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Child and Family > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Name the two predominant proteins found in infant formulas and breastmilk

A

Casein and Whey

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2
Q

When should cow/goat milk formula be given?

A

For patients who are not breastfed should be given as sole source of nutrition for first 6 months and then alongside complementary food for the next 6 months

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3
Q

What formula should babies with cows milk protein allergens receive?

A

Extensively hydrolysed formula

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4
Q

What is the POV of the WHO on follow-up formula?

A

It is unnecessary

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5
Q

What is the significant difference of anti-reflux milks?

A

Thickened milk to prevent GORD

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6
Q

What is the replacement carbohydrate for lactose in lactose-free milk?

A

Glucose syrup or maltodextrin

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7
Q

Identify some of the signs of congenital and primary lactose intolerance

A

abdominal pain, diarrhoea, flatulence and/or bloating after ingestion of food containing
lactose

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8
Q

Name a paediatric condition that can cause secondary lactose intolerance

A

Gastroenteritis

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9
Q

Which two types of milk are recommended for babies from 0-12 months old? What types are only used under medical supervision?

A

Breastmilk
cow/goat milk formula
Specialised formulas e.g. partially hydrolysed, anti-reflux, lactose free, comfort milk

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10
Q

On average how many times should a child be breastfed/formula fed per day until 6 months?

A

7-8 times at the beginning cutting down to 4 by 6 months. Also the recommended portion and daily portion increases from around 500ml to 1000ml

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11
Q

When are additional fluids recommended for babies?

A

If the baby is unwell or dehydrated

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12
Q

What is the definition of a preterm, term and post-term baby?

A

preterm- birth before 37 weeks gestation
term- birth after 37 but before 41 weeks gestation
post-term- birth after 41 weeks gestation

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13
Q

What is the normal birthweight and what is considered LGA and SGA?

A

Small for Gestational Age- <2.5kg
Normal weight- 2.5-4.0kg
Large for Gestational Age- >4.0kg

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14
Q

During uterine contractions in labour a very ______ environment is created making it a dangerous time for the mother and baby. The presence of ________ haemoglobin helps to counteract this

A

Hypoxic

Foetal

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15
Q

Identify some of the factors that make labour difficult for the child

A

Hypoxic environment
prolonged labour extends period in this environment
placental insufficiency
growth restriction or excess

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16
Q

Name the score used to measure perinatal adaptation.

A

Apgar score (out of 10) score greater or equal to 8 is normal

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17
Q

Name the vitamin given almost immediately to a newborn baby. What disease is it used to prevent?

A

Vitamin K given IM/ oral if parents disagree

Haemorrhagic disease of the newborn

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18
Q

Identify 6 infections that should be asked about in the maternal history

A 
Hepatitis B- if so given early vaccine
Hepatitis C
Syphilis
Group B Streptococcus
HIV
TB- if so given BCG early
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19
Q

Name two vaccines that new mothers are given

A 
Maternal Pertussis (Whooping cough)
Influenza
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20
Q

What does the blood-blot screening card screen for?

A

Cystic fibrosis- screen for immunoreactive trypsin (if positive then further genetic test)
Sickle cell disease
Congenital hypothyroidism- Thyroid function testing
haemoglobinopathies
metabolic diseases

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21
Q

In addition to blood-spot screening tests what other screening tests are there for newborns?

A

Newborn Examination
Hearing screening
Hip screening- mainly clinical but further USS maybe

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22
Q

What is cephalohematoma and Caput succedaneum?

A

cephalohematoma- collection of blood between the periosteum and one or more of the skull bones (mainly parietal) which is most commonly found in infants delivered using forceps/suction/under pressure
Caput succedaneum- Temporary swelling of the soft parts of the head of a newly born infant.

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23
Q

What is the red reflex used to check?

A

If a baby has congenital cataracts

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24
Q

What contact is essential after birth?

