Paeds 6 Flashcards
List some reasons to refer a child who you suspect has developmental delay:
- Regression (at any age)
- Concerns about vision (tracking, flowing objects)
- Hearing loss
- No speech by 18 months
- Head circumference >99.6th centile
- unable sit unsupported at 12 months
- walk by 18 months
- run by 2.5 years
- reach for objects at 6 months
- point and share interest by 2 years
What are some causes of gross motor delay?
Cerebral palsy
Duchene muscular dystrophy
Prolonged illness or hospitalisation during key milestone times
SMA
Chromosomal abnormalities
TORCH infections
*referral to specialist physiotherapist and paediatrician
What are some causes of speech delay?
Autism
Hearing impairment
Poor social interaction/ deprivation
Down syndrome
*referral to SALT and hearing test
What professionals in the community are usually involved with a child who requires special needs or has complex difficulties?
OT
Physio
Community paediatrician
SALT
Specialist nurse
CAMHS
Health visitor
What are the three main domains of ASD?
Social interaction behaviour
Social communication
Repetitive/ Ritualised
What is the definitions of nocturnal enuresis:
Involuntary bed wetting
x2 weekly
>5 years old
Primary: never managed continence
- with daytime symptoms
- without daytime symptoms
- overactive bladder
- structural abnormalities
- chronic constipation
- neurological deficit
Secondary: previously dry for 6 months
- diabetes
- UTI
What are the managements strategies for nocturnal enuresis:
Encouragement
Goals set
Enuresis alarm
Desmopressin - for short term use
When can global developmental delay be used up till?
5 years old
What are the most common causes of bacterial tracheitis?
Staph Aureus
Strep
What type of pneumonia is most common in children and how should it be investigated?
Bronchopneumonia is more common in children
Investigations:
bloods:
- FBC
- WBC
- blood cultures
Orifices:
- throat swab
X-ray :
- CXR
*if pneumonia keeps reoccurring then consider sweat test
What are some signs of cardiac disease in a baby?
Feeding problems Breathless on feeding Sweating Failure to thrive \+/- oedema cyanotic attacks
What is the management of severe pneumonia in a paediatric patient?
Oxygen
Secretions sucked out
NG feds (if say to do so)
Antibiotics for severe pneumonia:
- IV cefuroxime
+
- IV gentamicin
*if you suspected staph infection (say following Influenza infection) then add Flucloxacillin
When carrying out resuscitation breaths in baby - what important practical point must you remember?
Cover over the nose as well as the mouth
In terms of burns - which get referred and which are sent to PICU?
All burns over 3% are referred
Full thickness burn >1 % is referred
Any over >10% will ned IV fluids
> 30% need PICU
Any burns in genitals, face or joints are referred
What investigations do you want in a child who has presented with diarrhoea?
Bloods: - FBC - U&Es - CRP \+/- - Blood cultures
Orifices:
- Urine dip (check for ketones)
- Stool culture
What is your fluid replacement for a dehydrated child?
5% dehydrated: 50mls/kg + Maintancing fluid over 48 hours
10% dehydrated: 100mls/kg + Maintancing fluid over 48 hours
*maintenance fluid is over 24 ours but the dehydration fluid is over 48 hours
What are some of the complications from meningitis?
Cerebral oedema
SIADH
Deafness
Long-term damage:
- cerebral palsy
- epilepsy
What is the antibiotics given to a newborns with suspected meningitis?
<6 weeks:
- ceftriaxone
- Gent
- Amoxicillin
6weesk - 3 months:
- IV ceftriaxone
> 3 months:
- Ceftriaxone
+
- Dexamethasone (if no purpura)
In a neonate how does an UTI present:
Poor feeding Vomiting Fever Jaundice (conjugated) Weight loss
What is the immediate management of child who has swallowed a toxic substance?
Induce vomiting
- fingers down throat
or
- Syrup Ipeacac 15ml + glass of water
**this is contraindicated in volatile hydrocarbons or caustic substances.
What are some immediate 1st aid managements to do whilst a child is fitting?
Remove anything dangerous around them
Place in prone position
- prevents choking on vomit
Don’t open mouth may cause damage to teeth
Remove restrictive clothing if possible
What is the scoring system used to assess if a child has septic arthritis and how is a septic arthritis in a child managed?
Kocher's - unable to weight bare - fever >38.5 - WWC >12 - ESR >40 \+/- - CRP
IV antibiotics (<5 cefuroxime, >6 is flucloxacillin)
- Sepsis 6
Surgical wash out
*no joint aspiration is done
What position is the septic arthritic hip usually held in?
Externally rotated and flexed
What is the investigations done into DDH and why is treatment needed?
< 6 months = ultrasound of hips
> 6 months = x-ray
If not fixed the child in later life will almost certainly need a hip replacement
What are some of the signs of Legg-Perthes disease?
Loss of abduction
Loss of Internally rotated
LLD
Low social economic status
Maternal smoking
Body shape
<6 = monitoring, with braces to hold hip in place >6 = may require surgery
What disease are children who have synovitis at an increased risk of developing?
Legg - Perthes
- 10% will develop this
What foods would you advise to avoid before < 6 month and a year?
<6 months:
- unpasteurised milks/ Cheeses
- Shell fish
- Wheat based food
<1 year
- honey
*try to avoid anything that may trigger allergies
When should the birth weight lost be regained by?
10-14 days
Why are infants at risk of faltering growth?
