Specific Problems in Children Flashcards
What is the PURPLE cyring
P = P eak—your baby may cry more each week, the
most at _______, then less at 3–5 months
U = _________—crying can come and go and you
won’t know why
R = ________—your baby may not stop crying
no matter what you try
P = _________—babies may look like they are in
pain, even when they’re not
L =_________—crying can last as much as 5 hours
a day, or more
E =_________—your baby may cry more in the
late afternoon or evening
2 months
U nexpected
R esists soothing
P ain-like face
L ong-lasting
E vening cluster
Babies usually cut their teeth from age ______
6 months until 2–3 years
The first teeth to appear (which seldom cause
discomfort) are usually the _______
lower incisors (during the first year).
The _____ and _______ (ages 1–3) tend to
cause problems
first and second molars
Usually the first set (20 teeth) is complete soon
after the ______
second birthday
In teething, Paracetamol should be used only for ______
significant discomfort
Teething gels are _______ and are
not recommended.
salicylate-based
Some children who are breastfed for long periods
(e.g. 3 years) may develop ________
unsightly pitting of the front surface of their teeth
________ involves placing the thumb or finger
on the roof of the mouth behind the teeth (hard
palate) and sucking with the mouth closed
Thumb sucking
Thumb sucking
It occurs in children up to the age of 12 years but is most common under the age of ______
4 years.
Thumb sucking
One effect is that the pressure on the front teeth may
cause protrusion of the front teeth _________
(i.e. buck teeth);
Thumb sucking
Effect another is a narrowing of the bite with a gap between the top and bottom incisors, referred to as an ___________
open anterior bite
Snuffling in older infants is usually caused by
rhinitis due to an ___________
intercurrent viral infection
About 20% of infants develop watery eyes, but
most resolve by _______
12 months
Excessive eye watering
in infants is the key sign that there is ______
inherited
narrowing of the nasolacrimal ducts
When is Blocked nasolacrimal duct usually obvious?
It usually becomes obvious in infants between 3 and 12 weeks and affects one or both eyes.
T or F
Blocked nasolacrimal duct
Self-correction usually occurs from 6 months of
age onwards or even earlier
T
Problems on growth charts
They are based on Caucasian children and are
not fully representative for some other groups (e.g.
Asian children tend to be smaller).
Classically, failure to thrive (FTT) has been defined
as children whose :
weight <3 rd percentile on ≥ 2
occasions, or whose weight crosses two centile lines
over time.
Weight gain slows further after _________
12 months of age.
Traditionally, FTT was divided into____ and_____
organic and nonorganic
causes
Basic labs to investigate FTT
- FBC, CRP
- iron studies
- UEC/LFTs
- urine MC&S
- coeliac screen
- stool fat globules/fatty acid crystals
______ is considered to be below the 3rd
percentile.
Short stature
Short stature cause
_______________—this follows the family
trend of a genetically small family
Familial short stature
Short stature cause
__________—a common
and normal variant in which the growth spurt is
later than average. Bone age is delayed
Constitutional delay in maturation
Pathological causes of short stature
some are rare but serious conditions, such as coeliac
disease, Crohn disease and chronic kidney failure.
Rough rule for expected adult height
based on parental height
- Boys—mean of parents’ heights + 5 cm
* Girls—mean - 5 cm
___________
for those children with idiopathic short stature (ISS,
a diagnosis of exclusion) increases height in some
children, with the range of benefit usually between
3 cm and 7 cm
Recombinant human growth hormone treatment
Tall stature is considered to be above the _______
percentile
97 th
Causes of tall stature
• familial (predicted final height should roughly
match mid-parental height)
• precocious puberty
• growth hormone excess (pituitary gigantism)
• hyperthyroidism
• syndromic: Marfan, Klinefelter, homocystinuria
Tall Stature Tx
If treatment is considered appropriate, ________ is used in very tall girls (accelerates epiphyseal maturation and reduces final height) while __________ is used
for boys.
