Pedratrics Flashcards
acronym for Infant development milestones?
B.A.B.I,E.S
Infant - birth - 1 year
B - body changes
0 Anterior
fontanelle (
18 months
closure)
0 Posterior ( 2 months of age )
Weight -
A - achieved milestones ( motor & cognitive) B - Baby safety I - interventions E -eating plan S - social stimulation (play)
When do you check a child weight from birth to 11 years ?
Healthy child schedule
- Birth
Up to 2 weeks after birth
- 6 -12 months
- 21/2 years
- 4 - 5 years - primary school entry
- 10 - 11 years - end of primary school.
* babies should be measured more often if there is concern about poor or excessive weight
* excessive frequent weighing is generally unhelpful.
When can BMI be used in children ?
From the second year .
How and why do we measure circumference of head (OFC - Occciptal frontal circumference) ?
Prompt diagnosis of hydrocephalus , mirco/macrocephaly
Possible causes of microcephaly- intrauterine infections, congenital abnormality and developmental concerns.
(small head can be normal )
- Measured at Birth or as soon as head is moulded at delivery.
( measure 3 times - largest reading taken)
GP check - 6 - 8 weeks after birth.
How and why do we measure the weight of a child ?
to check for normal growth and check for no obesity of faltering growth.
What it is the most you would measure a child’s weight if you were concerned (consider the different age groups ) ?
0 Daily if less than (1 month old
Weekly (Between 1–6 months old)
0 Fortnightly (between 6–12 months)
0 Monthly from (1 year of age)
Babies’s weight - physiology
Baby lose weight after being born by 80 % gain it within 2 weeks , some within 3
- assess if more than 10 % is lost- check for :
- signs of illness
- parents know when baby is hungry ?
- Breast fed - do full feeding assessment ( attachment to breast etc)
- Is supplementation required ?
Measurement of height ?
Up to 2 years - supine length - measured on their
back.
Aged over 2 years - height on feet . (unless able to stand - due to disablilty - length should be used. )
Faltering growth - can be endocrine , skeletal, genetic disorders
(e.g Turner’s syndrome , growth hormone deficiency
Rapid growth - precocious (early puberty )
Hydrocephalus ?
Pathway of CSF production & flow ?
Choroid plexus contains ependymal cells —> produce CSF —> Lateral ventricle ——> 3rd ventricles ———> cerebral aqeduct —————-> 4th ventricle —————-> subarachnoid space (but arachnoid and pia matter ) ——————————> Dural sinus - in dura matter
(* arachnoid matter has finger like projection into dura mater so CSF flow from high pressure to low pressure)
What is normal pressure hydrocephalus ?
Primary - idiopathic
Secondary - damage to arachnoid villi ( CSF cannot get out of ventricles into dural sinus - ventricles enlarge/dilate , CSF not reabsorbed & compress nearby structures)
NOTE - pressure normal because ventricles dilate to normalize pressure
- Lateral ventricle - can compress corona radiata - nerve fibers - sensory and motor btw body & cerebral cortex.
e. g. especially those for leg & bladder
- URINARY INCONTINENCE
- GAIT DISTURBANCE
- compress - PERIVENTRICULAR LIMBIC SYSTEM ( limbic system around ventricles - responsible fr emotions, behaviour responses , memory e.g fornix , corpus callosum , pineal gland etc) - DAMAGE - DEMENTIA
- Commonly affect the elderly .
CAUSES - Secondary ( damaged villi )
0 Subarachnoid haemorrhage
0 Meningitis / infection
0 Tumour
0 complications of surgery
Symptoms 3 W *Wet - urinary incontinence *Wobbly - Gait disturbance ( wide based - set far apart and slow) *Wacky - dementia
CT / MRI - enlarged ventricles
Spinal tap / lumbur puncture
Treatment
Short term - lumbar puncture
Long term - Shunt
Aqueductal stenosis ?
