paeds Flashcards
SIDS five main risk factors
- prone sleeping
- parental smoking
- bed sharing
- hyperthermia and head covering
- prematurity
Treatment for baby with GORD (regurgitates and gags during feeds)
- Breastfed infants - 1-2 week trial of alginate e.g. Gavison
- Bottlefed infants - 1-2 week trial of feed thickener
- Then 4 week trial of omeprazole if no improvement
- Refer to paeds if none above work
A formula fed infant with GORD should have feeds reduced to
150ml/kg per day
treatment for head lice
malathion
children with head lice - do they need to be excluded from school
no!
How do you work out the corrected age of a premature baby when working out milestone ages
The age minus the number of weeks he/she was born early from 40 weeks
e.g. born prematurely at 32 weeks
- normal milestone to smile = 6 weeks
- for this premature baby = 40-32 = 8, then add on 6 = 14 weeks is their milestone
NICE suggest what regarding chickenpox and school exclusion and infectivity in relation to the rash
Most infectious period is 1-2 days before rash appears
Infectivity continues until all lesions are dry and crusted over, usually about 5 days after rash onset
IM benzylpenicillin doses for meningococcal septicaemia for:
(a) <1 year
(b) 1-10 years
(c) >10 years
(a) <1 year = 300mg
(b) 1-10 years = 600mg
(c) >10 years = 1200mg
When should premature babies have their vaccines - at normal timetable, or delayed (correct for gestational age)
AT NORMAL TIMETABLEq
maintenance and reliever therapy (MART) inhalers are combination of what two
LABA + ICS
treatment of asthma in kids aged 5-16
- SABA
- SABA + low dose ICS
- SABA + low dose ICS + LTRA
- SABA + low dose ICS + LABA
- SABA + MART (contains ICS + LABA)
- SABA + moderate dose ICS MART
- SABA + high dose ICS MART, theophylline, asthma specialist!
Children 15:2 chest compressions to rescure breaths
What speed should chest compressions be for kids
100-120/min
Babies with absent or weak femoral pulses at 6-8 week baby check - what should you do
Discuss immediately with paeds
what are 3 cyanotic congenital heart diseases (right to left shunt)
- tetralogy of Fallot
- transposition of great arteries
- tricuspid atresia
what are 5 acyanotic congenital heart diseases (left to right shunt)
- ventricular septal defect
- atrial septal defect
- patent ductus arteriosis
- coarctation of aorta
- aortic valve stenosis
first line medication option for ADHD
methylphenidate
if inadequate response, switch to lisdexamfetamine
NICE do not recommend a proton pump inhibitor (PPI) to treat overt regurgitation in infants and children occurring as an isolated symptom. A trial of one of these agents should be considered if 1 or more of the following apply:
- unexplained feeding issues e.g. refusing feeds, gagging or choking
- distressed behaviour
- faltering growth
When should kids have an USS urinary tract with UTIs:
- <6 months with UTI should have USS within 6 weeks
- > 6 months who have an atypical or recurrent UTI
what scan can be done in children after UTI to identify renal scars
Static radioisotope scan e.g. DMSA
4-6 months after initial infection
what scan can be done in children after UTI (atypical or recurrent infections) to identify vesicoureteric reflux
micturating cystourethrography (MCUG)
what cardiac issue occurs with Kawasaki’s disease
coronary artery aneurysms
Traetment for Kawasaki disease
High dose aspirin
IvIg
Echocardiogram - initial screening test for coronary artery aneurysms
High-grade fever > 5 days
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Red hands + feet with desquamation that peels
what is the diagnosis
Kawasaki disease
bronchiolitis is usually caused by what pathogen in 80% of cases
respiratory syncytial virus (RSV)
fine inspiratory crackles can be found in what common lower respiratory tract infection in those aged <1 year with acute bronchiolar inflammation
bronchiolitis!