High energy demands
Low storage
Smaller in size
- increased metabolic turnover
Reliance of food from others
What are the main causes of rectal bleeding in a child?
Anal fissure
Swallowed blood from epitaxis
Mekel’s diverticulum
Intussusception
Gastroenteritis
IBD
What is the complication that can occur with Port wine stains?
These are Capillary defects which enlarge as the person grows.
10% are due to Sturge- Weber Syndrome
- which affects the V1 branch
- Ipsilateral arachnoid and pia of the cortex
- learning difficulties and seizures
- macrocephaly
- glaucoma
What disease in childhood is associated wit the development of diabetes?
Cystic fibrosis
Trisomy 21
*note that steroid induced may also be a cause in those suffering with severe asthma
What genetics are associated with diabetes type I? and what percentage of cells need to be destroyed in order for symptoms to be noticed?
DR3/ DR4
> 90%
If a child presents with DM-1 diabetes - what addition diseases should you consider screening for?
Addisons
Coeliac
Thyroid
What specific things do you want to monitor during ketoacidosis?
GCS
ECG
BP
Ketones
What are the causes of CKD in children?
Obstructive causes:
- Pelvis uterieric obstruction
- Vesicoureteric reflux
- PUV’s
Dysplasia
Cystic disease
Infection
How is Vesicoureteric reflux treated?
Prophylactic antibiotics
Surgical (usually done via cystoscopy)
Indication for surgery:
- UTI prophylaxis
- Progressive scaring
- pain on voiding
What are the main questions you want to ask following a heard injury to child?
Mechanism? - any large forces involved? Unconsciousness - with any amnesia? Vomiting? NAI - story consistent? Any other injuries?
What advice can be given to parents for the return of their child following a head injury?
ACORN
- after concussion return to normality
*provides info and the do’s and don’t following concussion in a traffic light system as well as worsening advice.
What are the indications for a CT head scan in a child following an injury?
Witnessed >5 mins loss of consciousness
Amnesia >5mins
> 3 episodes of vomiting
Abnormal drowsiness
Signs of basal skull fracture
Seizure following injury
Generically what order should investigations and examinations be done into a child presenting with stomach pain be done?
History Examination Urine dip Bloods Repeat examination US
What are the essential bloods that must be done in a child presenting with abdominal pain?
FBC U&Es CRP LFTs Amylase Glucose
List some specific referral times:
Non-weight baring - 12 months
Non- sitting unsupported - 12 months
Not walking - 18 months
Not running - 2.5 years
No babble - 9 months
No words - 18 months
No symbolic play - 18 months
What are some co-morbities to cerebral palsy?
Learning difficulties
Seizures
Feeding difficulties
- often need a gastrostomy feeding peg
Osteoporosis
Behavioural problems
Deformity
- physio
- ortho
- botulism injections
At what level of spina - bifida will a patient not be able to walk?
L3
What are the tissues that are present in Meckel’s diverticulum and what is the presentation?
Gastric
Pancreatic
Jejunal
Presentation:
- Haemorrhage (gastric acids)
- Obstruction (volvulus)
- Diverticulitis (bacterial infection)
What is the special test that can be done to diagnose Meckel’s diverticulum?
Meckel’s scan
- binds to gastric mucosa
What is a very important point in the history of a child where you suspect NAI to consider with regards to the mechanism of injury, and what will you do in A&E if you suspect NAI?
Is the child old enough to be able to perform such an action which could cause that injury
- for example - rolling off a couch at 2 months old is not likely
- Inform senior
- Admit child
- Tell parents what you are doing
In a child who is missing developmental milestones - what things would you want to ask the parents?
History of pregnancy
History of peri-natal period
Neonatal illness/ prelonged stays in hospital
Notable family history of illness
- duchenes? cystic fibrosis?
How far can a baby see at 3 months and when is myelination of the optic nerve complete by?
1m at 3 months
or 3ft
*3 months can see 3ft
24 months myelination complete
How can visual acuity be tested in a baby?
Gratings - 10 weeks old
*lines on a baord which a child will follow when compared to a grey board
Kay pictures
- 3 years old
What are some indications for a gastrostomy and why is used for additional feeds over just increasing food volume?
Any child where an NG tube is likely to be in place for more than >3 months a gastrostomy should be considered.
- neurological conditions
- oesophageal atresia
- increased nutrients requirements
advantages of increased nutrients requirements:
- continuous feeding as opposed to bolus
- night time feeding
- still allows food to be ate orally
What type of genetic defect increases the likely hood of parents having another child with Down’s syndrome - and what is the most common neurological defect seen in almost all Down’s syndrome babies?
Robertsonian Translocation
- increases risk of recurrent Down’s syndrome
Hypertonia is a feature seen in almost all Down’s syndrome babies
What is the risk of a further febrile convulsion within the same illness? and what actions can be done to reduce another convulsion? and what advice should be given if there is another seizure?
33% risk of a further convulsion
Regular paracetamol
Removal of clothing to keep child cool
Regular temperature checking
Call ambulance if >5mins
Remove anything near mouth if seizing
Place in recovery position following seizure
How much bacterial growth is needed for there to eb a diagnosis of UTI? and explain how to do a clean - mid- stream catch:
> 100,000 bacterial colony forming units/ml of urine
Wait until 1 hour after feed, then hold baby up and tap just above the pubis with 2 fingers.
- this should trigger micturition
