W20 73 paediatrics/child at risk

Question 1

What are some non-specific disease patterns in young children?

Answer 1

Behaviour change, poor feeding, anorexia, failure to thrive, screaming episodes, fever

Question 2

What are some specific disease patterns in young children?

Answer 2

Acute stridor - related to creep?
Wheeze - related to asthma?
Non-blanching rash - meningococcal disease?
Swollen face/lips - underlying allergic reaction?

Question 3

What does normal growth and development of a child depend on?

Answer 3

Health of child, parental size, nutrition of child, genetic profile
Smoker parents, parental age, ethnic background, socio-economic status

Question 4

What are differences in children’s growth to age five influenced by?

Answer 4

More influences by nutrition, feeding, practices, environment, and healthcare rather than genetics or ethnicity

Question 5

What does it mean if height and weight are not within a few centiles of each other?

Answer 5

If height is very low and weight is very high, may signify obesity
If height is very high and weight is very low, may signify an underlying endocrine problem

Question 6

When does a child grow fastest?

Answer 6

First year of life
Primary school
Puberty

Question 7

What are the 4 main areas of childhood development?

Answer 7

Gross motor
Fine motor and vision
Hearing, speech and language
Social and personal activities of daily living

Question 8

What are the highest causes of death in UK children under 15?

Answer 8

Cancer, cardiovascular disease, injury and poisoning, congenital and malignant disease, preterm and low birth weight, suicide, chronic disease management

Question 9

How does obesity harm children and young people?

Answer 9

Emotional and behavioural - stigmatise, bullying, low self esteem
School absence
Health - high cholesterol, high BP, pre-diabetes, bone and joint problems, breathing difficulties
Increased risk of becoming overweight adults
Risk of ill health and premature mortality in adult life

Question 10

How do you identify a chronically unwell child?

Answer 10

Faltering growth and developmental delay

Question 11

What might be causing a chronically unwell child?

Answer 11

Chronic inflammatory disease: eg connective tissue, bowel disease
Illness - eg diabetes, atrophic disease

Question 12

What common childhood illnesses are there?

Answer 12

Hand foot and mouth disease (HFMD)
Herpangina
Scarlet fever
Recurrent mouth ulcers
Diphtheria

Question 13

What is hand foot and mouth disease and how does it present?

Answer 13

1 or all may be affected:
Oval-gray roofed vesicles with erythematous rims
Hands and feet - on sides of feet and hands, palms, soles
Mouth - buccal mucosa, tongue, lips
Other-common in younger children: papula lesions, buttocks, uppers thighs, knees
Usually occurs beneath age 10 but can be any

Question 14

What causes HFMD? (Pg705 image)

Answer 14

Coxsackie virus
Usually in the late summer/early autumn

Question 15

What is treatment of HFMD?

Answer 15

Lesions usually last 7-10days
May need to treat pain and dehydration (from not feeding)

Question 16

What is herpangina and what is it characterised by?

Answer 16

Characteristic enanthem (rash/small spots on the mucous membranes)
Posterior mouth especially, eg soft palate, uvula, tonsillar pillars
Usually occurs age 3-10

Question 17

What causes herpangina?

Answer 17

Coxsackie virus
Summer-early autumn

Question 18

What is treatment for herpangina?

Answer 18

It is self-limited, lesions last 1 week usually
May need to support hydration, treat pain

Question 19

What is the difference between herpes stomatitis and herpangina?

Answer 19

Herpes stomatitis can affect the whole mouth, including gingiva and buccal mucosa

Question 20

What is Scarlett fever and what might it present as?

Answer 20

A rash, usually appearing first on the neck and face. Fades by 6th day of infection, affected skin might peel.
Tongue - thick, white coating that peels are 4-5 days - strawberry appearance = papillae protruding through causing this.
Peak incidence = 4-8yeats

Question 21

What causes scarlet fever?

Answer 21

Group A streptococcus as bacterial infection

Question 22

What are the acute and delayed complications of scarlet fever?

Answer 22

Acute complications including cervical lymphanitis, otitis media, mastoiditis, meningitis and pneumonia
Delayed complications like rheumatic fever, glomerular nephritis, erythema nodosum (painful nodules on shins)

Question 23

What is treatment for scarlet fever?

Answer 23

Supportive, penicillin (for bacterial infection)

Question 24

There are lots of causes for recurrent mouth ulcers, name a few. Pg707 table.

Answer 24

Infection, autoimmune disorders, immune disorders, vitamin deficiencies, neoplastic
Read table for more.

Question 25

What is diptheria and what does it cause?

Answer 25

Upper airway obstruction - causes sore throat and high grade fever. Pseudomembrane of the tonsils, pharynx and nose which leads to difficulties breathing. Also releases a toxin which causes paralysis of the respiratory muscles.

Question 26

Complications of diptheria

Answer 26

Myocarditis
Vocal cord paralysis
Guillan Barre syndrome

Question 27

What greatly reduces diptheria deaths?

Answer 27

Immunisatioon

Question 28

What can you be immunised against?

Answer 28

Table page 708 - read (more details abt age and site etc):
Common ones - diptheria, tetanus, polio, rotavirus, influenza, MMR, HPV

Question 29

What is the spectrum of child abuse?

Answer 29

Casual attitudes, carelessness, poor parenting
Neglect, poor physical care, emotional unavailability
Inflicted physical or emotional abuse
Severe, deliberate and persistent abuse

Question 30

What are the categories of abuse?

Answer 30

Physical abuse - causing physical harm or when a parent or carer deliberately induces illness in a child
Emotional abuse - persistent emotional maltreatment of a child
Sexual abuse
Neglect - persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or develoment

Question 31

What are the categories of need (for support)

Answer 31

Main - abuse or neglect is main one
Others include - child’s disability/illness, parent disability/illness, family in acute stress, family dysfunction, socially unacceptable behaviour, low income, absent parenting