Week 4: Paediatrics 1 (common childhood problems and neonatal development checks) Flashcards
Weaning
- Introduction of solid foods, alongside breast milk
- At first the amount of food is less important than them getting used to food
how to start weaning
- Single vegetables and fruit
- Progress to potatoes rice pasta meat dairy
- explore new tastes and textures e.g. mash, lumpy and finger food
when weaning DO NOT
- Don’t add salt- not good for kidneys and avoid ready made since a lot of sugar
when can weaning start (time and clear signs)
6 months.
Clear signs they are ready
- Sit up and hold their head steady
- Coordinate eyes hands and mouth feed themselves
- Can swallow food so more goes in mouth than around face
rashes seen at birth
jaundice
mongolian spot
erythema toxicum
milia
newborn dry skin
cradle cap
baby acne
heat rash
eczema
jaundice
- Yellow discolorations in the babies skin and eyes
- Occurs in first few days of birth
mongolian spot
- common birthmarks which look like bruises, are harmless and usually fade away
- more common in asian babies
- Look like a big bruise (back, bottom or legs)
- >6inch
erythema toxicum
- a common new-born rash that goes away within a few days
- Nothing needs to be done
Milia:
tiny white bumps which go away on their own
Newborn dry skin
peeling skin is nothing to worry about and goes away
- Surrounded by fluid in womb
Cradle cap
like dandruff, this causes scales on the babies scalp but usually resolves itself
baby acne
- no treatment necessary (2-3 weeks of ages because of mothers hormones)
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heat rash
- when a babies sweat glands get blocked (neck armpits and diaper)
- Help by keeping baby at comfortable temp
Eczema
environmental allergens or heat can be triggers for this itchy rash (face drunk elbows knees or the diaper area)
- Moisturise with non-scented cream
rashes in older children
measles
scarlet fever
rubella
erythema infectiosum (fifth disease)
roseola infantum
chicken pox
measles
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Measles
- Erythematous, partially confluent exanthem of a dark red colour which begins behind ears and disseminates to the body
- Enanthem of the palate and kolpiks spots (white lesions in mouth)
scarlet fever
- Fine and light red and maculopapular rash that develops into scarlet-like, partially confluent rash after 1 to 2 days
- Begins on neck
- Non blanching
- Red face
- Bright red tongue- strawberry tongue
rubella
- Non-confluent, pink and maculopapular
- Rash begins behind ears and extends to whole body
erythema infectiosum (fifth disease)
- Wont necessarily develop a rash
- Red papules may emerge on extremities and trunk → lace like
- Blotchy red rash appears on the cheeks which group together to form red, slightly swollen plaques
- ‘slapped cheek’
roseola infantum
- Patchy, rose pink
- Pronounced on the torso
- Febrile phase and sudden decrease in temp
chicken pox
- Widespread
- Inc oral mucosa
- Small red bumps which develop into pustules and then scabs
- Starry sky characteristic
chicken pox background
- Highly infectious disease
- Mostly mild to moderate and self-limiting
- Milder in younger children
- Infection severe in pregnancy- high risk of pneumonia and risk to fetus
- Can be dangerous for immunocompromised
- Shingles: Reactivation of dormant virus after bout of chickenpox leads to herpes zoster (Shingles)
- Like chickenpox but confided to just one dermatome
- Occurs worldwide and is endemic in most contries
which virus causes chicken pox and shingles
varicella-zoster virus (DNA)
incubation period of chicken pox
- Infectivity is from a few days before onset of lesions until the crust falls off
RF of chicken pox
- Immunocompromised missed e.g. HIV, children
- Older age
- Steroid use
- Malignancy
transmission of chicken pox
- Transmission- virus enters through URT , viraemia occurs 4-6 days later, skin lesions last 10-14 days
presentation of chicken pox
- First feature- pyrexia
- Headache and malaise
- Crops of vesicles , mostly on head , neck and trunk, sparse on limbs
- Papules → vesicles → pustules → crust
- When crust falls off they may leave a mark which will be present for a few weeks (higher risk of scarring in older children )
- Redness around lesion could be bacterial superinfection
management of chicken pox
- Simple advice: fluid intake, minimising scratching, avoid contact with pregnant women and neonates
- Symptomatic treatment – paracetamol (analgeisa and antipyretic), give antihistamine and emollients to help with pruritus
- Do not give NSAIDS (risk of necrotising soft tissue infections)!!!