Blockage of cerebral aqueduct - e.g pineal tumor
Congenital - malformed aqueduct (Forking )
——————————-> Obstructive hydrocephalus —> ventricles dilate , compresses brain tissue
Headaches Seizures Vomiting Balance disturbance Visual disturbances
Children
- Enlarged head
Developmental delays
Intellectual disability
Investgation - MRI - visualise entire lenght of aqueduct
Treatment - SHUNT - venticuloperitoneal shunt.
Physiotherapy - help develop motor skills.
Neural tube defects?
Spina bifida
Embryology - what structures does the ectoderm derive into ?
Neural tube - forms CNS ( neurons , Gial cells (astrocytes , oligodendrites ) , Posterior pituary , Pineal gland , Retina )
Neural crest cells
C - chromaffin cells ( in adrenal medulla)
R - rostral tissues ( tissues towards head e.g bone , muscles , connective tissue )
E - enteric nervous system
S - satilile cells , schwann cells (glial cells of peripheral nervous system)
T - the PNS (Spinal nerves & ganglion)
C - Carotid bodies (measure conc of o2 and co2)
E - endocardial cushions (helps form spetum & valves)
L - Light skin and dark skin - melanocytes
L - Leptomeningeses - PIA & Arachnoid mater.
Olfactory placode - form roof of nasal cavity - olfactory epithelium
Lens placode - Cillary msucle e.g. far & near vision
OTIC placode - inner ear - cochlea , vestibule , semicircular canals.
Surface ectoderm - epithelial tissue (epidermis nails , hair, sweat glands, lines cavities e.g. nasal (except roof) , oral , external ear canal , inferior anus below pectinate line )
E - epithelial tissue C - CNS The lens pLacode Otic & olfactory placode Dang crest cells E - eyes (retina- part of CNS) RATHKE'S POUCH - becomes anterior pituary gland after budding of epithelial tissue in nasal cavity
M - Melatonin (pineal gland) - CNS .
Gastroenteritis ( Stomach bug) - CHILDREN
Types :
- Viral (most commonly - Rota virus- vomiting really common)-
- Bacterial
* if bloody diarrhea - most likely bacterial rather than viral.
Symptoms
0 diarrhoea -------------------------------> dehydration ( can be severe - signs - reduced skin turgor , prolonged capillary refill , thirst , dry mucous membranes , decreased urine output etc - signs depend on severity) 0 vomiting 0 fever - low grade (viral) - High grade (> 39 - bacterial)
0 Crampy abdominal pain
0 abdominal tenderness
- Mild - viral
- Severe - more likely bacterial.
( abdomen is usually soft , non -distended - if distended suggest underlying malnutrition)
0 hyperactive bowel sounds.
0 decreased body weight - linked to dehydration
- may have mucous in stool.
RF
- under 5
- poor hygiene
- Winter months
- immunodeficiency
- lack of rota virus vaccine.
(given between 8 week and 12 weeks - 2 doses , 4 weeks apart) - lack of breastfeeding / feeding ( lack of fluid intake)
Ask about symptoms (blood , pus , mucus in stool , diarrhoea - how many times , urine output , fluid intake ? , occupation e.g food handler , nursey worker( common in children) , risk factors (inclu . foreign travel , anyone else you have been contact with have the same symptoms. , recent hospital - C.diff)
Stages / categories of dehydration ?
assess skin , capillary refill , state of mucous membranes & eyes , fontanelles.
Signs of mild dehydration include: alert state; slightly decreased urine output; slightly increased thirst; slightly dry mucous membrane; slightly elevated heart rate; normal capillary refill; normal skin turgor; normal eyes; and normal anterior fontanelle.
Signs of moderate dehydration include: alert state, fatigued, or irritable; decreased urine output; moderately increased thirst; dry mucous membranes; elevated heart rate; prolonged capillary refill; decreased skin turgor; sunken eyes; and sunken anterior fontanelle.
Signs of severe dehydration include: apathetic or lethargic state; markedly decreased or absent urine output; greatly increased thirst; very dry mucous membranes; greatly elevated heart rate; prolonged or minimal capillary refill; decreased skin turgor; very sunken eyes; very sunken anterior fontanelle; cold extremities; hypotension; and coma.
