Week 5 - Paediatrics (A) and Health promotion Flashcards
Outline the NHS recommended low risk’ level of alcohol consumption per week
Men and women: no more than 14 units per week on a regular basis (around 6 pints of beer or 10 small glasses of wine)
Drinking should be spread over 3 days or more
Outline some of the dangers of excess alcohol consumption (acute binge drinking and chronic over 10-20 years)
Binge (single session) drinking:
- Accidents, leading to injury such as head trauma
- Alcohol poisoning
- Misjudging risky situations
- Loss of control, e.g. violence
10-20 years of regularly drinking above the low-risk drinking level (over 14 units per week):
- Cancer: mouth, throat, breast
- Stroke
- Heart disease
- Liver disease
- Damage to brain
- Damage to nervous system
Additional impacts on mental health, including self-harm and suicide
What advice should be given to pregnant women regarding alcohol?
Current guidance: if you are pregnant and think you could become pregnant, safest approach is not to drink at all to keep risk to the baby to a minimum
Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink resulting in greater the risk e.g. foetal alcohol spectrum disorder (severity linked to the amount drunk and the developmental stage of the foetus at the time) or foetal alcohol syndrome leading to restricted growth, behavioural disorders and facial abnormalities
However, the risk of harm to a baby is likely to be low if you have only drunk small amounts of alcohol before you knew you were pregnant
List some medications that have potential interactions with alcohol
Analgesia:
- Paracetamol
- NSAIDs e.g. Ibuprofen
- Opioids e.g. Codeine
Psychological:
- Sedatives e.g. Diazepam
- Antidepressants e.g. Sertraline
- Anticonvulsants e.g. Phenytoin
Cardiovascular:
- Anticoagulants e.g. Warfarin
- Antihypertensives e.g. ACEi
Endocrine:
- Antihyperglycemics e.g. Insulin and Metformin
+ Metronidazole
Name some screening tools for alcohol consumption
CAGE - basic, quick screening tool
AUDIT (classic questionnaire) or SADQ (severity of alcohol dependence questionnaire) - further detail
What vitamin deficiencies are chronic drinkers at risk of and what condition are they at risk of developing?
Mainly thiamine deficiency (vitamin B1), but also other B vitamins
Risk of developing Wernicke’s encephalopathy and Korsakoff syndrome (related to low B1 levels)
Outline some benefits of stopping smoking
Benefits of stopping smoking – benefits begin as soon as smoking is stopped:
- Reduced risk of smoking-related disease e.g. lung cancer, COPD and heart disease
- Reduced smoke risk to those around you including children
- Children in the family much less likely to smoke
- Reduced harms to foetus if pregnant
- Financial saving
List some common withdrawal symptoms from smoking cessation
- Irritability / aggression
- Depression
- Restlessness
- Poor concentration
- Increased appetite
- Lightheadedness
- Disturbed sleep
- Nicotine cravings
State the recommended calorie intake per day for males and females
Males: 2,500 calories / day
Females: 2,000 calories / day
State the NHS recommendations of exercise per week and how it differs for older people and children/younger people
At least:
150 minutes of moderate intensity activity per week
OR 75 minutes of vigorous exercise per week
- Spread evening over 4-5 days a week
- Try to break up periods of sitting down in the day
Older people:
- Same advice, but try to be physically active every day with a focus on improving strength, balance and flexibility
Children:
- Aim for 60 minutes of moderate or vigorous intensity activity per week
- Importance on variety of types and intensity of exercise to increase aerobic capacity and strengthen muscles and bones
List some limitations of the BMI calculation
- Unable to differentiate between excess muscle or fat (discriminates against muscular adults and athletes and older people who lose muscle may be in the healthy range but carrying excess fat)
- Can tell if you’re too heavy, but not if you’re too fat
- Not beneficial in individuals with eating disorders and pregnancy
Outline the BMI categories with the BMI ranges
< 18.5 = underweight
18.5-25 = normal
25-30 = overweight
30-35 = obese
> 35 = morbidly obese
List 3 groups of agents for substance misuse (rough grouping of unregulated drugs)
