The irritable infant Flashcards
Differential diagnosis
Periodic and related to discomfort Cow's milk protein intolerance GORD Lactose overload/malabsorption Infection- ?meningitis Intussusception Injury Other sources of pain
Acute: UTI \+ICP OM Hair tourniquet Corneal abrasion Incarcerated inguinal hernia
Periodic causes
Wet/dirty nappy Too hot or too cold Hungry Wind Colic Environmental stress Reflux esophagitis Teething
Dealing with periodic
Make sure well fed, warm, has a clean nappy, comfortable clothes and a calm and peaceful environment
Infantile colic: definition, crying associated with (3), signs, (3), child in between
Periodic crying in first 3 months Paroxysmal Hunger, wind, feeding Flushed face, tense abdomen, legs drawn up Happy in between
Management of colic overview (5)
- Engage in partnership->reassurance the infant is normal and healthy
- Explain normal crying and sleep patterns
- Help parents to help their baby deal with discomfort and pain
- Assess maternal and emotional state and mother-baby relationship->coping, stress, depression
- Provide printed information
Causes of abdominal pain
GIT: Peptic ulcer Gastroenteritis Acute appendicitis->anorexia, central to RIF, peritonism, tachy IBD->blood/mucus Henoch-schonlein purpura->purpuric rash and joint pain Constipation Intestinal obstruction Mesenteric adenitis Intussusception
Urinary:
UTI
Renal colic
Endocrine:
Diabetes
Respiratory:
Lower lobe pneumonia
History in abdominal pain
Intermittent unexplained screaming Blood in stool->intussusception, IBD, HSP, gastroenteritis VD, viral, joints Anorexia Vomiting bile
What does pallor and screaming suggest
Intussusception
Examination in abdominal pain
General and vitals
Abdominal examination
Evidence of peritonism
If suspect mesenteric adenitis, palpable lymphadenopathy elsewhere
Investigations and their significance in abdominal pain
FBC->+WCC (appendicitis, UTI), anemia
Glucose->diabetes
Urine MCS->nitrates, hematuria in HSP
AXR->obstruction (dilated loops), intussusception (abnormal gas pattern), fecal loading (constipation)
Abdominal US->Renal tract abnormality, diagnosis of intussusception
CXR->pneumonia
Barium enema->intussusception
CRP/ESR->IBD
Differential diagnosis for iliac fossa pain
GIT: Mesenteric adenitis GE Constipation IBD
Other: Urinary tract infection, Pyelonephritis HSP Ovarian pain Ectopic
At what age is intussusception most common
Aged 3-24 months
Non surgical causes of acute abdominal pain
Gastroenteritis PID, ectopic UTI, pyelonephritis DKA Lower lobe pneumonia HSP
Quick treatment of mesenteric adenitis
Analgesia
Presentation of colic
Extended periods of distressed behaviour Cries ++ Repeated, sudden onset Legs drawn up, face red Worse in late afternoon and evening Both sexes Breast + bottle Abates by 3 months in 60%, 90% by 4 months
Assessment of colic
Temporal association with feeds
Variation in context and environmental factors
Parental response
Supports for the parents
Research definition
> 3 hours crying/day for >3 weeks
Common non-pathalogical causes of crying
+Tiredness
Hunger
Temperature
Average sleep requirements at birth, 2-3 months
At birth 16 hours
2-3 months 15 hours/day