Full term infants sleep 2/3 of the day 1 year: 15 hrs (2-3 hrs during the day) • 12 years: 9 hrs Newborns start their sleep cycle (6o min cycle) in active sleep whereas older children and adults (90 min cycle) begin sleep in NREM sleep.

1 year 1 word: learn 1 new word per week 2 years 2 words together: 1 new word per day • 3 years 3 words together

2 months: response smiling •3 months: good eye contact •5 months: reaches for objects •10 months: sits unsupported •12 months pincer grip 18 months: walks unsupported 18 months : says single words with meaning •20 months: speaks in phrases

Pediatri Flashcards by Ellen Dahl

Pylorusstenose

– Olive shape mass in epigaster
– Lab: Hypochloremic metabolic alkalosis!!

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Kawasaki

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Major Milestones

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Når får nyfødte tilbake fødselsvekten?

Brystfødende: 6,5 dager

formula: 8,3 dager

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Vektutvikling:

Vekttap første par dager 5-10%
Tilbake etter 7-10dager (3,5kg)
Dobbel vekt (7kg) 4-5mnd
Trippel vekt (10kg) 1 år
Kvadruppel vekt: 2-3 år

10kg: 1 år
20kg: 5 år
30kg: 10 år

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Utvikling lengdevekst

Fødsel: 50cm
1 år: 75cm
90cm: 3 år
100cm: 4 år
økning på 5-7,5 cm/1. år til pubertet

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Speech - milestones

1 year: 1-3 words
2 years: 2-3 word phrases
3 years: routine use of sentences
4 years: routine use of sentence sequences
5 years: complex sentences, pronouns, prepositions

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Normal gråt og kolikk

Most infants cry little during the first 2 weeks of life. Between 2 and 6 weeks average from 2- 3 hrs per day
12 weeks: 1 hr daily crying
Colic: Crying more than 3 hrs per day for more than 3 days a week for more than 3 weeks (”Wessels rule of 3”)
< 5% of infants with excessive crying have organic etiology

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normal sleep

Full term infants sleep 2/3 of the day
1 year: 15 hrs (2-3 hrs during the day) • 12 years: 9 hrs
Newborns start their sleep cycle (6o min cycle) in active sleep whereas older children and adults (90 min cycle) begin sleep in NREM sleep.

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Phenylketonuria PKU

Screened for at birth

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Congenital hypothyroidism (CH)

Screened for at birth

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Vaksinering i Norge

6 weeks, 3 months
Rota virus

3 , 5 and 11-12 months:
Diphteria, tetanus and pertussis (DTP), Haemophilus influenzae type B (Hib), Poliomyelitis (IPV)
Pneumococcus (PKV)

15 months and 12-13 years:
Morbilli, Parotitis and Rubella (MMR)

6-7 year:
Diphteria, tetanus and pertussis (DTP) Poliomyelitis (IPV)

13-14 year:
HPV

15-16 year:
Diphteria and tetanus) (DT) Poliomyelitis (IPV)

Girls are offered HPV vaccine at the age of 12
Hepatitt B-vaccine recommended to children of parents from countries where Hepatitis B is common or children who are at risk for hepatitis B. Given in infancy/newborn period . BCG to risk population at 6 weeks

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Normal puberty

The normal age for onset of puberty is: 9 - 13.5 years for girls,
10 - 14.5 years for boys
The first signs are respectively beginning of breast budding
at an average age of 10-11 yrs.
and testicular enlargement (volume >4 ml), at an
average age of 11 yrs.

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Somatic development. Warning signs

If the child is not able to:
Reach for objects at latest 5 months
Sit at latest 10 months
Walk at latest 18 months

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Språkutvikling

1 year 1 word: learn 1 new word per week

* 2 years 2 words together: 1 new word per day • 3 years 3 words together

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milestones

2 months: response smiling •3 months: good eye contact •5 months: reaches for objects •10 months: sits unsupported •12 months pincer grip
18 months: walks unsupported
18 months : says single words with meaning •20 months: speaks in phrases

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Fever, key point:

(Bruun Wyller)
• The younger the child, the more concerned!
• Lack of effect of temperature lowering attempts might signal more serious condition
• Temperature values in itself is not very informative

Does the baby seem attentive?
How is the general condition?
Why is the mother so worried?