Majority of labial adhesions (fusion of labia minora in midline) are symptomatic and spontaneously resolve in puberty. 2 complications that can occur and treatment for that are:
- problems with micturition with pooling in vagina - this can be managed with oestrogen cream for 6 weeks then emollient
- adhesions
if cream fails, then surgical intervention may be warranted
if a child has measles how long do they need to be kept off school for - in relation to their rash
keep off school for 4 days from onset of rash
when can chickenpox go back to school in relation to the rash
the most infectious period is 1-2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash).
Nose bleeds under what age is rare and need urgent paeds referral for trauma/ bleeding disorders?
Under age 2
‘Beefy red’ well-defined patches, involves the flexures, satellite regions on baby’s bum suggest
Candida/thrush cause of nappy rash
Rx: Topical antifungals (imidazole). Stop barrier creams until candida has settled.
what pathogen causes croup
parainfluenza viruses
stridor
barking cough (worse at night)
fever
what is the diagnosis
croup
Mild croup criteria
Occasional barking cough
No stridor at rest
No intercostal recession
The child is happy
Moderate croup criteria
Frequent barking cough
Stridor at rest
Some intercostal recession
No agitation
The child is happy
Severe croup criteria
Frequent barking cough
Stridor at rest
Marked intercostal recession
Significant distress or lethargy
Tachycardia, hypoxaemia
NICE suggest admission for children with what three criteria in croup
- Moderate or severe croup
- < 6 months of age
- Known upper airway abnormalities e.g. Downs, larynomalacia
chest x-ray in croup may show what sign in posterior-anterior view
steeple sign
i.e. subglottic narrowing
CXR lateral view in acute epiglottitis may show what sign
thumb sign
i.e. swelling of epiglottis
management of croup and dose
and alternative Rx, emergency Rx
- oral dexamethasone 0.15mg/kg
- prednisolone is dexamethasone is not available
emergency Rx = high flow oxygen and nebulised adrenaline
non-IgE mediated allergies tend to affect which two bodily systems
- skin
- gastrointestinal system
If there is history suggestive of IgE-mediated allergy (symptoms in skin, GI tract, resp, anaphylaxis), what should be offered?
Skin prick test
Or blood tests specific IgE antibodies to suspected allergens
If history is suggested of a non-IgE food mediated allergy, what should be offered?
Eliminate the suspected allergy for 2-6 weeks
Then reintroduce
NICE advises to consult with a dietitian for follow up
Treatment for threadworms (for patients >6 months old)
Mebendazole
Single dose for patient + household members
what 3 bone marrow failure effects are seen with acute lymphoblastic leukaemia
- anaemia - lethargy, pallor
- thrombocytopenia - easy bruising, bleeding
- neutropenia - infections
what is the peak incidence of age of acute lymphoblastic leukaemia (the commonest childhood cancer)
peak incident 2-5 years
A 14-month-old girl is diagnosed as having roseola infantum. What is the most common complication of this disease?
Febrile seizures
Roseola infantum aka sixth disease is caused by what pathogen
HHV6 - sixth! disease
5 vision issues that is seen in Down’s syndrome
- refractive errors
- strabismus - squint
- cataracts
- recurrent blepharitis
- glaucoma
What 3 reasons would infants need a routine ultrasound examination to screen for developmental dysplasia of the hip?
- First degree family history of hip issues
- Breech after 36 weeks GA
- Multiple pregnancy
Clinical examination uses Barlow and Ortolani test to look for developmental dysplasia of the hip. What do these do?
