Paeds - community + genetics Flashcards
What are the 5 measures of child development?
- Gross motor
- Fine motor
- speech and language
- social, emotional, behavioural
- hearing and vision
What are the 4 types of child abuse?
- physical abuse
- sexual abuse
- emotional abuse
- neglect
When should you be more aware or suspicious of physical child abuse?
- young kids especially those <2 years old are at highest risk
features of a hx that should raise your suspicion are…
- mechanism of injury not compatible with the injury sustained
- childs developmental stage inconsistent with the injury
- Eg. a 3 month old sitting up and banging its head when…
- sitting without support, commando crawling, wriggling, stands holding to furniture = 9 months
- standing without support, bum shuffles, crusing on furniture, unsteady walking = 12 months
- walking without support, crawling upstairs = 15 months
- jumping on 2 feet = 30 months
- Eg. a 3 month old sitting up and banging its head when…
- significant injury with little/no explanation
- inconsistent hx given
- delay in presenting child to health care providers
- recurrent injuries
- parents reaction not appropriate to situation (eg. overly concerned, aggressive, elusive, vague)
What are some medical/ nutritional/ educaitonal/ physical presentations of neglect?
- Medical = unimmunised, missed appointments, poor compliance with medication, failure to seek appropriate or timely medical help
- Nutritional = faltering growth due to failure to provide sufficient diet, obesity due to failure to control lifestyle
- Educational = poor school attendance
- Physical = inadequate hygiene, severe or persistent infections or infestations, inappropriate clothing for childs size and weather
- Failure to supervise eg. frequent A&E attendances, injuries like burns or scalds that suggest lack of care, ingestion of harmful substances
What are some presentations of a child that has been sexually abused?
- allegation
- pregnancy
- sti
- ano-genital injury
- unexplained vaginal bleeding
- unexplained rectal bleeding
- recurrent vaginal discharge
- soiling, bowel problems, enuresis
- behavioural difficulties
- being around an adult that has been identified as a risk to children
What is your responsibility as a medical professional when you suspect child abuse?
- have a low threshold if you have concerns
- document everything clearly in patient notes
- sign, date, time all entries
- seek advice from senior colleagues on how to proceed
- go up in seniority or contact doctor/nurse in charge of safe guarding if the advice is not sufficient
- communicate with nursing staff
- dont ask leading questions during disclosure (can affect case if it goes to court)
- reassure child you believe them, they are not in trouble, listen to everything, however do not make promises you cannot keep
What are some potential differentials of global developmental delay?
- Down’s syndrome
- Fragile X syndrome
- foetal alcohol syndrome
- Rett syndrome
- Metabolic disorders
What are some differentials for fine and gross motor delay?
Gross motor
- cerebral palsy
- ataxia
- myopathy
- spina bifida
- visual impairment
Fine motor
- dyspraxia
- cerebral palsy
- muscular dystrophy
- visual impairment
- congenital ataxia
What are some differentials for language and social delay?
Language
- specific social circumstances eg. exposure to multiple languages
- hearing impairment
- learning disability
- neglect
- autism
- cerebral palsy
Social and personal
- Emotional and social neglect
- Parenting issues
- Autism
Define:
- Dyslexia
- Dysgraphia
- Dyspraxia
- Auditory processing disorder
- Non-verbal learning disability
- Profound and multiple learning disability
Dyslexia = specific difficulty in reading, writing, spelling
Dysgraphia = specific difficulty in writing
Dyspraxia = “developmental co-ordination disorder”. A specific difficulty in physical co-ordination. presents as delayed gross and fine motor skills, a clumsy child.
Auditory processing disorder = specific difficulty in processing auditory information
Non-verbal learning disability = specific difficulty in processing non-verbal information eg. body language and facial expressions
Profound and multiple Learning Disability = severe difficulties across multiple areas, usually requiring help with all aspects of daily life
How would you classify the severity of a learning disability?
Based on IQ
Mild = 55-70
Moderate = 40-55
Severe = 25-40
Profound = Under 25
What are some features of anorexia nervosa?
- excessive weight loss
- amenorrhoea
- lanugo hair across most of the body
- low fsh, lh, oestrogen, testosterone
- hypokalaemia
- high cortisol, gh, hypercholesterolaemia
- hypotension
- hypothermia
- changes in mood, anxiety, depression
- solitude
- means to lose weight eg. diet pills, laxatives, excessive exercise
complications eg. arrhythmia, cardiac atrophy, sudden cardiac death
What are some features of bulimia nervosa?
- alkalosis due to vomiting (seen on abg)
- hypokalaemia
- erosion of teeth
- swollen salivary glands (swelling to face or under jaw)
- mouth ulcers
- gastro-oesophageal reflux and irritation
- calluses on knuckles from being sick = Russell’s sign
- fluctuating body weight or normal body weight
- binge eating followed by “purging” by vomiting, laxatives or excess exercise
What is binge eating disorder? How is it different to bulimia?
Characterised by episodes of excessive eating.
- usually eats very quickly, almost in a “dazed” state
- unrelated to hunger, eats until they are uncomfortably full
Not a restrictive condition like anorexia or bulimia.
What is the pathophysiology of refeeding syndrome?
- typically occurs 3-4 days after eating begins
- occurs in people that have been in severe nutritional deficit for a long period of time, when they eat again
- those at a BMI<20 or who have had little to eat for the past 5 days are at high risk
- lower the BMI and longer the period of malnutrition = higher risk
- prolonged malnutrition causes the metabolism in cells and organs to slow down
- when you start eating again, and your cells need to start processing glucose/protein/fats again, they use up magnesium/potassium/phosphorus
- this leads to low serum electrolytes (Hypomagnesaemia, Hypokalaemia, Hypophosphataemia) and hypoglycaemia
- low phosphate can cause muscle weakness = diaphragmatic deficiency
- These patients become at risk of cardiac arrhythmias, heart failure and fluid overload
How would you manage refeeding syndrome?
- slowly reintroduce food with restricted calories
- monitor magnesium, potassium, phosphate and glucose with other routine bloods
- fluid balance monitoring
- ecg monitoring in severe cases
- supplementation with electrolytes and vitamins (particularly B vitamins and thiamine)
What is autism spectrum disorder?
(Use PSYCH NOTES FOR REVISION)
A range of conditions (eg. Aspergers syndrome and Autistic disorder)
characterised by challenges to social interaction, repetitive behaviours and communication skills (speech and non-verbal)
How would you manage ADHD in kids?
(Use PSYCH NOTES FOR REVISION)
- Pre-school = ADHD focused group parent training programme
- School age = group based support for parents/carers
- liase with school/college/uni if consented
- individual parent training programmes if they don’t like group
- Medications if ADHD is causing severe impairment
- Methylphenidate 1st line
- alternatives = Lisdexamfetamine, dexamfetamine, atomoxetine
- CBT can be used in combo with meds if meds need a little help
-
Monitor child’s weight/height/BP/HR every 6 months to see if medications are affecting their growth
- if so, suggest a planned break over school holidays to allow “catch-up” growth
What is a personality disorder?
(Use PSYCH NOTES TO REVISE)
characterised by patterns of thought, behaviour and emotions that differ from what is normally expected by society
What are some examples of simple and complex tics?
(Use PSYCH NOTES TO REVISE)
Simple tics
- clearing throat
- blinking
- head jerking
- sniffing
- grunting
- eye rolling
examples of Complex tics
- Copropraxia = making obscene gestures
- Coprolalia = saying obscene words
- Echolalia = repeating other peoples words
- etc
