Paeds Flashcards
What units should be used for feeding + weight?
Ml for feeding
g/Kg for weight
Convert from oz/pounds
What are the important questions regarding poo?
Frequency
Size, shape, appearance/consistency
Difficulties pain on passing/
Blood/mucus
What are the important parts of a paeds history?
Birth history PMH Immunisations Development Drugs/allergies
What are you trying to exam in paeds?
ABCDE and baseline observations/ vital signs General condition and peripheries Respiratory system Cardiovascular system Alimentary system Neurological and musculoskeletal systems ENT and skin Developmental skills Measurements and centile
What do you look for in hands/arms?
Warmth, cap refill, radial/brachial pulses (rate/ rhythm)
Clubbing, nail changes, hand skills, pen marks
What do you look for in head/face?
Eyes (jaundice), Lips (Colour, moisture), Tongue, Nose
Scalp changes, Bruises, Rashes, Fontanel
What do you look for in the neck?
Rashes and Nodes (easier from the front); size, shape, mobility, position, consistency, symmetry Tracheal tug (Don’t push for carotid pulse or trachea)
What do you look for in chest/back?
Murmurs (Timing, pitch, quality, location, radiation)
Apex beat, thrills, chest expansion (limited if wee)
Breath sounds (all areas, reduced, symmetry, added)
Percussion (limited in infants, not routine, commonly forgotten when dealing with pneumonia)
Resonance and fremitus? (most are pre-school!)
Rashes and skin marks (inc neuro-cutaneous)
Spine alignment, deformity, sacral dimples
What do you look for in abdomen/groin?
Tenderness- watch their face and movement
Masses (esp stool) and organomegaly (liver, spleen, kidneys). Thumb can be used to feel
Bowel sounds and bruits (v.rare)
Femoral pulses (essential in infants)
Hernias (and testis)
Genital/ anal appearance (routine in nappies but often not appropriate for older children)
DON’T DO A RECTAL EXAM! (Senior staff only)
What do you examine for in legs/feet?
Mobility, changing posture, movements, tone
Reflexes (easy when v. young), plantars, clonus
Power, coordination, sensory assessment if older
Pulses, warmth, cap refill, colour, mottling,
Rashes, bruises, marks
Deformities and gait usually evident on inspection
What are the phases of childhood?
Neonate (<4w) Infant (<12m/1y) Toddler (~1-2y) Pre-school (~2-5y) School age Teenager/ Adolescent
What are the developmental domains?
Gross motor Fine motor Social and self help Speech and language Hearing and vision
What are the milestones for gross motor?
6-9 months - sits without supports, crawls, lifts head
10-12 months - cruises furniture
2years - jumps with 2 feet together, runs
Throws overarm
3 - rides tricycle, up and own stairs, hops
What are the milestones for fine motor + vision?
6-9 months - Transfers objects
10-12 months - immature pincer grip
2years - scribble, 6-7 block tower, neat pincer
3 - Train of bricks, 9-10 tower, copy circle
When should you refer for abnormal milestones?
If not achieved by limit age (2SDs)
Correct for prematurity until 2 years
What are the red flags for development?
Loss of developmental skills (NEVER normal)
Parental/ professional concern re. vision (simultaneous referral to paediatric ophthalmology)
Hearing loss (simultaneous referral for audiology/ ENT)
Persistent low muscle tone/ floppiness
No speech by 18 months, esp if no other communication (simultaneous referral for urgent hearing test)
Asymmetry of movements/ increased muscle tone
Not walking by 18m/ Persistent toe walking
OFC > 99.6th / < 0.4th / crossed two centiles/ disproportionate to parental OFC
Clinician uncertain/ thinks that development may be disordered
What are the average measurements at birth?
3.3kg
50cm (length)
35cm (head circumference)
What are the average measurements at 4 months?
6.6kg
60cm (length)
What are the average measurements at 12 months?
10kg
75cm (length)
45cm (head circumference)
What are the average measurements at 3 years?
15kg
95cm (length)
What can cause failure to thrive?
Increased metabolic demands
Excessive nutrient loss
Decreased intake