Barlow test - dislocates articulated femoral head
Ortolani test - relocates dislocated femoral head
What imaging is done to confirm clinical suspicion of developmental dysplasia at what ages
Ultrasound if <4.5 months
X-ray if >4.5 months
treatment of developmental dysplasia of hip
most spontaneously stabilise by 3-6 weeks of age
Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
Older children may need surgery
what type of primary headache is the most common in children
migraine without aura
paediatric migraine treatment
- ibuprofen > paracetamol
- over 12 years, sumatriptan nasal spray
paediatric migraine prophylaxis
pizotifen and propranolol
2nd line = valproate, topiramate, amitryptilline
what is first line replacement formula for infants with CMPA with mild to moderate symptoms if the baby is formula fed
extensive hydrolysed formula milk
what is second line replacement formula for infants with CMPA i.e. if they have severe CMPA or no response to first line (extensive hydrolysed formula) if the baby is formula fed
amino acid based formula
management of CMPA if breastfed
- continue breastfeeding
- eliminate cows milk protein of mum’s diet + supplement Ca
- use eHF milk when breastfeeding stops - until 12 months of age, and at least for 6 months
Alpha-thalassaemia is due to a deficiency of
alpha chains in haemoglobin
Clinical severity of alpha-thalassaemia depends on the number of alpha-globulin alleles affected.
What happens if:
(a) 1 or 2 allele are affected
(b) 3 alleles are affected
(c) 4 alleles (homozygote) are affected
(a) 1 or 2 allele - hypochromic, microcytic, normal Hb
(b) 3 alleles are affected - hypochromic microcytic anaemia with splenomegaly. HbH disease.
(c) 4 alleles (homozygote) are affected - death in utero, hydrops fetalis
Paeds BLS
Number of rescue breaths
And then chest compression to rescue breathe ratio?
5 rescure breaths
15:2 chest compressions to rescue breaths
precocious puberty is the development of secondary sexual characteristics at what age for females and males
before 8 years in females
before 9 years in males
achondroplasia - what is the mode of inheritance
autosomal dominant
side effects of MMR vaccine
malaise, fever, rash
usually after 5-10 days and lasts approx 2-3 days
constipation in children - what laxative treatment
- movicol
- add senna
- switch to lactulose if no response
A child with scarlet fever can return to school when…?
24 hours after starting antibiotics
what pathogen causes scarlet fever
group A haemolytic streptococci
patients with scarlet fever (caused by group A strep) who are allergic to penicillin can have what treatment
azithromycin
what is the most common complication of scarlet fever (group A strep)
otitis media
is scarlet fever a notifiable disease
yes
24 hours off school after starting antibiotics
A newborn baby is noted to have low-set ears, rocker bottom feet and overlapping of her fingers. What is the most likely diagnosis?
Edward’s syndrome
Macrocephaly
Long face
Large ears
Macro-orchidism
what is the diagnosis
fragile X syndrome
what trisomy is Edward’s syndrome
trisomy 18
cleft lip or palate, polydactyly (extra digits), microphthalmia (small eyes), scalp defects, and congenital heart disease
what is the disease and trisomy
Patau’s syndrome
Trisomy 13
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
what is the diagnosis
noonan syndrome
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
what is the diagnosis
Pierre-Robin syndrome
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
what is the diagnosis
william’s syndrome
child with fever followed later by rash
febrile seizures common
what is the diagnosis
Roseola infantum
sixth disease - HHV6!
Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the four following features:
- paroxysmal cough
- inspiratory whoop
- post-tussive vomiting
- undiagnosed apnoeic attacks in young infants
what is the diagnostic test for whooping cough
nasal swab culture for Bordetella pertussis
three clinical signs of prodomal phase of measles
Irritable
Conjunctivitis
Fever
how many cases of laryngomalacia self-resolve
99% by 18-24 months
if a child not immunized against measles comes into contact with measles what should be offered
MMR vaccine
give within 72 hours
repeat dose to be given in 3 months
what is caused by parvovirus B19
erythema infectiosum
fifth disease
slapped cheek syndrome
erythema infectiosum
fifth disease
slapped cheek syndrome
is caused by which pathogen
parvovirus b19
At what age would the average child be expected to have visual acuity similar to that of an adult?
