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PMMH > PAEDS > Flashcards

PAEDS Flashcards

1
Q

MILESTONES: Gross motor

A
  • 3 months: Hold head up independently
  • 6 months: Sit unsupported, roll over, pull to crawling position and rock
  • 9 months: Get into sitting position unsupported, wriggle, crawl, put things in mouth
  • 10 months: Pull self up to a standing position on furniture
  • 1 year: Crawl upstairs, walk short steps and collapse
  • 18 months: Walk independently, stoop and pick objects up
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2
Q

MILESTONES: Fine motor

A

4 months: Play with rattle
5 months: Reach for objects using whole hand grasp
6 months: Basic manipulation between hands
7 months: Eat finger foods
9 months: Beginning to use pincer grip
12 months: Mature pincer grip (fingers and thumbs)
15months: Build a tower of 2 blocks
18 months: Scribble with a pencil, build a tower of 4 blocks

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3
Q

Milestone- social developments

A

4-6wks: Fixes eyes to faces
6wks: Smile in response
3mths: Simple babbles
4mths: Laughing out loud
7mths: Stranger anxiety
8mths: Double babbles
9mths: Peakaboo, waving bye
12mths: 2/3 words
18mths: 10 words
24mths: 2 word sentences
3 years: Chatterboxes!!

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4
Q

Milestone red flags:

A
  • Parental concerns
  • If they’re losing skills
  • if they’re not smiling by 10wks

6mths:
- If they have a persistent squint, referral to ophthalmology
- Hand preference- too early to determine at this age
- Little interest in people, toys, noise- ?neurodivergent

10-12 mths:
- no sitting
- no double syllable babble
- not chewing

18mths:
- not walking independently
- Less than 6 words
- Persistent mouth drool

2 1/2 yrs:
- no 2-3 word sentences
- not responding to one word commands
- no symbolic play- acting like role models

4 yrs:
- unintelligeble speech

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5
Q

Head injuries

A
  • Very common in toddlers
  • Breath holding in under 3, look very cyanotic, usually stops by 5.
  • When they respond to the trauma, instead of crying, they go cyanotic as they change their breathing pattern.
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6
Q

Reflex anoxic sezures

A
  • Tantrum after head injury is abnormal behaviour
  • Common in 6mths-2yrs
  • Lasts 30-60secs, not life threatening, may be mistaken for a tantrum
  • In very rare cases, a pacemaker may be required
  • Breath holding
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7
Q

Head injury assessment:

A
  • More difficult to assess in paeds
  • Children are more likely to vomit and fit after banging their head, not necessarily a sign of raised ICP
  • Worsening care advice- give very clearly to an adult
  • Teenagers may experience headaches 2-3 weeks post head injury, it should respond to OTC analgesia and should self resolve
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8
Q

Skull

A
  • Base of skull fractures
  • Very subtle
  • Battle sign is a late sign in paeds!
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9
Q

Facial injuries

A
  • Very unlikely to fracture nose in paeds under 7 as their nose hasn’t ossified yet!
  • Still, look inside the nose for haematoma around the septum
  • Nose bleeds- prior? Is it quick to stop
  • If frequent and hard to stop, think childhood leukaemia/haemolytic disorders
  • Lip tissue heals faster than facial tissue
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10
Q

Oral injuries

A
  • Torn frenulum: Contains an artery so it will bleed a lot.
  • Think abuse, are they being force fed, how are parents coping?
  • Intraoral injuries- what happened, paeds soft palpate is more vulnerable, any post nasal drip/bleeding?
  • Inspection tounge
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11
Q

Teeth

A
  • Baby teeth that’s come out should not be reinserted due to choking hazard
  • Permanent tooth can be put in within 2 hours, store in cheek or milk
  • Only successful if blood supply is reestablished
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12
Q

Critic

A
  • Ossification of the elbow
  • elbow ossifies later in life
  • With a FOOSH, the transferred force has gone up the arm resulting in a fractured clavicle/scapula, due to lack of lower ossification
  • everything ossifies at approx 20
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13
Q

Fractures

A
  • Children have bendy bones due to 20% more water than adults
  • worried about growth of bone if physis or Epiphysis is injured.
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14
Q