- Acyclovir not recommended in children
- Encephalitis – admission to hospital
Sore or cracked nipples
- When your baby is not well positioned and attached at the breast
- Important not to stop breastfeeding as with help feeding should become more comfortable again
- If nipples start to crack, try dabbing a little expressed breast milk onto them after feeds
Not enough milk
- Offer baby both breasts at each feed and alternating which breast you start with – stimulates milk supply
- Signs your baby is getting enough milk
- Wet and dirty nappies are a good indication
- Hearing swallow
- Exclusive breastfeeding is recommended for around the first 6 months of babies life
- Baby comes off the breast on their own at the end of feed
- Mouth looks moist after feeds
- Baby appears content after most feeds
- Breasts feel softer after feeds
- Baby gains weight steadily
Breast engorgement
- When breast get too full of milk
- May feel hard, tight and painful
- Can happen in the early days when you and baby still getting used to breastfeeding
- Also happen when weaning child
Latching
- Baby should be facing the breast always
- Have head free so can tip back
- Lead chin to breast and nose to nipple
- Need wide open mouth
- Nipple should lie on soft palate
- Fast suckling at the beginning and then deeper slower suckling
- They should have rounded cheeks and seem content
Breastfeeding and thrush
Thrush infections can sometimes happen when your nipples become cracked or damaged. This means the candida fungus that causes thrush can get into your nipple or breast.
mastitis
- Happens when a blocked milk duct is not relieved
- Breast becomes hot and painful and can give flu-like symptoms
- Important to carry on breast feeding
Breast abscess
Occurs if mastitis is not treated or does not respond – may need operation
Feeding and tongue tie
- 1 in 10 babies have tongue tie
- Due to frenulum being shorter
- Can make it harder to breast feed
- Tongue tie is easily treated
Colic
Colic is when a baby cries a lot but there’s no obvious cause
cause of colic
- Not know
- May be because babies find it harder to digest food when young
- Allergy e.g. cows milk
diagnosing colic
- If baby cries more than 3 hours a day, 3 days a week for at least 1 week
- Often crying more in afternoon and evening
presentation of colic
- it’s hard to soothe or settle your baby
- they clench their fists
- they go red in the face
- they bring their knees up to their tummy or arch their back
- their tummy rumbles or they’re very windy
It can start when a baby is a few weeks old. It usually stops by the time they’re 6 months old.
how to soothe baby with colic
- hold or cuddle your baby when they’re crying a lot
- sit or hold your baby upright during feeding to stop them swallowing air
- wind your baby after feeds
- gently rock your baby over your shoulder
- gently rock your baby in their Moses basket or crib, or push them in their pram
- bath your baby in a warm bath
- have some gentle white noise like the radio or TV in the background to distract them
- keep feeding your baby as usual
differential for colic
pyloric stenosis (frequent, projectice vomiting)
infant reflux (chronic cough, pneumonia, feeding difficulty)
dietary intolerance e.g. cows milk protein allergy
Head lice resentation
Head lice can make your head feel:
- itchy
- like something is moving in your hair
treatment of headlice
Treatment
Treat them as soon as you spot them and check everyone in household
-
Wet- combing (try this method first)
- wash hair
- apply lots of conditioner
- comb the whole head from roots to the end
- do wet combing on. Days 1,5,9 and 12 to catch any newly hatched eggs
- check everyones hair on day 17
- Medicated lotions and sprays
Normal gait and gate issues
- Until a child is approximately 3 years old, their normal gait doesn’t resemble that of an adult. Initially there is a wide-based stance with rapid cadence and short steps.
- Toddlers have a broad-based gait for support, and appear to be high-stepped and flat-footed, with arms outstretched for balance. Legs are externally rotated, with a degree of bowing.
- Heel strike develops at around 15-18 months with reciprocal arm swing[1].
- Running and change of direction occur after the age of 2 years.
- In the school-aged child, the step length increases and step frequency slows.
- Adult gait and posture occur around the age of 8 years
Normal gait and gate issues
- Until a child is approximately 3 years old, their normal gait doesn’t resemble that of an adult. Initially there is a wide-based stance with rapid cadence and short steps.
- Toddlers have a broad-based gait for support, and appear to be high-stepped and flat-footed, with arms outstretched for balance. Legs are externally rotated, with a degree of bowing.
- Heel strike develops at around 15-18 months with reciprocal arm swing[1].
- Running and change of direction occur after the age of 2 years.
- In the school-aged child, the step length increases and step frequency slows.
