W06 - PAEDS: Approach to assessing children; Children are not small adults; Adolescent Health; SUDI

Question 1

Physiological differences and risks to children

Answer 1

dt diff SA:vol, water content, metabolic activity
more at risk of
- hypothermia
- dehydration
- hypoglyc.

Question 2

Wt and food amounts conversion

Answer 2

0.45lb = 1kg

1 ounce = 29.6 ml

Question 3

Developmental Red Flags

Answer 3

Loss of developmental skills

Referral elsewhere

Hearing loss (simultaneous referral for audiology/ ENT)

Persistent low muscle tone/ floppiness

No speech by 18 months, esp if no other communication (simultaneous referral for urgent hearing test)

Asymmetry of movements/ increased muscle tone

Not walking by 18m/ Persistent toe walking

OFC > 99.6th / < 0.4th / crossed two centiles/ disproportionate to parental OFC

Clinician uncertain/ thinks that development may be disordered

Question 4

Areas of development

Answer 4

Fine motor skills

Gross motor

Social & self-help

Language & Comms

Question 5

Child Health Screening

Answer 5

Primary care w/ midwives. Recorded in red book.

Question 6

SUDI: triple risk model

Answer 6

a

Question 7

SUDI

Answer 7

The sudden and unexpected death of a child under 1 for which no adequate case is found after a thorough post mortem and case report

Question 8

Significance of Back to Sleep Campaign

Answer 8

Since the 1980s onwards, campaign highlighting awareness of certain practices which saw a decrease in cot deaths.

• potentially preventing rebreathing when baby is left to lie on front

NOW:
- chaotic, lower socioeconomic, high parity, inappt. sleeping conditions, illicit drugs, alcohol, LATER NEONATAL AGE than before

Question 9

SUDI vs SIDS

Answer 9

SIDS subset of SUDI, where no suspicious circumstances or untoward features are found.
* SIDS incidence is decreasing

whereas SUDII = leaves room for potential explanation for death to appear later. In practice, more commonly used etc.
SUDI better than ‘unascertained’ for optics, and leaves case ‘open’.

Question 10

Significance of increasing complexity of investigating SUDI

Answer 10

positive findings will arise the more tests are ran d/t the nature of variability in testing results, however minor they may be.

*consider impacts of continuous testing and results

Question 11

3 typical cases of SUDI

Answer 11

OBVIOUS HOMICIDE
* suspicious circumstances:
* evidence of fractures
* genetics contribute to PREDISPOSITION not CAUSATION

NATURAL CAUSE IDENTIFIED
*congenital
* SEPSIS

UNKNOWN CAUSE
* most common
*

Question 12

Methadone withdrawal in infants

Answer 12

• excessive feeding, highly irritable, mouthing a lot prior to death.

Question 13

Milestones

Answer 13

• social smile ~2mos onwards
• sitting ~3mos onwards, ~6mos +/- hand support, 8mos: w/o support
• walking ~9mos pull to stand, ~12mos walking development
• first words: ~9mos sounds, then ~12mos simple single words

*refer if not walking by 18mos

Question 14

Developmental Assessment

Answer 14

a

Question 15

6-8w Review (GP & HV)

Answer 15

ID, feeding, parental concerns, development, measurement, examination, sleeping position

Question 16

27-30mos Review

Answer 16

carried out by HV
- ID data
- development
- physical measurements

Question 17

Growth Monitoring

Answer 17

Physical measurements: wt., length, head circumference (OFC)

Question 18

Wt. and Length and OFC

Answer 18

Birth:
3.3kg, 50cm, 35cm (OFC)

4mos:
6.6, 60cm,

12mos:
10kg, 75cm, 45cm (OFC)

3y:
15kg, 95cm

Question 19

Causes of failure to thrive in early life

Answer 19

DEFICIENCIES: lactation, feeds, prematurity, palatal abn., neuromusc. disease

INCREASED METABOLIC DEMANDS: disease of organ, infection, anemia, CF, malignancy

EXCESSIVE NUTRIENT LOSS: reflux, pyloric stenosis

Question 20

Failure to Thrive Algorithm

Answer 20

HX => PC, dietary assessment, birth/family/social

PHYS. EXAM => dysmorphic features, anthropometry, systems, development

TRIAL OF FEEDING IN HOSPITAL => observing feeding, handling, SALT assessment, developmental assessment

Good intake => non-rganic or organic

Poor intake => Organic cause; Feeding disorder; Non-organic or mixed

Question 20

Failure to Thrive Algorithm

Answer 20

HX => PC, dietary assessment, birth/family/social

PHYS. EXAM => dysmorphic features, anthropometry, systems, development

TRIAL OF FEEDING IN HOSPITAL => observing feeding, handling, SALT assessment, developmental assessment

Good intake => non-rganic or organic

Poor intake => Organic cause; Feeding disorder; Non-organic or mixed

Question 21

Understand key aspects of adolescent brain development

Answer 21

• bio, psycho, social development between 11-25yrs
• developing prefrontal cortex
• concrete thinking dev => abstract thinking
• self-id, self-consciousness, independence
• risk taking behaviours and exp.

support development by:
- normalise challenges
- suport goal setting and problem solving
- negotiating support
- reminders
- opportunities to recognise success

Question 22

Discuss how young people may present within healthcare settings including health outcomes

Answer 22

• over half of MH problems are established by age 14 and 75% by age 24
• ?rising prevalence

Question 23

Be familiar with the impact of adolescence on chronic conditions such as diabetes

Answer 23

• highest graft failure rates; kidney loss/rejection
• HbA1c deterioration

Question 24

Consider important communication adaptations

Answer 24

• offer seeing adolescent on their own: standard, chaparone, followed by bringing parents

*set agenda, aim for conversation, explore priorities/concerns

• discuss adherence
• discuss understanding of disease and treatments, and assess motivation

Question 25

Adolescent Social Hx

Answer 25

HEADSS

Home
Education/Employment
Activities
Drugs/Alcohol
Sexuality
Suicide/Self-Harm

Question 26

Transition from paeds to adult services

Answer 26

At 16yrs
- begin process of promoting independence etc early!
- ensure good udnerstanding & eduation on condition and medication
- INITIAL JOINT APPT. W/ ADULT AND PAED TEAMS
- checklists to improve