Diffdiagnoser v feber

• A localized infection (common!)
 Upper airway infection, incl. otitis 
 Lower airway infection
 Urinary tract infection
 Gastroenteritis
 Meningitis/encephalitis
 Osteomyelitis/arthritis
 Skin infections
• A generalised infection (possibly dangerous!)
 Generalised viral infection
 Generalised bacterial infection, incl. septicaemia
• Other (rare!)
 Autoimmune disease
 Malignancies
 Immune deficiency

Tolkning av syre/ base-prøve

x
Se Bruun Wyllers forelesning fra 22/8

Metabolsk acidose
Metabolsk alkalose
Respiratorisk =

Apgar Score

Range from 0 to 10. Routinely scored after 1, 5 and 10 minutes.
Provides information on asphyxia (general lack of oxygen) during delivery
Might be regarded a measure of general condition in the newborn

Nutritional deficiencies – key notes

- Affected nutrients
• Proteins (low albumin)
• Lipids (low triglycerides)
• Minerals (calcium, iron)
• Water-soluble vitamins (folic acid)
• Fat-soluble vitamins (Vitamin A)
- Possible diagnosis
• No access to nutrients
• Anorexia nervosa
• General malabsorption, eg. celiac disease
• (Excessive energy and nutrient consumption, eg. heart failure)
- Acid-base balance
• Often slight metabolic acidosis due to increased break-down of ketone bodies

Tonsilitt og Centor kriteriene:

4/5 må oppfylles for diagnose i allmenpraksis.
Sår hals (akutt start)
Temp over 38,5
Store innflammerte tonsiller m puss
Såre/ forstørrede lymfeknuter på hals
Fravær av hoste

wilms tumor

Ewings sarcoma

Diagnoser viktige hos premature barn

``` (IVH) Intraventricular hemorrhage (BPD) Bronchopulmonary dysplasia (NEC) Necrotizing enterocolitis (ROP) Retinopathy of prematurity (RDS) Respiratory distress syndrome (PVL) Periventricular leukomalacia ```

Key notes prolonged jaundice

``` - Possible diagnoses • Normal physiology  Gilbert syndrome  Breast milk jaundice • Hemolysis  Rhesus incompatibility  Other incompatibilities • Liver disease  Hepatitis  Biliary atresia • Other  Inborn errrors of metabolism  Hypothyreosis  Gut obstruction ```

Key Notes rash

- Possible diagnoses • Petecchiae/bruises/purpura  Septicaemia  Leukemia  Idiopathic/immune trombocytopenic purpura (ITP)  Henoch-Schönlein purpura • «Infectious rash»  Virus infections (measles, rubella, varicella, herpes simplex, erythema infectiosum, roseola infantum, hand-, foot- and mouth disease, warts, molluscum)  Bacterial infections (scarlatina, borreliosis, impetigo)  Fungal/parasite infections/infestations (candida, scabies, tropical diseases ) • Skin inflammations  Kawasaki syndrome (mucocutaneous lymph node syndrome)  Eczema  Acne  Toxic erythema  Hives

Limping key notes

``` - Possible diagnoses • Infections  Osteomyelitis  Arthritis (bacterial, viral/’reactive’) • Autoimmunity  JRA  Spondyloartheritis  Reumatic fever • Malignancies  Leukemia  Primary bone tumor • Traumas  Fractures  Epiphysiolysis • Neuromuscular disorders • Congenital malformations/miscellaneous  Congenital hip dislocation  Calvé-Legg-Perthes disease - Supplemental investigations • Lab screening (haematology, infection/inflammation markers) • Imaging (x-ray, ultrasound, MRI) ```

SMA - spinal muskelatrofi

Tre typer: | III: Barn som kan gå og som ser vanlig ut, men kan ikke løpe, hoppe, hinke

Fecal Calprotectin

Jern i IBD

Gi aldri jern PO. | bare iv.

Exclusive Enteral nutrition

* Liquid diet * 8 week course * ”Liquid bandadge” * Mucosal healing * No side effects ( except compliance) • Does not work in UC

Celiac spesific angibodies

• IgA anti- transglutaminase ( tTG) • IgG anti deamidated gliadine

Cøliaki tester

Immunglobuliner HLA-typing biopsi

ENCOPRESIS

Involuntary passage of stools in children over 4 years of age

Kernicterus

Neonatal jaundice

• Jaundice is caused by accumulaJon of unconjugated bilirubin in the skin – In most infants - normal physiology – In some infants addiJonal factors may increase the degree of jaundice

Bilirubin toxicity

• Bilirubin encephalopathy - brain funcJon is affected transitorily (probably): • Lethargy/anorexia • Neurophysiologic changes (ABR, VER) • Kernicterus - brain damage • Death in acute phase – Typically in Rhesus isoimmunizaJon 100+ years ago – And sJll today in LMICs • In survivors a CP-like condiJon with choreoathetosis, deafness, gaze palsy, ⇓I.Q.

”Physiologic” jaundice in neonates is due to the simultaneous occurrence of two phenomena:

– High bilirubin production (x2 relative to adults) due to breakdown of fetal erythrocytes • fetal red cells have shorter survival time • hemoglobin higher in fetal life – Hepatic excretory capacity for bilirubin is low • low ligandin in liver cells • low activity of glucuronyl transferase

Empiric antibiotic treatment of most respiratory tract infections in Norway

``` • Drug of choice: Penicillin – Exceptions: • Pertussis: Erytromycin • Mycoplasma: Erytromycin • Allergy to penicillin: Erytromycin ```