(SYNOPTIC) Neonates + Paediatrics

Question 1

How do we assess pain in children?

Answer 1

Self-report (if child is able)
Behavioural indicators
Physiological indicators

Question 2

How should pain be assessed when they are unable to tell you verbally, i.e. a neonate?

Answer 2

Facial Expression?
0 - relaxed
1 - grimace

Crying?
0 - no
1 - whimper
2 - vigorous crying

Arms?
0 - relaxed
1 - flexed/ extended

Legs?
0 - relaxed
1 - flexed/ extended

Posture?
0 - relaxed
1 - flexed/ extended

State of arousal?
0 - asleep/ awake
1 - restless

Heart rate?
0 - baseline
1 - increase by 10-40BPM
2 - increase by ≥40BPM

Respiratory rate?
0 - baseline
1 - alteration in breathing

Question 3

When observing pain of a neonate, and having allocated a score, how are the scores interpreted?

Answer 3

1-3: Nurse-controlled measure

• non-nutritive sucking
• repositioning

4-7: Consider sucrose/ alternative pain relief + nurse-controlled measures

8-10: Review with medical team
- discuss alternative prescription for pain relief

Question 4

What is FLACC, with regard to pain?

Answer 4

Pain assessment score

Face
Legs
Activity
Crying
Consolability

Question 5

What are some behavioural indicators of pain?

Answer 5

• Irritability
• Unusual quietness or lethargy
• Restlessness
• Sobbing, screaming or whimpering
• Increased clinging
• Loss of appetite
• Laying ‘scared stiff’

Question 6

What are some physiological indicators of pain?

Answer 6

• heart rate
• respiratory rate
• blood oxygen
• blood pressure

Question 7

Treatment for mild pain

Answer 7

Paracetamol

Question 8

Treatment for mild to moderate pain

Answer 8

Paracetamol + NSAID

Question 9

Treatment for moderate pain

Answer 9

Paracetamol + NSAID + codeine?? look at codeine cards

Question 10

Treatment for severe and very pain

Answer 10

Paracetamol + NSAID + morphine

Question 11

For what patient age group is codeine considered suitable?

Answer 11

Patients older than 12

Question 12

For what patient age group is codeine contraindicated?

Answer 12

All children under 18yrs who undergo removal of tonsils/ adenoids

For the purpose of sleep apnoea

Question 13

What do you do in suspected asthma?

Answer 13

Diagnosis and assessment

Question 14

What do you do in diagnosed asthma?

Answer 14

• assess symptoms
• measure lung function
• check inhaler technique and adherence
• adjust dose
• update self-management plan
• move up and down as appropriate

Question 15

What is the management of suspected asthma in neonates and paediatrics?

Answer 15

Initiation of treatment with very low-> low dose ICS

Question 16

What is the management ladder of diagnosed asthma in neonates and paediatrics?

Answer 16

(1) Regular preventer

(2) Initial add-on therapy
- VERY low dose ICS
- ≥5 add LABA/ LTRA
- <5 add LTRA

(3) Additional controller therapies:
- Consider increasing ICS to low dose
- ≥5 add LABA/ LTRA
- no response to LABA: consider stopping

(4) Refer for specialist care

Question 17

When would you consider moving up the ladder?

Answer 17

If using 3 doses or more a week

Question 18

If child is at 5 and still have symptoms what would we do?

Answer 18

Objective tests
- FeNO
- Spirometry
- Bronchodilator reversibility

Monitor peak flow for 2-4 weeks if there is diagnostic uncertainty

Question 19

FeNO

Answer 19

35ppb or more

Question 20

Spirometry

Answer 20

FEV1/FVC ratio < 70%

Question 21

What is LTRA treatment?

Answer 21

Leukotriene receptor antagonist therapy

Question 22

What dose of beclometasone dipropionate is considered to be a very low dose for use in children?

Answer 22

50 microgram

2 puffs

BD

Question 23

What dose of beclometasone dipropionate is considered to be a low dose for use in children?

Answer 23

100 micrograms

2 puffs

BD

Question 24

What dose of beclometasone dipropionate is considered to be a medium dose for use in children?

Answer 24

200 micrograms

2 puffs

BD

Question 25

Why should you use a spacer with your child’s inhaler?

Answer 25

• Spacers help get medicine into the lungs more effectively
• Stop meds from sticking to the back of the mouth
• Reduces risk of thrush and sores

Question 26

What is the treatment for mild atopic eczema in children?

Answer 26

• emollients
• mild topical CS

- mild topical corticosteroids (hydrocortisone)

Question 27

What is the treatment for moderate atopic eczema in children?

Answer 27

• emollients
• moderate topical corticosteroids (betamethasone/ clobetasone)
• topical calcineurin inhibitors
• bandages

Question 28

What is the treatment for severe atopic eczema in children?

Answer 28

• emollients
• potent topical CS (betamethasone/ mometasone)
• topical calcineurin inhibitors
• bandages
• phototherapy
• systemic treatment

Question 29

Name some side effects of systemic corticosteroid use.

Answer 29

• impairment of growth and healing
• fluid retention
• osteoporosis
• weight gain
• peptic ulcers
• altered mood/ psychosis
• electrolyte imbalances
• blood glucose increase

Question 30

Name some side effects of topical corticosteroid use.

Answer 30

• may thin skin if very potent

- if used on younger children, may get systemic exposure via skin

Question 31

When should oral antihistamines be offered to children with eczema?

Answer 31

Not to be used routinely

Offer 1 month trial of NON-SEDATING to children with SEVERE atopic eczema/ severe itching

Offer 7-14 day trial of SEDATING if ≥6 months with sleep disturbance

Question 32

What is the first line treatment for secondary infections of eczema in children?

Answer 32

Flucloxacillin

Erythromycin
- if penicillin allergy

Question 33

What is the treatment for a meningitis infection in children?

Answer 33

Broad spectrum ABx

(1) Cephalosporin
- ceftriaxone
- cefotaxime

(2) Add amoxicillin for babies <3 months

Question 34

What is a potential complication of this drug when used in children?

Chloramphenicol

Answer 34

Neonates cannot metabolise

Can result in grey baby syndrome

Liver is not mature enough to metabolise correctly

Question 35

What is a potential complication of this drug when used in children?

Sulfonamides

Answer 35

Kernicterus in neonates

- Brain damage due to high levels of bilirubin in blood

Question 36

What is a potential complication of this drug when used in children?

Ceftriaxone

Answer 36

Kernicterus in neonates
- Brain damage due to high levels of bilirubin in blood

Forms precipitate with calcium

Question 37

What is a potential complication of this drug when used in children?

Nitrofurantoin

Answer 37

Haemolytic anaemia in children <3 months

Question 38

What is a potential complication of this drug when used in children?

Tetracyclines

Answer 38

Bind to calcium in growing bones + teeth

Causes discolouration

Question 39

What is a potential complication of this drug when used in children?

Quinolones

Answer 39

Arthopathy in children

- joint disease

Question 40

What are some common reasons for having to admit term babies?

Answer 40

• Hypoglycaemia
• Hyperbilirubinaemia
• Infection
• Poor feeding
• Asphyxia during birth

Question 41

What are some common issues for preterm babies?

Answer 41

• hypoglycaemia
• electrolyte imbalance
• hyperbilirubinaemia
• infection/ necrotising colitis
• respiratory distress syndrome
• patient ductus arteriosus
  ø condition where blood flows back to lungs from heart
• intraventricular haemorrhage