A

It is essential for a newborn baby to have immediate skin to skin contact with the mother/father

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25
Q

Identify three benefits of breastfeeding for newborns

A

Reduced:
incidence of dental caries
malocclusion
otitis media

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26
Q

Identify 6 possible benefits of breastmilk

A 
Reduced:
incidence of infections
severity of allergies, asthma, wheeze 
Sudden Infant Death Syndrome
Childhood and adulthood Obesity
Childhood Leukaemia
UC and CD
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27
Q

Identify three benefits of breastfeeding for mothers

A 
reduced:
Breast and ovarian cancers
Cardiovascular disease
Osteoporosis
T2DM and obesity
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28
Q

What disease contraindicates breastfeeding? How is this catered for in NHS Tayside?

A

HIV

Given a card which covers 1 year supply of milk formula

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29
Q

What is the area around the nipple called?

A

Areola

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30
Q

The hormone ________ binds to its receptor sites on the ___________ of the alveolus. Milk collects in the __________ sacs. The milk exits when the __________ cells contract.

A

Prolactin
Lactocytes
Alveolar
Myo-epithelial

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31
Q

At what point in gestation does colostrum production begin?

A

16 weeks gestation

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32
Q

What is the effect of progesterone before a baby is born?

A

During pregnancy progesterone suppresses milk production until the baby is born

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33
Q

Increasing the _______ of breastfeeding ________ milk production.

A

Frequency

increases

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34
Q

If breastfeeding is ineffective identify some possible consequences for the mother and child

A 
Mother:
Sore nipples
engorgement
mastitis
low milk production
loss of confidence
Child:
Feed very frequently
frustration
poor weight gain
jaundice
hypernatraemia
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35
Q

While breast milk is high in _____ protein _____ _____ protein in formula milk can increase the risk of Juvenile onset diabetes

A

Whey

Cow’s milk

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36
Q

What is the name of the initial stools of a newborn child

A

Meconium

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37
Q

What is expressed breast milk?

A

Breast milk that is expressed by hand or using a pump

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38
Q

What is tongue tie/ankyloglossia? How is it treated?

A

Where a baby has an abnormal lingual frenulum which restricts tongue movement.
Frenotomy

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39
Q

What is meconium ileus? What diseases is this a sign of?

A

Where the meconium obstructs the small intestines

Cystic fibrosis

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40
Q

If a new-born baby is vomiting green fluid what should be your assumption until proven otherwise?

A

Have Malrotation and volvulus

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41
Q

What period counts as the neonatal period?

A

First 27 days of life

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42
Q

What are the 5 factors that are scored in the Apgar score?

A 
Appearance (skin colour)- checking for cyanosis
Pulse- should be above 100bpm
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
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43
Q

What is the normal temperature for a baby?

A

36.5-37.4

44
Q

What is hypoxic ischaemic encephalopathy?

A

A multisystem neonatal disorder where there is multiorgan damage due to tissue hypoxia. Presents with low Apgar score

45
Q

Name the two most common respiratory conditions in normal term babies

A

Transient Tachypnoea of the new-born

Pneumothorax

46
Q

What is hydrops fetalis and what are the most common causes?

A

Severe oedema of a new-born baby. Mainly because of Rhesus disease or chromosomal defects.
Have a swollen liver and severe abdominal swelling

47
Q

What is inhaled nitic oxide used to treat in new-borns?

A

Persistent Pulmonary Hypertension of the New-born

48
Q

Identify some of the risk factors that are related to prematurity

A 
Smoking, alcohol, illicit drug use
Social deprivation
Increased maternal age
Increased preterm caesarean sections
Abnormally shaped uterus
Multiple pregnancies
IVF
Poor nutrition
<6 months between pregnancies
High BP, diabetes, miscarriages and abortions
49
Q

Identify 4 considerations necessary for preterm infants

A

Keep warm
delayed cord clamping
gentle lung inflation
Oxygen saturation monitoring

50
Q

Why is thermal regulation ineffective in preterm babies?

A

Low Basal Metabolic Rate
Minimal Subcutaneous fat insulation
Minimal muscular activity
High Ratio of Surface area to body mass

51
Q

Why are preterm babies at increased risk of nutritional compromise?

A

Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands

52
Q

What is the ductus arteriosus?

A

A blood vessel in the unborn child connecting the pulmonary artery directly to the ascending aorta thus bypassing the pulmonary circulation

53
Q

Name a GI disease that is most common in preterm babies

A

Necrotising enterocolitis

54
Q

What is the difference between LOS and EOS?