high-dose oestrogen
high-dose testosterone
__________ is associated with growth
acceleration and advancement of bone age, while
__________has the opposite effect
Nutritional obesity
endocrine obesity
Delayed puberty
This is the absence of pubertal development
(testicular enlargement in boys or breast development
in girls) in:
- girls >________
- boys >_______
13 years
14 years
MCC of delayed puberty
constitutional delay of growth and puberty (CDGP)
is usually familial and the commonest cause. It is
associated with delayed growth and bone age
Other causes of delayed puberty
• chronic illness (e.g. severe asthma, cystic fibrosis,
kidney failure)
• poor nutrition and exercise
• anorexia nervosa
Puberty is trending earlier than in previous
generations, known as the ‘secular trend’, and is
presumed to be due to improved nutrition and
absence of chronic disease
Precocious puberty
True precocious puberty is considered to be:
- girls <8 years
* boys <9 years
In precocious puberty:
Growth spurts will be earlier and bone growth
will be advanced, though final adult height may be
reduced from what would otherwise be expected
due to __________
premature fusion of the long bones
True precocious puberty is ______ more common in girls
than boys
20 times
Precocious puberty
It is usually idiopathic, though _______ are a rare cause and more common as a
cause in boys (boys always require brain imaging).
pituitary
adenomas
Precocious puberty
Treatments are often not required, but may include
____ and _______
gonadotrophin releasing hormone (GnRH) analogues
and cyproterone
This is breast development in girls under 8 years old
without other pubertal signs.
Premature thelarche
This is the isolated appearance of pubic hair in
boys or girls aged 6–9 years old. There are no other
features of virilisation or oestrogenisation, and the
hair remains until other signs of puberty appear at
the normal time.
Premature adrenarche
Premature adrenarche
It is usually a normal variant (no
specific treatment necessary) but may rarely signify
atypical __________
congenital adrenal hyperplasia
This is a normal variant of male puberty, with a
prevalence of about 40–50% and is usually a transient
phenomenon, subsiding in 2–3 years
Pubertal gynaecomastia
A breast ‘bud’ is common in most term babies and may
enlarge with breastfeeding. Milk may
discharge from some (‘witches’ milk) but reassurance
is all that is required
Infant breast hyperplasia
- Typical age 3–12 years
- Positive family history
- Usually bilateral and non-articular
Growing pains
localization for growing pains
typical sites include
shins, calves, thighs, popliteal fossa
True about growing pains
a. Problem resolves spontaneously in time
b. Reassurance
6. Consider analgesic and heat packs (usually
unsuccessful)
d. Massage is a reasonable option—appears to
help
AOTA
Many children and infants will be found to have
systolic murmurs on routine examination, especially
in the presence of a__________
fever, anxiety or fear
Criteria of innocent murmur
• there are no other abnormal physical findings
• the child is asymptomatic
• no history of risk factors for structural heart
disease
• auscultatory features typical of an innocent
murmur
T or F
In murmurs heard in infants under 12 months of
age, the risk of asymptomatic structural heart disease
is higher, and further assessment is warranted.
T
What are the 7S of innocent murmur
1 S ensitive (changes with child’s position or with
respiration)
2 S hort duration (not holosystolic)
3 S ingle (no associated clicks or gallops)
4 S mall (murmur limited to a small area and nonradiating)
5 S oft (low amplitude)
6 S weet (not harsh sounding)
7 S ystolic (occurs during and is limited to systole)
__________ or bedwetting, is urinary
incontinence occurring during sleep in a child with
a developmental age of 5 or older
Nocturnal enuresis (NE),
_________ (80% of cases) occurs in a child who has never had urinary continence for 6 months,
Primary enuresis
______(20%) occurs after 6 months or more of day
and night dryness, and is more commonly associated
with organic or psychological causes
secondary enuresis
The spontaneous resolution of NE is _______ per year
15%
The causes of NE are not fully understood, but are thought to be multifactorial, including: 1 2 3
- disturbance in arousal
- overactive bladder
- nocturnal polyuria
It takes
around _______ for the child to recognise the sensation
of a full bladder, and around_____ to achieve
dryness (success is measured as 14 consecutive dry
nights).
3 weeks
12 weeks
_______ (giving additional fluids at bedtime to those who achieve dryness) can improve the child’s response to a
full bladder signal and reduce the risk of relapse,
especially in those who are sleeping through dry.