2 years
papular enanthem on the uvula and soft palate in roseola infantum (HHV-6 sixth disease) are called
Nagayama spots
Cystic Fibrosis nutritional guidelines recommend what diet for patients
High calorie
High fat
Pancreatic enzyme supplementation for every meal
Management of cystic fibrosis
- regular (at least twice daily) chest physio + postural drainage
- high fat, high calorie diet
- pancreatic enzyme supplements with meals
- vitamin supplementation
- avoid hanging out with other CF patients
- lung transplant
- lumacaftor/ivacaftor (orkambi)
what are the two medications that can be used to treat homozygous cystic fibrosis delta F508 mutation patients
lumacaftor
ivacaftor
retinoblastoma average age of diagnosis
18 months
mode of inhertiance of retinoblastoma
autosomal dominant
features of retinoblastoma
absence of red reflex
strabismis
visual problems
prognosis of retinoblastoma
excellent
>90% survive into adulthood
Parents should be advised to call an ambulance if a febrile convulsion lasts longer than…
5 minutes
obesity /weight is measured in children using what tools
BMI percentile charts
5 causes of obesity in childrn
GH deficiency
hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prader-Willi syndrome
Congenital rubella results in what developmental issues
Sensorineural deafness
Congenital cataracts
Congenital heart disease e.g. PDA
Glaucoma
what is the most common congenital infection in the UK
cytomegalovirus
when is the Guthrie test/heel prick test done
5-9 days of life
Guthrie test/neonatal blood spot heel prick test is usually done at 5-9 days of life. what is screened for?
hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
MCADD
MSUD
HCU, GA1, IVA
wetting the bed (enuresis) is considered abnormal in age older than what
5 years or older
management of enuresis (wetting the bed if age 5 and over)
- reward systems - for agreed behaviour, NOT dry nights
- enuresis alarms
- desmopressin
moderate asthma attack criteria
SaO2 >92%
PEFR <50% best (not included if <5 years)
no clinical features
severe asthma attack criteria
SaO2 <92%
PEFR 33-50% best or predicted (not included if <5 years)
cannot complete sentences
HR >125 (or >140 if <5 years)
RR >30 (or >40 if <5 years)
using accessory neck muscles
life-threatening attack in asthma
SaO2 <92%
(PEFR <33% best) - not a criteria for <5 years
silent chest
low GCS
cyanosis
management of children with mild to moderate acute attack of asthma
B-2 agonist (salbutamol) via spacer
1 puff every 30-60 seconds up to maximum of 10 puffs
If not controlled, repeat above and refer to hospital
+ steroids for 3-5 days
What is the most useful investigation to screen for the complications of Kawasaki disease?
echocardiogram
What is the first sign of puberty in boys?
Increased testicular volume
What is the first sign of puberty in girls?
breast development
how long should children be excluded from school with scarlet fever
24 hours after starting antibiotics
scarlet fever is a notifiable disease
how long should children be excluded from school with impetigo
48 hours after starting antibiotics OR until all lesions are crusted and healed
how long should children be excluded from school with hand foot mouth disease
no exclusion
how long should children be excluded from school with mumps
5 days from onset of swollen glands
how long should children be excluded from school with rubella
5 days from onset of rash
what pathogen causes scarlet fever
group A haemolytic strep
usually strep pyogenes
management of scarlet fever
- 10 day course of oral pen V
- Penicillin allergy - azithromycin
Throat swab - but start Abx beforehand
Children can return to school after 24 hours of starting Abx
What is the most common complication of scarlet fever
otitis media
Management of autism
- Early educational and behaviour interventions
- applied behavioural analysis, ASD preschool, teaching - Medication - SSRIs, antipsychotics, methylphenidate for ADHD
- Family support and counselling
Croup management
single dose of oral dexamethasone (0.15mg/kg)
given immediately regardless of severity
Emergency Rx = high-flow oxygen and nebulised adrenaline
if oral dexamethasone is not available for croup, what is second line
prednisolone 1-2mg/kg
this may need to be repeated 24 hours later
what pathogen causes croup
parainfluenza viruses
Mild croup criteria
- occasional barking cough
- no stridor at rest
- no intercostal recession
- happy child
Moderate croup criteria
- frequent barking cough
- stridor at rest
- intercostal recession
- no distress
- child is still interested in surroundings
Severe croup criteria
- frequency barking cough
- lots of stridor at rest
- sternal wall retractions
- significant distress or tiredness
- tachycardia
When should you admit a child with croup?
