WEEK 3: Children are different! Flashcards
Why are children not small adults?
*Different and unique exposures
*Anatomic differences
*Clinical norms are dynamic with age, body size
*Physically and politically vulnerable
*Longer life expectancy
Children have different exposures to adults.
Exposures: Transplacental and perinatal
State 3 main types of these exposures.
Toxins:
Thalidomidephocomelia
DES-vaginal cancer
X-raysleukaemia
AlcoholFetal alcohol syndrome
Deficiencies:
Folic acid deficiencyNeural tube defects
Pathogens:
Congenital infections: Zika, HIV, Syphilis, CMV, Toxoplasmosis
Acquisition of both supportive and pathogenic organisms (e.g. Group B streptococcus) during birth
State the effect of the following exposures to children.
Thalidomide
DES
X-rays
Alcohol
Thalidomidephocomelia
Phocomelia is a rare congenital condition characterized by the underdevelopment or absence of limbs, particularly the long bones of the arms or legs.
DES-vaginal cancer
X-raysleukaemia
AlcoholFetal alcohol syndrome
Exposures: Breastfeeding
State the effects of breastmilk on the baby.
Breast milk is the safest and most complete nutrition for infants.
Infections transmitted during breastfeeding.
HIV (exceedingly rare among infants of virally suppressed mothers), HTLV, Measles
Exposures: Exploratory behaviors
State the effect of exploratory behavior of the children.
*Exploration of surroundings relying on hand-to-mouth, and object-to-mouth behaviors
*Higher incidence of infections transmitted fecal-orally: Hep A, Coxsackie, Shigella, Rotavirus
Exposures: Accidental ingestions of toxins.
State its effect on children.
Inability to read warning signs & labels, recognize danger
State anatomic differences that children have from adults.
*Thinner skin
*Immature immune system
*High metabolic activity
*Higher respiratory rates
*Immature blood-brain barrier
*Larger body surface area
*Rapidly dividing cells
Anatomic differences: Body surface area
The ratio of the newborn’s skin surface area to body weight is approximately three times greater than that of an adult.
Why is this relevant?
Greater risk of excessive loss of heat and fluids, toxins rapidly absorbed through the skin.
Anatomic differences: Immunity
State the effect of the weak and immature immune system of Children.
Increased Susceptibility to Infections:
Children may be more susceptible to various infections, including bacterial, viral, and fungal illnesses, due to their less experienced immune responses.
Higher Severity of Infections:
When children do get infections, the illnesses may be more severe compared to adults. This is partly because the immune system may not respond as rapidly or effectively to certain pathogens.
Increased Risk of Complications:
The immature immune system may struggle to regulate the immune response properly, potentially leading to complications or an overreaction of the immune system, such as in the case of certain autoimmune disorders.
Anatomic differences: Blood brain barrier
State the effect of immature blood-brain barrier on children.
- Increased Permeability:
The blood-brain barrier in infants and young children is more permeable than in adults. This increased permeability allows a wider range of substances to pass from the bloodstream into the brain. While this permeability is necessary for the delivery of essential nutrients and oxygen to the developing brain, it also means that potentially harmful substances may have easier access.
- Greater Vulnerability to Neurotoxic Substances:
The immature blood-brain barrier makes the developing brain more vulnerable to neurotoxic substances. This includes certain drugs, chemicals, and toxins that, in adults, might be prevented from entering the brain by the more robust blood-brain barrier.
- Potential Impact on Brain Development:
The permeability of the blood-brain barrier is a critical factor during the early stages of brain development. Exposure to certain substances during this sensitive period can affect neuronal development and lead to long-term consequences, including cognitive and behavioral issues.
- Risk of Infections:
While the blood-brain barrier helps protect the brain from pathogens, its immaturity in children may increase the risk of infections reaching the CNS. This vulnerability can have serious consequences, as infections in the brain can lead to inflammation and other complications.
Clinical norms are dynamic with age.
Dynamic clinical norms: Vital signs
Heart Rate (Pulse):
Infants: Generally, have a higher resting heart rate compared to older children and adults. A normal heart rate for a newborn can range from 120 to 160 beats per minute.
Children: As children grow, their heart rate gradually decreases. The average resting heart rate for school-age children is typically between 70 and 100 beats per minute.
Adults: The normal range for adults at rest is typically between 60 and 100 beats per minute.
- Respiratory Rate:
Infants: Tend to have a higher respiratory rate compared to older children and adults. A normal respiratory rate for a newborn can range from 30 to 60 breaths per minute.
Children: The respiratory rate in children decreases as they grow. A typical respiratory rate for school-age children is around 20-30 breaths per minute.