Non accidental injuries

A
  • Rule of 4: Any bruising on a child less than 4 months is suspicious as they don’t have the mobility.
  • Look at trunks, underneath the clothes
  • Ears: Pinch marks for pulling, grabbing
  • Neck injuries are a red flag
    Trunk
    Ears
    Neck
    4 years or younger
    Frenulum- inside of mouth around lips
    Auricular area
    Cheek
    Eyes
    Sclera- blood, shaken baby
    Patterned bruising- handprints?
  • Does hx match injury?
  • Burns: immersion?
  • Bruising in a child who is not independently mobile, neck is a red flag, always consider hx
  • One or more fractures with no hx of fragile bone conditions, absent or unsuitable explanations
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15
Q

Common childhood illnesses:

A
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16
Q

PAED assessment triangle

A

Appearance:
- Abnormal tone?, interactivity, consolability, abnormal look/gaze, speech, cry?
Circulation:
- Pallor, mottling, cyanosis
Work of breathing
- Abnormal sounds, position, retraction, flaring?, apnea/gasping

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17
Q

TICLS

A
  • TONE- Good muscle tone?, limp?, resisting examination?
  • INTERACTIVITY- Alert?, playing with toys/caregiver?, following pen torch, equipment?
  • CONSOLABILITY- Can they be consoled by the caregiver?, responding well to reassurance?
  • LOOK- Are they watching you?, giving eye contact to the caregiver, non focused gaze?
  • SPEECH- are they crying?, is their cry strong or weak?, is voice normal/abnormal
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18
Q

Appearance

A
  • Baby’s should be able to hold their head up
  • Floppy baby’s have bad tone, make a u shape hang upside down, making little to no movement.
19
Q

Circulation

A
  • Cynaosis
  • Pallor
  • Mottling
20
Q

Child VS adult breathing

A
  • Infants up to 6months are nose breathers, due to narrow nasal passages which increase the risk of obstruction.
  • Upper & Lower airways are relatively small, more prone to obstruction
  • Infants rely mainly on diaphragmatic breathing, greater risk of tiring (abdominal breathing)
  • Pre term infants are at a higher risk of respiratory failure as they have fewer type 1 fibres.
  • Ribs lie more horizontal in infants, so less chest expansion

ASSESS FOR:
- Nasal flaring, head bopping, intercostal recession , tracheal tug (late sign), grunting, IWOB

21
Q

Child vs Adult neuro

A
  • Primitive reflex present in infants:
  • Palmar grasp- trying to grab finger when placed in palm of their hand, disappears by 3 months
  • Plantar grasp- putting finger on bottom of foot, their foot moves towards your finger.
  • Moro reflex- startle reflex, disappears by 6 mths
  • Stepping
  • Fencing, disappears by 6mths
22
Q

IMMUNITY

A
  • PAEDS have less Immunoglobulin stores
  • Pre term babies are more prone to infections because they received less passive immunity from mum in the 3rd trimester as they came out too early :/
23
Q

GI

A
  • Paeds stomachs can only hold 10-20ml volume at birth, and it empties very very fast.
  • Initially they can use ketones, it may be normal for child’s BM to be less than adults.
  • How many wet nappies are they having?
24
Q

Thermoregulation

A
  • Neonates & infants are at a greater risk of hypothermia due to large surface area to body mass
  • Paeds can’t thermoregulate
  • Effect of cold stress: Hypoxia, acidosis, hypoglycaemia
25
Q

Fontanelles

A
  • Look out for sunken and bulging fonatanelle

Sunken fonatnelle:
- Dehydration

Bulging fontanelle:
- Raised ICP

26
Q

Dehydration

A
  • sunken eyes
  • lack of tears when crying
  • excessive thirst
  • no water in first 6mths
27
Q

Gastroenteritis

A
  • It’s common for babies to vomit in the early weeks of life:
    1. Posseting- Bringing up small amounts of milk after a feed
    2. Reflux- bringing up lots of vomit after a feed
  • If accompanied by diarrhoea and look unwell, it may be gastroenteritis (stomach bug)
  • Babies have a greater risk of dehydration

*ADVICE: drioralyte, ice lolly, small sips, small sips
- seek help if not resolving after a few days

28
Q

Pertussis/whopping cough

A
  • Not always accompanied with a fever
  • Paroxysmal coughing
  • Bacterial infection
  • Incubation period is one week, stay awayyy!
  • May result in hypoxia, seizures, pneumonia
29
Q

Croup

A
  • Dexamethasone, fast acting steroid
  • Common viral respiratory illness in paeds
  • Seal bark cough
  • Keep child as calm as possible, sit child up, increase humidity by getting a cool shower going.
30
Q