A

Early Onset Sepsis- Due to bacteria acquired before/during delivery, most likely group B strep
Late Onset Sepsis- Mainly due to bacteria acquired after delivery, most likely Staph aureus

55
Q

What does RDS stand for? What causes this condition?

A

Respiratory distress syndrome

Surfactant deficiency

56
Q

Identify some of the signs and symptoms of Respiratory distress syndrome in preterm babies

A 
Rapid, Laboured, shallow breathing
grunting 
Nasal flaring
cyanosis
worst in days 2/3
57
Q

Name the three treatments for RDS

A

Antenatal steroids
ventilation
surfactant

58
Q

What volume of blood to babies generally have?

A

300ml

59
Q

What is a normal blood glucose level in a newborn baby?

A

Greater than or equal to 2.6mmol/L

60
Q

What is the neonatal abstinence score used to determine?

A

Whether a newborn suffers from neonatal abstinence syndrome.

61
Q

Define neonatal abstinence syndrome

A

The signs and symptoms exhibited by a newborn baby due to drug withdrawal when the baby has been exposed to addictive drugs through maternal substance abuse/misuse

62
Q

Identify some of the signs and symptoms of NAS

A 
High pitched crying
convulsions
tremors
frequent yawning
poor feeding
sucking of fists
Diarrhoea
Vomiting
Sweating
Nasal stuffiness
tachypnoea
63
Q

What drug is administered to hypoglycaemic neonates?

A

Buccal dextrose gel

64
Q

Haem is converted to ___________ by Haem ____________. ____________ is then converted to Bilirubin by _______ __________.

A

Billiverdin
Haem oxygenase
Billiverdin reductase

65
Q

Define jaundice

A

Yellowing of the eyes and skin as a result of excess billirubin in the bloodstream

66
Q

What is the most common cause of jaundice in newborns? And what is the most common reason for this?

A

Physiological jaundice

Decreased conjugation of billirubin

67
Q

What is the most common cause of early pathological jaundice (<24hrs)?

A

Haemolysis due to one of the following:
ABO incompatibility
Rh immunisation
Sepsis

Rare cause of early jaundice= hepatitis

68
Q

What are the fontanelles?

A

Fibrous membranes between the bones of the calvarias of neonates. 4 fontanelles: posterior, anterior, mastoid, sphenoidal

69
Q

Identify three ways that HIV transmission from mother to child can be reduced

A

Anti-retroviral treatment for mother and infant
Caesarean section
avoidance of breastfeeding

70
Q

Identify two benefits of colostrum

A

It contains high levels of immune proteins and so helps colonise the baby with normal bacteria that do not pose a risk of infection. It also has a laxative effect which helps infants pass meconium and prevent jaundice.

71
Q

Name the two hormones which are higher during breastfeeding

A

Prolactin- stimulates lactation

Oxytocin- stimulates milk ejection from the breast

72
Q

Should up to 10% weight loss of a newborn baby be a concern?

A

No is quite normal and physiological

73
Q

What are the main causes of jaundice in children who are <24 hours old?

A

Haemolysis- ABC/Rhesus incompatibility
Sepsis
Hepatitis

74
Q

What investigations should be recommended for patients who present with jaundice who are <24 hours old?

A

Serum bilirubin concentrations
Maternal blood group, antibodies
Coombs test- babies blood group

75
Q

Identify 5 causes of Persistent Unconjugated Hyperbilirubinemia

A 
Breast milk jaundice
poor milk intake
Haemolysis
infection
hypothyroidism
76
Q

Name a possible endpoint complication of Persistent Uncomplicated jaundice

A

Kernicterus- Death of brain cells and yellow staining due to toxic unconjugated bilirubin

77
Q

Name two possible causes of persistent conjugated hyperbilirubinemia

A

Hepatitis

Biliary atresia

78
Q

Identify some of the signs and symptoms of mastitis

A

erythematous, hot, tender breast
fever
fatigue
breast abscess (complication)

79
Q

Identify three genetic tests of babies in-utero

A

Chorionic Villus atrophy
Amniocentesis
Non-Invasive Pre-natal Testing (NIPT) Tests for foetal DNA in maternal bloodstream

80
Q

What makes chorionic villus sampling a possibly flawed result?