- Moderate or severe croup criteria
- <6 months of age
- Known upper airway abnormalities e.g. down’s syndrome, laryngomalacia
- Uncertainty about diagnosis
Most croup is diagnosed clinically. if a chest x-ray is done, what sign can it show
steeple sign = subglottic narrowing
what sign is seen on lateral view in acute epiglottis on chest x-ray
thumb sign = swelling of epiglottis
Mum having a baby with Down’s syndrome risk for age 20, 30, 35, 40, 45
- 20 = 1 in 1500 risk
- 30 = 1 in 800 risk
- 35 = 1 in 270 risk
- 40 = 1 in 100 risk
- 45 = 1 in 50 or greater
94% of Down’s syndrome cases are due to what mode of cytogenetics
Non-disjunction - this is a 1 in 100 risk of recurrence if mother <35 years
Translocation is 5%
Which childhood syndrome condition is most strongly associated with supravalvular aortic stenosis?
William’s syndrome
Asthma in children: prednisolone dose
1-2 mg/kg od for 3-5 days
how long does a patient need to stay off school for whooping cough
48 hours after starting Abx
Or 21 days from start of symptoms if no Abx
phimosis (non-retracting foreskin or during micturition in a child) treatment if:
(a) under 2 years
(b) older than 2 years
(a) under 2 = physiological, self-resolves
(b) older than 2, or recurrent UTI or balanoposthitis, then treat
febrile convulsions occur between ages of ..
6 months and 5 years
seen in 3% of children
what test is used to screen newborns for hearing problems
otoacoustic emission
3 innocent murmurs
- ejection murmurs - due to turbulent blood flow at outflow tract of heart
- venous hums - blood in great veins returning to heart, continuous blowing noise
- Still’s murmur - low pitched sound at lower left sternal edge
are systolic or diastolic murmurs typically more innocent murmurs
systolic = innocent
Babies found to have bilateral undescended testes at the newborn examination should have what referral
Review by senior paediatrician within 1 day
may be associated with endocrine disorder e.g. CAH
average age of puberty in males and females
males - 12 years
females - 11.5 years
if a child has recently been given another live attenuated vaccine, there should be a minimum gap of how long before MMR vaccine is given?
4 weeks
small, white, keratin-filled cysts that can appear on the gums or the roof of a newborn baby’s mouth. what is the diagnosis
epstein’s pearl
turner’s syndrome what chromosome abnormality
45 XO
If a newborn baby has an abnormal otoacoustic emission hearing test at birth they are offered what test
the auditory brainstem response test
Unilateral undescended testicle - what is management
review at age 3 months
if persistent - then refer
Fever of over 38 degrees is very common with the Meningitis B vaccine, and it is advised that infants should receive what medication
three doses of paracetamol routinely to prevent it developing; the first dose given as soon as possible post-vaccination
commonest cause of nephrotic syndrome in children
minimal change glomerulonephritis
blood stained stool, ‘red-currant jelly’
sausage shaped mass in RUQ
is seen with what diagnosis
intussusception
USS shows a target like mass
treatment of intussusception
- reduction by air insufflation
- if signs of peritonitis or above fails, surgery
How much oral rehydration therapy should be given over 4 hours on top of usual maintenance fluids?