- Adult gait and posture occur around the age of 8 years
antalgic gait (caused by pain)
- Reduced time spent weight-bearing on the affected side.
- A multitude of possible causes.
- A smaller child may just present with unwillingness to weight-bear, so an index of suspicion is required.
- May be observed in juvenile idiopathic arthritis (JIA), although children do not always complain of pain.
ircumduction gait
- Excessive hip abduction as the leg swings forwards
- Typically seen with a leg length discrepancy, with a stiff/restricted joint movement as in JIA, or with unilateral spasticity as in hemiplegic cerebral palsy.
spastic gait
- Stiff, foot-dragging with foot inversion. This is often seen in upper motor neurone neurological disease (eg, diplegic or quadriplegic cerebral palsy, stroke).
ataxic gait
- Instability with an alternating narrow-to-wide base.
- Seen in ataxic cerebral palsy affecting the cerebellum, in cerebellar ataxia, and in Friedreich’s ataxia.
Trendelenberg’s gait
- Results from hip abductor muscle weakness or hip pain. While weight-bearing on the ipsilateral side, the pelvis drops on the contralateral side, rather than rising as is normal. With bilateral hip disease, this leads to a waddling ‘rolling sailor’ gait with hips, knees, and feet externally rotated.
- May be observed in Perthes’ disease, slipped upper femoral epiphysis, developmental dysplasia of the hip, arthritis involving the hip, muscle disease (eg, inherited myopathies), and neurological conditions.
Toe-walking gait with absent heel contact
Habitual toe walking is common in children and associates with normal tone, range of movement around the feet and normal walking on request. However, persistent toe walking is observed in spastic upper motor neurone neurological disease (eg, cerebral palsy). It can (rarely) be a presentation of mild lysosomal storage disorder.
Stepping gait
- The entire leg is lifted at the hip to assist with ground clearance.
- Occurs with weak ankle dorsiflexors, compensated by increased knee flexion.
- Observed in lower motor neurone neurological disease (eg, spina bifida, polio) and peripheral neuropathies (eg, Charcot-Marie-Tooth disease).
‘Clumsy’ gait
- This term is commonly used to describe difficulties in motor co-ordination (fine and gross motor skills).
- The child may present with frequent falls, and with difficulty in self-help skills such as dressing or feeding at school.
- Poor handwriting and learning disabilities may be noted.
- It is important to exclude specific, albeit mild, neurological disabilities (cerebral palsy, cerebellar ataxia, or lower motor neurone disorders), inflammatory arthritis or myopathies, and orthopaedic problems such as in-toeing.
- Dyspraxia is a term for children with delayed motor development who fall in the bottom 5% for their age group. By definition this includes 5% of children and is a late-maturation problem which tends to be familial and is more common in boys. It causes ‘clumsiness’ but there is no specifically altered gait.
hay fever in children
- Hay fever is caused by an allergy to grass or hay pollens. Grass pollen is the most common cause and tends to affect people every year in the grass pollen season from about May to July (late spring to early summer). However, the term is often used when allergies are caused by other pollens such as tree pollens. Tree pollens tend to affect people from March to May (early to late spring) each year.
causesof hay fever
- IgE mediated inflammatory disorder of the nose which occurs when the nasal mucosa becomes exposed and sensitised to allergens
- E.g. pollen from grass, trees, weeds etc
- More common in atopic children e.g. asthma, eczema
presentation of hayfever
- sneezing and coughing
- a runny or blocked nose
- itchy, red or watery eyes
- itchy throat, mouth, nose and ears
- loss of smell
- pain around your temples and forehead
- headache
- earache
- feeling tired
management of hay fever non-pharmacological
- Keep windows closed at night so pollen does not enter the house.
- Buy your child a pair of wraparound sunglasses to stop pollen entering their eyes.
- Apply petroleum jelly or another pollen blocker around the inside of your child’s nose to trap pollen and stop it being inhaled.
- Wash your child’s hair, face and hands when they come back indoors and change their clothes.
- Do not dry clothes outside as this will pick up pollen.
- Do not let them play in fields or large areas of grassland.