Adults: The normal respiratory rate for adults is generally between 12 and 20 breaths per minute.
- Blood Pressure:
*Children: Blood pressure norms for children are influenced by age, height, and gender. Normal ranges increase with age.
*Adults: Blood pressure norms are commonly categorized into normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. Normal blood pressure for adults is generally considered to be around 120/80 mm Hg.
- Body Temperature:
*Infants and Children: Tend to have higher normal body temperatures than adults. The average body temperature in children can range from 97.8°F to 99.1°F (36.5°C to 37.3°C).
Adults: The normal body temperature for adults is typically around 98.6°F (37°C), although it can vary slightly from person to person.
Dynamic clinical norms: Lab values
Describe.
- Complete Blood Count (CBC):
*Red Blood Cell Count (RBC):
RBC values tend to change with age. Newborns usually have higher RBC counts, and these counts gradually decrease as they grow.
*White Blood Cell Count (WBC):
WBC counts can vary with age, and different age groups may have different reference ranges. Infants and young children may have higher WBC counts compared to adults.
*Blood Glucose (Blood Sugar):
*Newborns and Infants: Blood glucose levels may be lower in newborns, especially premature infants. The reference range increases as the child grows.
*Children and Adults: The normal fasting blood glucose range is generally consistent across children and adults.
- Lipid Profile:
*Cholesterol Levels: Cholesterol levels can change with age. In children, cholesterol levels are typically lower than in adults. As people age, there may be variations in the acceptable ranges for total cholesterol, LDL (low-density lipoprotein), HDL (high-density lipoprotein), and triglycerides.
- Liver Function Tests:
*Alkaline Phosphatase (ALP): ALP levels may be higher in growing children due to bone growth. In adults, elevated ALP may indicate liver or bone issues.
*Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST): These liver enzymes may have different reference ranges for children and adults. Elevations may indicate liver damage or disease.
- Renal Function Tests:
*Blood Urea Nitrogen (BUN) and Creatinine: Normal levels of BUN and creatinine may vary with age. Creatinine levels, for example, can be influenced by muscle mass, which changes with age.
- Thyroid Function Tests:
Thyroid Hormones (TSH, T3, T4): Thyroid function can vary across different age groups. Children may have different reference ranges than adults.
- Coagulation Studies:
International Normalized Ratio (INR) and Partial Thromboplastin Time (PTT): These measures of blood clotting may have different reference ranges for children and adults.
Dynamic clinical norms: Neurodevelopment
- Motor Development:
*Infants: Motor development begins with reflexes and progresses to voluntary movements, such as reaching, rolling, and crawling.
Children: Motor skills become more refined, including the development of fine motor skills (e.g., handwriting) and gross motor skills (e.g., running, jumping).
*Adolescents: Continued refinement of motor skills, with the acquisition of complex movements and coordination.
- Cognitive Development:
*Infants: Early cognitive development involves sensory experiences, basic learning, and the development of object permanence.
*Children: Cognitive abilities expand, including language development, memory, problem-solving, and the ability to understand abstract concepts.
*Adolescents: Cognitive functions continue to mature, with increased reasoning abilities, abstract thinking, and decision-making skills.
- Language Development:
*Infants: Begin to communicate through cries, coos, and simple gestures.
*Children: Develop vocabulary, grammar, and language comprehension.
*Adolescents: Further refinement of language skills, with the ability to understand and use complex language.
- Social and Emotional Development:
*Infants: Forming attachments, recognizing emotions, and responding to caregiver interactions.
*Children: Developing friendships, understanding and expressing emotions, and learning social norms.
*Adolescents: Forming more complex social relationships, identity development, and emotional regulation.
- Sensory and Perceptual Development:
*Infants: Sensory experiences play a crucial role in early development, with a focus on vision, hearing, touch, taste, and smell.
*Children: Refinement of sensory and perceptual skills, including visual-motor coordination.
*Adolescents: Continued maturation of sensory and perceptual abilities.
- Executive Function:
*Children and Adolescents: Executive functions, such as working memory, cognitive flexibility, and inhibitory control, continue to develop and become more sophisticated throughout childhood and adolescence.
Dynamic clinical norms: Medication dosages
For children, dosages are usually calculated per kilogram of body weight or per square meter of body surface area.
For adults, dosages are usually fixed or based on other criteria.
Physically and politically vulnerable
Describe how this affect children.
*Preverbal children are inability to express their complaints
*Abused or neglected children may not disclose information for fear of retribution
*They are defenseless in a world that adults have created for them and vulnerable to environmental hazards and toxic stress
*Children do not vote