50ml/kg
4 central causes of hypotonia in baby
Down’s syndrome
Prader-willi syndrome
hypothyroidism
cerebral palsy
All breech babies at or after 36 weeks gestation require USS for DDH screening when?
at 6 weeks regardless of mode of delivery
how much simple emollients should be given for eczema
large quantities e.g. 250g/week
ratio to steroids of 10:1
should steroids or emollient be applied first
apply emollient first
then at least 30mins after apply steroid
n.b. creams soak into skin faster than ointments
What is the most common cause of hypertension in children?
renal parenchymal disease
pain is felt in the anterior aspect of the joint and is worse when walking up and down stairs
what is the diagnosis
chondromalacia patallae
characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms
seen with what disorder
infantile spasms
or west syndrome
EEG shows what in infantile spasms/west syndrome
hypsarrhythmia in two-thirds of infants
Management of infantile spasms/west syndrome
Vigabatrin
ACTH
poor prognosis
what vaccinations are pregnant women offered (if they have had all other childhood vaccines previously)
pertussis (whooping cough)
influenza
Swelling on head
Several hours after birth
Doesn’t cross suture lines
Can take months to resolve
Cephalhaematoma
Swelling on head
Crosses suture lines
Over vertex
Poorly defined margins
Caput succedaeneum
13-18 years immunisations
DPT (3 in 1: tetanus, diphtheria and polio)
Men ACWY
The oral rotavirus vaccine is given at
2 and 3 months
what type of vaccine is the rotavirus vaccine
oral, live attenuated vaccine
The Men B vaccine is given at what ages
2, 4 and 12-13 months
routine 6 week baby exam looks for what 4 key issues
- congenital heart disease
- Developmental dysplasia of the hip (DDH)
- Congenital cataract - look for red reflex
- Undescended testes
growing pains usually aged 3-12 years have what features
- usually at night
- worse after day of activity
- normal examination
- no limp, no limitation
- boys and girls equally affected
B-2 agonist (salbutamol) via spacer dose for mild to moderate asthma attacks
1 puff every 30-60 seconds up to maximum of 10 puffs
What is a common side effect of montelukast to warn them about?
nightmares
Patients with otitis media with cleft palate or Trisomy 21 (Down’s syndrome) require what management
Urgent specialist assessment
Any infant with hip abnormality detected at 6-8 week check should be managed with..
refer to specialist and hip ultrasound within 10 weeks of age
if parents disagree with immunisation, then it cannot go ahead without
specific court approval
does a person with parental responsibility need to be present with kid during vaccination
NO!
can be another childminder as long as parental responsibility has consented in advance
written confirmation is not required
what is the most common cause of death in measles
pneumonia
Why should the first dose of the oral rotavirus vaccine should not be given after 15 weeks
Risk of intussusception
second dose cannot be given after 23 weeks
what 6 immunisations are included in the 6-in-1 vaccine
diptheria
tetanus
polio
pertussis
HiB type B
Hepatitis B
urine collection method for children with UTIs
- clean catch is preferable
- if not possible, then urine collection pads
- invasive methods such as suprapubic aspiration should only be used if non-invasive methods are not possible
Management of UTIs for infants less than 3 months old
Refer immediately to paeds
Management of UTIs for infants older than 3 months old with UPPER UTI
Admit to hospital
If not admitted, oral Abx such as cephalopsorin or co-amoxiclav for 7-10 days
Management of UTIs for infants older than 3 months old with LOWER UTI
Oral antibiotics for 3 days
Ask parent to bring child back if still unwell after 24-48hours
what is an atypical UTI infection
- very ill/sepsis
- poor urine flow
- abdo/bladder mass
- raised Cr
- infection with non-E.coli organisms
investigations for UTI in children
- urine MC&S
- DMSA - identifies renal scars done 4-6 months after initial infection
- MCUF - identifies vesicoureteric reflex - only for infants <6 months with atypical or recurrent infections