- Keep the car windows shut when driving
management of hay fever pharmacological
-
Antihistamines
- Drowsy- piriton (chlorphenamine)
- Non-drowsy – loratadine
- Eye drops
- Steroid nasal spray (on prescription) / tablets
atopic eczema
- a chronic, relapsing, inflammatory skin condition characterised by an itchy red rash that favours the skin creases such as the folds of the elbows or behind the knees
- can become infected crusting, weeping e.g. cellulitis
causes of atopic eczema
- Environmental irritant and allergens
- Soaps and detergents
- Skin infections- SA
- Contact allergens
- Dietary factors e.g. egg
- Inhaled allergens e.g. dust mites
- Genetic mutations
- Stress
- Hormonal changes
diagnosis of atopic eczema
- Itchy skin condition +
- Itchiness in skin flexor regions
- History of asthma or hay fever
- General dry skin
management of atopic eczema
- Education
- Provoking factors avoided
- Emollients form basis pf treatment (3-4 times a day)
- Corticosteroids
- Mild: For face and flexure (hydrocortisone)
- Potent corticosteroid required for adults with discoid or lichenified eczema ( watch out for topical corticosteroid withdrawal)- betamethasone
Bronchiolitis
Bronchiolitis is a common lower respiratory tract infection that affects babies and young children under 2 years old.
Most cases are mild and clear up within 2 to 3 weeks without the need for treatment, although some children have severe symptoms and need hospital treatment.
auses of bronchiolittis
- Respiratory syncytial virus (RSV) spread through resp droplets from coughs and sneezes
- Infection causes bronchioles to become infected and inflamed
RF for bronchiolitis
- Most common in 3-6 months
presentation of bronchiolitis
The early symptoms of bronchiolitis are similar to those of a common cold, such as a runny nose and a cough.
Further symptoms then usually develop over the next few days, including:
- a slight high temperature (fever)
- a dry and persistent cough
- difficulty feeding
- rapid or noisy breathing (wheezing)
management of bronchiolitis
- No medication to kill virus
- Usually self limiting within 2 weeks
osgood schlatter
- Continued traction from quadriceps leads to repetitive injury
- Causes pain and swelling below the knee joint where the patellar tendon attaches → due to growth spurt
RF for osgood schlatter
- commonly happens in children going through growth spurts and exacerbated by sport
clinical features of osgood schlatter
gradual onset and intermittent pain
v
management of osgood schlatter
ibuprofen and using ice packs, physiotherapy to stretch muscles, check vitamin D, reassurance that it will improve as growth slows 12—24 months
DD for Osgood Schlatters
croup
Croup refers to an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough.
presentation of croup
- Barking cough
- Symptoms worsen with agitation- stridor
causes of croup
viral
treatment of croup
- Doesn’t require hospital admin usually
- If stridor present at rest may need emergency intervention
Viral wheeze
- Chest becomes tight and wheezy when child has a virus
- Last 2-4 days, but may continue for some weeks post infection
- Usually child is well between infections
Pathophysiology of vrial wheeze
- Viruses in small airways can cause inflammation and oedema , which triggers constriction of the airways – narrowing leads to wheeze
- Little effect on larger airways
RF for viral wheeze
- Premature babies
- Bronchiolitis in past
- Children around smokers
management of viral wheeze
- Salbutamol inhaler via spacer
- Sometimes prednisolone
differentuals for a viral wheeze
asthma
resp infection
inhaled foreign object
GORD in older children
- Acid reflux generally due to incompetent LOS resulting in damage and inflammation of the mucus lining of the oesophagus
- If left untreated can lead to aspiration pneumonia or oesophagitis and recurrent otitis media
presentation of GORD
- Dyspepsia/retrosternal burning
- Vomiting
- Cough
RF for GORD in older children
- Obesity
- Hiatus hernia
- Parental history of GORD
- Premature
management of GORD in older children
- Antacids/alginate therapy to thicken the stomach and acid and neutralise
- PPIs last step
- Refer patient with haematemesis/melaena and any red flags (intestinal obstruction)
toddler diarrhoea
- Persistent diarrhoea in children between ages 1-5
- Multiple loose stools a day with child being generally well
causes of toddler diarrhoea
not clear but balance of fluid, fibre, fats and sugars may be change
presentation of toddler diarrhoea
management of toddler diarrhoea
- No treatment needed as symptoms are usually mild and ease with time
- Usually resolves completely by ages 5-6
- Dietary changes
functional constipation
- Constipation common childhood prob
- Describe all children in whom constipation does not have organic aetiology
causes of functional constipation
- multifactorial
- result of withholding of faeces in child who wants to avoid painful defecation
presentation of functional constipation
management of functional constipation
- soften stools using osmotic laxative and stool softener and diet
- fecal disimpaction may be necessary
- bowel training
