Paeds Flashcards
Risk factors for DDH (developmental dysplasia hip)
Breech presentation in 3rd trimester
FHx DDH (parent or sibling)
Oligohydramnios
Twins
Congenital or position talipes
Congenital knee dislocation
Plagiocephaly or torticollis
Neuromuscular or syndromic condition
Birth weight>4.5 kg
Examination features DDH
Age<3m, barlow and ortolani’s causing hip clunk when relaxed
Age>3m asymmetrical limited abduction, leg length discrepancy, asymmetrical hip skin creases
Limp/toe walking due to shorter leg
USS via hip screening or in 2ndary care
If older, urgent T+O appt
What features show flat foot as being flexible?
Arch reconstitutes when on tiptoes
Arch reconstitutes when not weight-bearing
Heel swings into varus
Obs meaning a child should be admitted
Sats<92%
Fever:
Age<3 months >=38°C
Aged 3 -6 months>=39°C
RR:
Aged 0- 5 months>60
Aged 6-12 months >50
Age>12 months>40
HR:
<1 year>160
Age 1-2 years >150
Age 3-4 years>140
CRT> 2 seconds
Examination findings meaning a child should be admitted
Appears seriously unwell, does not wake or doesn’t stay awake
Nasal flaring, Tracheal tug
Cyanosis, Apnoea
Grunting
Intercostal/subcostal recessions
Marked abdominal breathing
Auscultation suggesting effusion, abscess, or empyema
Poor feeding < half of normal
Dehydration (no wet nappy 12 hrs)
Management acute severe wheeze in children
Salbutamol neb:
Age<5 years – 2.5 mg
Age>5 years – 5 mg
Ipratropium neb – 250 micrograms
repeat every 20 minutes for the first hour.
Or salbutamol MDI 10 puffs via spacer, 5 tidal breaths each puff. Can be repeated every 10 to 20 minutes if needed. + ipratropium MDI via spacer 2 puffs every 20 minutes for 1 hour
PO prednisolone:
Age< 5 years – 20 mg
Age> 5 – 40 mg
What age do you start giving pred for wheeze?
Don’t give under age 2
Do not routinely given under age 4 unless known asthma
Features septic arthritis/osteomyelitis
a limp.
single, painful, or swollen limb.
refusal to weight-bear
unable to move a limb normally (in infants who are not yet mobile).
unwell with a fever, but no obvious cause.
skin infection that is slow to resolve especially if over a joint.
Features bronchiolitis
Coryzal, then persistent cough, increased work of breathing, widespread wheeze or crackles, and a fever of less than 39°C
usually peaks day 3- 5 and resolves within 3 weeks.
Features diabetes
Thirst (polydipsia)
Thinner (weight loss)
Toilet – passing urine frequently (polyuria)
Tired
Enuresis or nocturia in a previously toilet trained child
Recurrent thrush esp if prepubertal
Recurrent UTI
When should you consider IBD in abdo pain in children?
perioral and/or perianal symptoms
blood in stool
poor growth
FHx
raised platelets + CRP
When should you consider coeliac disease in abdo pain in children?
non-specific GI symptoms
lethargy
poor growth
refractory iron deficiency
FHx
Delayed puberty, short stature
Features functional abdo pain
Recurrent central abdominal pain (context of anxiety)
Recurrent of nausea and upper GI pain (before school)
Strong colic reflex (cramps before soft bowel motions, usually soon after meals)
Abdominal migraines (periodicity of attacks, associated nausea +/- vomiting, FHx migraines)
Ix for abdo pain in children
Diarrhoea – molecular enterics
upper GI – H. Pylori faecal antigen
sus IBD – faecal calprotectin if teen
Consider urinalysis.
FBC, ferritin, CRP, U+E, bone, LFT.
Coeliac screen (need 6 weeks of normal gluten intake) and total IgA.
Finger prick glucose if ?diabetes
Where is gluten found?
Wheat, rye, and barley.
Oats are generally tolerated but normal oats can be heavily contaminated with wheat. 5% of coeliac patients will be intolerant to oats.
Untreated coeliac disease risks
anaemia
nutritional deficiencies
osteopenia or osteoporosis
malignancy, particularly small bowel carcinoma or lymphoma
If low total IgA, symptoms suggestive coeliac disease and negative IgA TTG, what is the next step?
IgG TTG
as could be false negative
Red flags for constipation in children
Meconium passage>48 hours after birth
Symptoms within 1st week of life
Faecal incontinence or soiling in a school-aged child without known constipation
Ribbon stools from birth
Leg weakness
Unintentional weight loss
-> same day paeds
Contributory factors for constipation in children
Medications or supplements (eg thickener)
Excessive cow’s milk intake
When solids are introduced, during toilet training, or when starting school.
Features of faecal impaction
Failing to pass a stool for several days, followed by a large, often painful or distressing, bowel motion.
Soiling of underclothes between bowel motions
Vomiting.
Severe abdominal pain.
Palpable mass.
Loss of awareness.
Urinary retention or wetting.
Management constipation
Adequate fluid (eg adding water inbetween feeds if bottle fed)
Regular toileting (5 mins BD after meals)
Fibre (6 fruit/veg daily with peel)
Cycling legs, massage
When to do cxr in children with cough
Cough> 8 weeks.
features suggesting a chronic respiratory condition, e.g. poor growth, chest deformity, finger clubbing.
Features IgE mediated cows mild protein allergy
Reactions <2 hours after ingestion, usually within 20mins
Urticaria, angio-oedema, itching, cough, hoarseness, wheeze, or breathlessness
Vomiting, diarrhoea, oral itching
Unlikely if no eczema
Featured non IgE mediated CMPA
Delayed until 2-72hrs after ingestion.
GORD, abdominal discomfort, constipation, diarrhoea, or atopic eczema, particularly if symptoms are severe or resistant to treatment.
Unlikely if no eczema
Blood/mucus stool, perianal redness
Management CMPA
trial elimination of all cows’ milk.
If non‑IgE‑mediated symptoms, planned early reintroduction of cows’ milk after 4 weeks
Prescribe an appropriate hydrolysed formula (nutramigen or aptamil pepti)
If severe symptoms/no reponse to hydrolysed, trial amino acid based (alfamino/neocate)
If symptoms resolve, and return on reintroduction- urgent dietician
cows’ milk-free diet until 9 -12 months old, for a duration of at least 6 months.
Referral criteria CMPA
Admit if unwell +:
rectal bleeding ?proctocolitis.
profuse vomiting and/or diarrhoea 2 -4 hours after food (?enterocolitis)
Routine paeds if CMPA suspected +:
faltering growth, or
significant IgE‑mediated CMPA symptoms or severe non‑IgE mediated symptoms.
Features croup
Sudden‑onset, seal‑like barking cough, often accompanied by stridor, hoarseness, and increased work of breathing.
Symptoms are typically worse at night and increase with agitation.
Management croup
Reduce anxiety
O2 non rebreathe 15 L
Nebulised adrenaline (5 mL 1:1000)
Dexamethasone 0.15 mg/kg as 2 mg/5 mL oral solution
or prednisolone 1-2 mg/kg
When to admit ?diabetes
Blood glucose >7 (>11 ?DKA)
Features DKA (vomiting, abdo pain, ketotic breath, lethargy)
