarlet fever and how is it treated?
Group A strep = penicillin
How does measles present?
cough/coryza/cranky/conjuncitvitis/kopliC spots
THEN
maculopapular rash from head to toe
What is a common complication of measles?
otitis media
How is measles treated?
supportive -> should resolve in 7-10 days
How does rubella present?
1- coryzal prodrome
2 - pink maculopapular rash
3 - LYMPADENOPATHY + ARTHRALGIA
How does parvovirus/slapped cheek disease present?
1 - coryzal prodrome/fever
2 - malar rash/ gloves and stocking
When does parvovirus stop being infectious?
When the rash disappears
Which organism is mostly responsible for bacterial tonsillitis?
Group A beta haemolytic strep
( Strep pyogenes)
When would you prescribe AbX for tonsillitis?
If they score 2-3 (delayed prescription)
If they score 4/5 (immediate prescription)
Which organism most commonly causes bronchiolitis?
RSV (Respiratory syncytial virus)
Which age group are most commonly affected by bronchiolitis?
<1
How is bronchiolitis managed?
Admit if:
- <3 months
- prem
- downs syndrome
- CF
- <75% milk intake
- RR >70
- O2 <92
Tx = NG/nasal suction/ O2
What causes croup?
Parainfluenza virus
Which age group are most affected by croup?
6m - 2 years
What symptoms would a child with croup get?
- increased WOB
- barking cough
- STRIDOR
- low grade fever
How is croup treated?
ORAL DEXAMETHASONE
- or high flow O2 + nebulised adrenaline if difficulty breathing
What is the causative organism in epiglottitis?
Haemophilus influenzae type b
