Random Flashcards
What are the features of PURPLE crying?
P = peaks around 6 weeks of age; subsides by 2 to 3 months
U = unexpected crying
R = resists soothing
P = pain-like face
L = lasts up to five hours per day
E = evening / night time is the worst
Identify some red flag features for the irritable infant.
✔️ fever ✔️ lethargy ✔️ reduced feeding ✔️ failure to thrive / poor growth ✔️ reduced consciousness ✔️ sudden onset irritability
Identify some ORGANIC and NON-ORGANIC causes for infant irritability.
ORGANIC CAUSES ✔️ overtired ✔️ overstimulated ✔️ hungry ✔️ overfed ✔️ temperature ✔️ wet or soiled nappy ✔️ parental psychosocial factors
NON-ORGANIC / PATHOLOGICAL CAUSES ✔️ infection (e.g. UTI, gastroenteritis, respiratory infection) ✔️ raised ICP (e.g. meningitis, encephalitis) ✔️ non accidental / accidental injury ✔️ substance / toxin ingestion ✔️ intersusseption ✔️ cow's milk intolerance ✔️ gastro-oesphageal reflux ✔️ lactose overload
Describe some key features of INFANTILE COLIC.
Infantile colic is a term used to describe abnormal irritability in an otherwise healthy / normal infant.
Diagnosis is based on crying:
✔️ > 3 hours per day
✔️ > 3 days per week
✔️ > 3 weeks in total
The exact cause of infantile colic is unknown, however, is believed to be contributed to by lag in the development of the normal peristaltic activity of the bowel and lack of self-soothing mechanisms.
Colic is a diagnosis of exclusion; all other organic and non-organic / pathological causes must be appropriately investigated and managed.
Describe some key features of COWS MILK PROTEIN INTOLERANCE.
Cows milk protein intolerance may be IgE or non-IgE mediated. Around 50% of infants with this condition will also be intolerant to SOY.
Symptoms include: ✔️ irritability, particularly post-feeding ✔️ vomiting ✔️ diarrhoea ✔️ mucus in stools ✔️ poor feeding ✔️ failure to thrive / poor weight ✔️ other signs of atopy (e.g. eczema, rhinitis, asthma) ✔️ positive family history
Cows milk protein intolerance can be managed by removing cows milk and all dairy from the mother’s diet. The baby may need to be commenced on lactose-free formula.
Most children grow out of this condition by 12 months of age.
Describe some strategies that can be recommended to help parents manage infant irritability.
✔️ establish a regular day and night time routine
✔️ darken the room for sleep during the day
✔️ avoid excessive stimulation (e.g. lights, noises) prior to settling
✔️ baby massages, gentle rocking, patting
✔️ calming music to settle baby
✔️ give permission for the primary parent to have designated time to themselves throughout the day without the pressure of having to perform household chores and other jobs
It is important to reinforce any strategies with printed information / parental education.
Define GLOBAL DEVELOPMENTAL DELAY.
GDD is defined as developmental delay in at least TWO developmental domains in a child < 5 years of age.
Define AUTISM SPECTRUM DISORDER (ASD).
ASD is an umbrella term for many neuro-cognitive conditions characterised by impairment to social interaction and communication.
The two main domains in which children with ASD struggle with are:
- social and emotional interaction / communication
- abnormal behaviours, interactions and play
Outline the DSM-V diagnostic criteria for ASD.
- Social and emotional interaction / communication (all THREE required)
✔️ reciprocity in communication (e.g. unable to hold a back and forth conversation, may talk over others, asks inappropriate questions)
✔️ relationships are impaired
✔️ reduced ability to “read others” (e.g. struggles with body language and other non-verbal cues) - Abnormal behaviours, interactions and plays (TWO out of four required)
✔️ strange interests, beyond what is considered age-appropriate
✔️ stereotyped behaviours, movements, speech and use of objects (e.g. lines toys up, may have a “tic”)
✔️ sameness and insistent on routine
✔️ sensory changes (increased or decreased) - Symptoms are present throughout the early developmental period
- Symptoms cause significant distress / impairment on every day
- Symptoms not better explained by another disorder or GDD
What is the diagnostic criteria for ADHD?
- Persistent pattern of inattentiveness / hyperactivity-impulsivity as demonstrated by a score > 6 in either of these domains
- Several traits present < 12 years of age
- Severe traits present across at least TWO domains (i.e. school and home)
- Significant impairment in social / academic / occupational functioning
- Symptoms do NOT occur in the context of psychosis or another mental health disorder
What are the parameters for normal weight gain in an infant / child?
0 to 3 months: 150 to 200g per week
3 to 6 months: 100 to 150g per week
6 to 12 months: 70 to 90g per week
Define POOR WEIGHT GAIN / FAILURE TO THRIVE.
FTT is defined as poor growth leading to a fall in weight for height across two major centiles.
It may also be observed in a child who is small for gender and age.
Outline some causes for POOR WEIGHT GAIN.
INADEQUATE FOOD AVAILABILITY / INTAKE ✔️ low socioeconomic status ✔️ low parental education ✔️ child abuse / neglect ✔️ inadequate formular preparations ✔️ breastfeeding difficulties ✔️ mechanical difficulties (e.g. micrognathia, cleft palate, tongue tie) ✔️ restricted diet (e.g. vegan / vegetarian) ✔️ sensory problems (e.g. ASD)
INADEQUATE / POOR ABSORPTION ✔️ cow's milk protein allergy ✔️ Coeliac disease ✔️ short gut syndrome ✔️ pancreatic insufficiency ✔️ chronic diarrhoea ✔️ chronic vomiting
INCREASED CALORIC LOSS / USAGE ✔️ sepsis ✔️ pneumonia ✔️ UTI ✔️ chronic disease (e.g. cystic fibrosis, congenital heart disease) ✔️ hyperthyroidism
What are some RED FLAG features in poor weight gain?
✔️ evidence of child abuse / neglect
✔️ previous child safety / protection report
✔️ poor family understanding
✔️ poor parental attachment
✔️ signs of dehydration
✔️ signs of malnutrition
✔️ previous FTAs to multiple appointments
Define OVERWEIGHT and OBESE in the context of children.
In children > 2 years of age, obesity is calculated based on BMI.
Overweight: between 85th to 95th centile on BMI chart
Obese: > 95th centile on BMI chart
In children < 2 years of age, obesity is based on the weight-to-age chart; obesity > 97th centile.
