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.
What are some features suggestive of an underlying medical cause for obesity?
✔️ dysmorphic features ✔️ height < 50th centile ✔️ developmental / intellectual impairment ✔️ obesity occurs < 2 years of age ✔️ hypogonadism
Outline some complications of CHILDHOOD OBESITY.
Psychological complications: o low self esteem o eating disorders o bullying / teasing o school avoidance o poor body image
Endocrine complications o Insulin resistance o Metabolic syndrome o T2DM o PCOS o Early onset puberty o Thyroid dysfunction
Orthopaediatric complications
o Blout’s disease
o Increased prevenance of fractures
o SUFE (slipped upper femoral epiphysis)
Cardiovascular complications o HTN o CAD o Dyslipidemia o Metabolic syndrome
GIT Complications
o constipation
o NAFLD
o Cholelithiasis
Respiratory complications
o decreased exercise tolerance
o OSA
o asthma (?)
Dermatological problems o Acne o Acanthosis nigricans o Furunculosis (boils) o Intrertrigo
Neurological complications
o Benign intracranial hypertension (headaches, vision loss)
Renal problems
o hypertrophy of the glomerulus
o adaptive focal segmental glomerulosclerosis
Describe some management options for childhood obesity.
DIETARY / NUTRITION
✔️ make healthy options more available
✔️ remove high-calorie food options from the house
✔️ encourage all members of the household to engage in healthy change
✔️ encourage small, regular, nutritious meals
✔️ control portion sizes
✔️ reduce consumption of sugary / processed drinks (e.g. juice, soft drink, caffeinated drinks)
PHYSICAL ACTIVITY
✔️ encourage 30 to 60 mins of exercise per day
✔️ walk or ride bike where possible
✔️ reduce screen time
✔️ join a team sport
✔️ encourage engagement in sport activities at school
What is the normal age of puberty in males and females?
FEMALES: 11.5 to 12.5 years (lower limit is 8 years)
MALES: 12 to 12.5 years (lower limit is 9 years)
Define DELAYED PUBERTY. What are the most common causes?
Delayed puberty is defined as the absence of puberty symptoms > 13 years (females) or >14.5 years (males).
PRIMARY HYPOGONADOTROPSIM ✔️ Turner's Syndrome ✔️ Kleinfelter's Syndrome ✔️ gonadal dysgenesis ✔️ gonadal damage ✔️ trauma, infection, surgery ✔️ radiation or chemotherapy
Define PRECOCIOUS PUBERTY. What are the most common causes?
Precocious puberty is defined as the onset of puberty < 9 years of age (girls) or < 8 years of age (boys).
Females are tend times more likely to have precocious puberty compared to boys, however, boys are more likely to have an organic cause.
What are some causes for PRECOCIOUS PUBERTY?
✔️ obesity ✔️ genetic ✔️ familial ✔️ chromosomal abnormalities ✔️ adrenal hyperplasia / tumour ✔️ congenital adrenal hyperplasia
What is the diagnostic criteria for ACUTE RHEUMATIC FEVER (ARF)?
Evidence of GAS infection:
- Anti streptolysin O titre (ASOT)
- anti-DNAse B antibodies
MAJOR CRITERIA
- Carditis (acute or subacute)
- Joint pain (polyarthritis in low risk populations; mono arthritis or polyathralgia in high risk populations)
- Syndenham’s Chorea
- Subcutaneous nodules
- Erythema marginatum
MINOR CRITERIA
- Fever
- Joint pain (polyarthralgia or monoarthritis in low risk populations; monoarthralgia in high risk populations)
- Elevated CRP
- Elevated ESR
- Prolonged PR interval on ECG
Management of ARF?
- Primary survey
- Collect appropriate bloods
- O2 if < 90%
- Appropriate fluid management
- IV antibiotics (benzathine penicillin G)
- Aspirin for joint pain
- Paracetamol for fevers
What is the secondary prevention for RHD?
Benzathine penicillin G (BPG) injections 1,200,000 units IM, every 28 days.
Complications of ARF?
✔️ RHD
✔️ PSGN
✔️ ARF associated rash
✔️ Scarlett Fever
What is the most common hip complication on kids with obesity?
SUFE
Slipped upper femoral epiphysis
What are the THREE SENTINEL facial features of FASD?
- small palpable fissures
- flat philtrum
- thin upper lip
What are some of the neurocognitive / behavioural problems associated with FASD?
FASD has much overlaps with ASD, ADHD and ADD.
✔️ developmental delay ✔️ behavioural disturbances ✔️ poor attention ✔️ hyperactivity and disruption ✔️ impulsivity ✔️ poor affect regulation
What is the cause of TURNER’S SYNDROME?
Turner’s Syndrome is a genetic condition that is characterised by absence of one X chromosome in females (monosomy X).
This condition is NOT inherited; occurs spontaneously after conception.
What are some characteristics of TURNER’S SYNDROME?
✔️ short stature ✔️ primary amenorrhea ✔️ premature ovarian insufficiency ✔️ broad chest with widely spaced nipples ✔️ low hairline at back of neck ✔️ webbing of the neck ✔️ congenital heart defects and murmurs ✔️ renal problems ✔️ thyroid problems ✔️ increased risk diabetes mellitus ✔️ recurrent middle ear infections leading to hearing loss
What is the cause of DOWN’S SYNDROME?
Down’s Syndrome is an inherited genetic condition characterised by an additional chromosome 21 (trisomy 21).
Risk is increasing maternal age.
What are some characteristics of DOWN’S SYNDROME?
✔️ up slanting narrow eyes, palpable fissures ✔️ flattened nasal bridge ✔️ low set ears ✔️ epicanthical folds ✔️ protruding tongue ✔️ short, broad hands ✔️ transverse palmar crease ✔️ hyper flexibility of joints ✔️ hypotonia
What are some risks that are increased with DOWN’S SYNDROME?
✔️ cardiovascular risk –> congenital heart defects
✔️ gastrointestinal problems –> Hirshsprung’s Disease
✔️ respiratory problems –> sleep aponea
✔️ developmental delay
✔️ hearing loss
✔️ hypothyroidism
Identify TWO antenatal investigations used to detect DOWN’S SYNDROME.
✔️ amniocentesis
✔️ nuchal translucency test