A

Placental cells can exhibit Confined Placental Mosaicism- some cells exhibit trisomy but not found in baby (Foetus)

81
Q

What are the gestation boundaries for abortion in the UK?

A

24 weeks in the UK

Only after 24 weeks if the mother’s life is at risk or if there is a serious abnormality in the child

82
Q

If the unborn child has a family history of Haemophilia when is it appropriate for them to have a genetic test?

A

Have NIPT if the child is a boy

83
Q

What is floppy baby also known as? What causes this?

A

Hypotonia, neuromuscular diseases, chromosomal abnormalities

84
Q

If a baby presents with hypotonia, how would you tell on examination whether it is a central problem or a motor neuron problem?

A 
Central- 
Normal strength
Normal/increased Deep tendon Reflexes (DTR)
Possible seizures
dysmorphic features, reduced alertness
Motor Neuron Problems
reduced strength
reduced/absent DTRs
fasiculations
alert
85
Q

If a baby presented with hypotonia how would you tell on examination whether it is a muscular problem or a nerve problem?

A

Muscle- proximal>distal weakness

Nerve- distal>proximal weakness

86
Q

What tests are recommended for a child presenting with hypotonia following examination?

A

Bloods- check for infection, CK levels, Genetics, metabolic disease
MRI/USS brain
EEG and EMG (electroencephalogram and Electromyography)

87
Q

With regards developmental milestones what is the difference between the Median Age and Limit Age

A

Median age- the age when 50% of the population achieve a skill
Limit age- age when skill should have been acquired by 97.5% of children

88
Q

Name the four areas of development

A

Gross motor
Fine motor and vision
Language and hearing
Social behaviour and play

89
Q

Gross motor development occurs in a __________ direction

A

Cephalocaudal

From head to trunk

90
Q

Name 5 different primitive reflexes

A 
Rooting and sucking
Plantar and palmar grasp
Moro reflex
ATNR- known as fencing reflex for when turns head
Stepping and placing
91
Q

Define developmental delay

A

Failure to meet the appropriate developmental milestones for child’s chronological age

92
Q

What are the three variants of developmental disorders?

A

Delay e.g. Downs (either global- multiple areas of development or specific- one area)
Deviation e.g. Autism spectrum disorder
Regression e.g. Rett’s syndrome

93
Q

Identify 7 red flags for development

A 
Loss of skills at any age
asymmetry of movement
Hypertonia/hypotonia
Unable to walk by 18 months (check CK)
No speech by 18 months
Concerns regarding hearing/vision at any age
Not reaching for objects at 6 months
Unable to sit unsupported at 12 months
94
Q

Identify some problems associated with Down’s syndrome

A 
Cardiac problems
Sleep apnoea
visual impairment
hearing impairment
growth impairment
Thyroid dysfunction
95
Q

Give three signs and symptoms of Duchenne’s muscular dystrophy

A

Gower’s sign- proximal weakness of the pelvic girdle muscles
Pseudo-hypertrophic calves
Progressive lumbar lordosis

96
Q

Name two conditions which are examples of motor developmental delay

A

Cerebral palsy

Duchenne’s muscular dystrophy

97
Q

Identify four different presentations of spastic cerebral palsy

A

Quadriplegic- both arms and legs
diplegic- both legs and elsewhere
paraplegic- both legs
hemiplegic- one side arm and leg

98
Q

Identify some of the signs/symptoms of oculocutaneous albinism

A

Fair skin/ light hair colour
photophobia
nystagmus
lack of iris and retinal pigmentation

99
Q

Identify two conditions which are examples of sensory deficit/delay

A

Oculocutaneous albinism

Preacher-Willi syndrome

100
Q

Identify the three components of the autism triad

A

Deviation/delay in:
communication
social interaction
flexibility of thought and imagination

Also sensory issues

101
Q

What does OFC stand for

A

Occipitofrontal Circumference

102
Q

What is microcephaly?

A

A small head

103
Q

What does CGH stand for?

A

Comparative genomic hybridisation

104
Q

Griffiths and Bayley’s are examples of what?

A

Developmental assessments

105
Q

What is ADOS?

A

An assessment scale for Autism

Child and Family (3 decks)

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