Bronchiolitis

A
  • May be mild or severe
  • Diagnosis: Coryzal prodrome lasting 1-3 days, followed by:
    . Persistent cough
    . Tachypnoea and/or chest recession
    . Wheeze or crackles on auscultation
    <6weeks may just present with apnoea
31
Q

Epiglottis

A
  • Stridor
  • Upper airway is occluded
  • Not necessary to look as it may distress them or occlude them more
32
Q

Asthma

A
  • Official diagnosis is for >5
  • Have they tried to use their inhalers?, inhaler techniques
  • What causes attacks?
  • Peak flow>5, best of 3
33
Q

Varicella zoster virus

A
  • AKA chicken pox
  • Fever, malaise, rash
  • Children are infectious 48hrs before spots appear and 5 days to a week after spots dry out.
  • No ibuprofen as we want their inflammatory defences to help manage it.
  • Calamine lotion can soothe it
  • Antihistamines may help
  • Stay away from: Elderly, immunocompromised people- pregnant
  • Check their eyes for pustules as they will need to be seen by ophthalmology!
34
Q

Chicken pox in pregnancy

A
  • Up to 28wks, risk of foetal varicella, which can affect the baby’s skin, eyes, limbs, brain, bladder and bowel
  • 28-36 wks- virus remains in baby’s body but not symptomatic, however may become active in 1st year of life causing shingles!

-> or equal to 36 wks, baby may be born with chicken pox or may contract it as a neonate. Both mum and baby need to be assessed and treated!

35
Q

Shingles

A
  • Varicella zoster within one nerve
  • Usually one one side
  • Shingles on the tip of the nose means the optic nerve is affected and pt needs an ophthalmology review
  • Sensory nerve is affected, always unilateral!
  • Acyclovir an antiviral can be used as treatment
36
Q

Impetigo

A
  • Very contagious
  • Very itchy and sore and vesicles and pustules erupt and crust over
  • Treatmnet is usually topical, bacterial
  • Child should not be going school
37
Q

Scarlet fever

A
  • Antibiotics are needed to prevent rheumatic fever
  • Rash is really rough, tounge has a white coating and after 5 days, it looks like strawberry seeds
  • They get a 10 day course of pen B, very contagious
38
Q

Hand, foot and mouth

A
  • Limiting viral infection
  • Small vesicles on hand and feet, sore throat and feeling unwell
  • Avoid acidic food and drinks, as it’s a virus, it’ll go away on its own!
39
Q

Henoch -scholein purpura

A
  • Non blanching rash, follows a primary infection
  • Occurs in <10
    *Caused by vasculitis by abnormal immune response. Takes 4 weeks to recover, usually without complications
  • Mistaken for meningitis!
40
Q

Slapped cheek

A
  • Mistaken for abuse
  • Fever, drippy nose, bright red cheek
  • Common in 2-12
  • Starts as a bright red rash on cheek which spreads to trunks, joint pains, pyrexia, runny nose and diarrhoea
  • Achy nose, high temp, runny nose, diarrhoea, pt feels rubbish
  • Paracetamol & ibuprofen
  • Paeds with known blood disorders like sickle cell disease are at a greater risk of anaemia, speak to a rapid response team!
  • Pregnant pts to be referred to GP to rule out rubella
41
Q

Rubella

A
  • MMR is the vaccine
  • Incubation period is 10-15 days
  • Initially presents with a cold (pt is now contagious) - Pt develops a macula rash, 2 days later on the face and body
  • Rash disappears after 3 days but are still contagious
  • Pt will have lymphoedema
  • High risk of premature birth/birth defects and stillbirth if pt is pregnant!
42
Q

Measles

A
  • Symptoms develop 7-10 days post infection
  • Infectious 4 days before and 4 days after the rash
  • Rash develops after 3 days, rash is not itchy, rash usually starts behind the ears, spreads to the face, neck and body!
  • Really bad cold, watery sore eyes, feverish
  • Usually ill for about a week
  • More serious than chicken pox!
  • Serious complication: pneumonia, death, encephalitis
43
Q

Mumps

A
  • Swelling of the face- Pain and swelling in front of the ears, under the chin
  • Swelling usually starts on one side of the face then the other
  • Symptoms 14-25 post infection, infectious for a week before facial swelling
  • Malaise, pyrexia
  • Complication: Swelling of testes in grown males

PMMH (12 decks)

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