‘Overlearning’
Meds for eneuresis
_______: while this vasopressin analogue
is very effective, it has a high relapse rate
Desmopressin acetate
Constipation is defined as having 2 or more of the
following over the previous 2 months:
• ______ bowel motions per week
•______ episode of faecal incontinence per week
(previously referred to as encopresis)
• large stools in rectum or palpable on abdominal
examination
• _________ (e.g. ‘stiff as a board’
standing/lying, tip toes, crossed legs, braces
against furniture) and withholding behaviour
(e.g. refuses, hides, requests nappy, denies need
to go)
• _______
<3
> 1
retentive posturing
painful defecation
The key feature in functional constipation is _____
chronic faecal retention leading to rectal dilatation and insensitivity to the normal defecation reflex
For acute faecal impaction, _______ can
be used until liquid stools are achieved, and then
revert back to maintenance treatment
high-dose laxatives
_______ are suitable only for children with acute severe
rectal pain or distress and are rarely required
Enemas
This benign condition occurs in around half of babies,
usually 1–2 days after birth (but may appear up to 2
weeks later) with 2–3 mm erythematous macules and
papules developing into pustules, with a surrounding
blotchy area of erythema, described as a ‘flea-bitten’
appearance
Toxic erythema of newborn
Rash of Toxic erythema of newborn
The rash starts on the face and spreads
to the torso and proximal limbs, and spares the palms
and soles. The rash usually fades over a week, but may
recur for a few weeks. No treatment is required
These are flat patches of pink or red skin with poorly
defined borders. They occur in 40% of all newborns,
and are seen at the nape of the neck (‘stork bite’) or
between the eyebrows/on the eyelids (‘angel’s kiss’)
Salmon patch (naevus flammeus nuchae)
Types of Infantile Hemangioma
(‘strawberry haemangioma
(‘cavernous haemangioma
What type of hemangioma
flat or lumpy, resembling
strawberry jam splashed on the skin
strawberry haemangioma
Large, deep
or multiple haemangiomas can be associated
with _______
malformations of organs,
True about infantile hemangioma
________ is a very promising new
treatment for more significant lesions, especially if
used early in the growth phase, and is now usually
preferred over oral steroids
Propanolol
These dark red to purple lesions (a type of naevus
flammeus) are present from birth and affect 3
in 1000 neonates. They are usually flat at birth,
though they can become lumpy
Capillary vascular malformation
‘port wine stain’
port wine stain
on the skin supplied by the ophthalmic division of
the trigeminal nerve is accompanied by glaucoma
and seizures, and patients are at increased risk of
developmental delay and hemiplegia
Sturge–Weber syndrome
Port wine stains will often respond well to_______
pulse dye laser (the
treatment of choice).
These are present at birth but can subsequently
grow. They can vary from large fluid-filled spaces
(cystic hygromas) down to clusters of small firm
blisters resembling frogspawn
Lymphatic malformation (lymphangioma
This condition presents as blue-grey discolouration
of the skin over the lower back and sacrum in
babies of east Asian and other dark-skinned ethnic
backgrounds.
Dermal melanocytosis
‘Mongolian spot’
_________ glands appear as tiny yellow–
white papules on the nose or forehead. They disappear
in several weeks.
Hyperplastic sebaceous
This is related to overheating and occurs in skin folds
such as around the neck and armpits, but also on the
face.
Miliaria (‘sweat rash’)
Types of Miliaria (‘sweat rash’)
• ‘________—beads of sweat trapped under the
epidermis with surrounding erythema
• ________—itchy red papules
crystallina
rubia
These common fleshy pink-red growths can cause a
persisting seropurulent discharge after the separation
of the umbilical stump
Umbilical granuloma
These are round or oval pale skin patches usually
on the face of children and adolescents, and are
more visible in tanned or dark-skinned patients.
• They can occur on the nec
Pityriasis alba
This common condition may appear typically in
infants on the cheeks of the face, the folds of the
neck and scalp and extensor surface of the limbs
Atopic dermatitis (eczema)
In nappy rash,
Sometimes ammonia is formed, resulting in a chemical burn (hence the alternative term _____
ammoniacal dermatitis
Other conditions such as ______ and ________
also need to be considered, especially for resistant or
recurrent nappy rash.
psoriasis and atopic dermatitis
_______is infantile seborrhoeic dermatitis
confined to the scalp. The seborrhoeic dermatitis may
also involve other areas
Cradle cap
Cradle cap is very common, usually occurring in the _________ of life and settling over the next few weeks to months, but it sometimes takes much longer.
first 6 weeks
Cradle cap
The yeast ______ may be involved.
Malassezia furfur
What shampoo to use in Cradle cap
2% ketoconazole shampoo (Nizoral) twice weekly
________ is usually diagnosed by its distinct
pink pearly appearance and central punctum
Molluscum
Spread of molluscum
and is usually spread by direct contact
Molluscum rarely leaves tiny pit-like
scars. It can have a reactive dermatitis surrounding
the lesions (especially in children prone to atopic
dermatitis) and ________ cream can be used to
help this
hydrocortisone
Warts in children
Even without treatment, 50% of them will go in_____ and
90% in 2 years.
6 months, and