- Illegal drugs (regulated by law) e.g. Cocaine or Heroin
- Legal highs (not regulated by law) e.g. Spice or bath salts
- Prescription only medications e.g. Opioids such as Morphine, Benzodiazepines
List some groups of people at risk of drug misuse
- Past or present addictions to other substances, including alcohol and tobacco
- Family history of substance abuse problems
- Certain pre-existing mental health conditions
- Peer pressure or a social environment where there’s drug use
- Young people aged 10-18, including those up to 25 with SEND
List 2 drugs used in opioid substitution
Methadone
Buprenorphine
Outline pharmacological and non-pharmacological approaches to treatment of problematic alcohol
Non-pharmacological:
- Short counselling session (initial step)
- Self-help groups e.g. alcoholics anonymous
- 12-step facilitation therapy (one on one AA meeting)
- CBT
- Family therapy
- At home detoxification (or hospital/clinic +/- Chlordiazepoxide medication)
Pharmacological:
Acamprosate - help prevents relapse in people who have achieved abstinence, to reduce craving (affects GABA signalling)
Disulfiram - stimulates unpleasant reaction to alcohol
Naltrexone or Nalmefene - help prevents relapse or limits drinking by blocking opioid receptors
Outline pharmacological and non-pharmacological approaches to treatment of smoking cessation
Non-pharmacological:
- NHS Quit Smoking app
- Vaping (not provided on NHS prescription)
- Quit smoking support groups
- Free National Smokefree Helpline
Pharmacological:
- Nicotine replacement therapy e.g. patch, nasal spray, chewing gum, losange, inhaler, sublingual microtabs
- Tablets Varenicline (nicotinic receptor partial agonist) or Bupropion (antidepressant)
Outline pharmacological and non-pharmacological approaches to treatment of weight reduction
Non-pharmacological:
- NHS Weight Loss Plan app
- Weight loss groups e.g. Slimming world or Weight Watchers
Pharmacological:
Only 2 licensed medications
Orlistat - lipase enzyme inhibitor which reduces dietary fat absorption
Liraglutide - GLP-1 agonist
List some physical issues in child development that may signal an abnormality
- Weight or height percentile changes from a pattern it’s been following
- Height progression is very different from midparental height calculation
- Abnormally low or high body mass index
Outline some things that happen in the newborn stages (< 1 month)
- Lift or turn their head from side to side when lying on their stomach
- Fix their eyes on a face or light, then begin to follow a moving object
- They move their hands to their mouth
Outline some things that happen in the first few months (1-3 months)
- Follows light, faces, objects
- Listens to sounds
- Opens and closes hands
- Begins to imitate some sounds
- More meaningful cries
Outline some things that happen in the first few months (4-6 months)
- Most reflexes disappear
- Balances head well
- Sits with support, back is rounded
- Can roll from belly to back
- Moves object from one hand to other
- Most babies try solid-ish foods e.g. porridge
Outline some things that happen in: 7-9 months
- Sits leaning forward on hands at first, then unsupported
- Begins to pull up to stand
- Reaches for and grasps objects
- Begins teething
- Puts everything into mouth
Outline some things that happen in: 10-12 months
- Walks around holding onto furniture
- May begin to take steps and walk on own
- Able to pick up food
Outline some things that happen at 1 year old
- Walks alone by 15 months
- Sits down on small stool
- Climbs stairs if holding on
- Dances with music
- Drinks well from cup
Outline some things that happen at 2 years old
- Walks and runs well
- Begins to throw, kick and catch balls
- Can do coordinated movements e.g. tricycle
- Has developed right or left-handedness by 3 years old
- Begins to have bladder and bowel control
Outline some things that happen at 3 years old
- Uses spoon well and feeds self
- Dresses and undresses self except for buttons and laces
- Washes and dries hands
- Vision is nearing 20/20
- Bladder and bowel control are usually established; uses potty chair or toilet
- Can concentrate on tasks for eight or nine minutes
- Has all 20 primary (“baby”) teeth
Outline some things that happen at 4-5 years old
- Complex movements e.g. hop on one foot
- Draw a circle and square
- Dress themselves
- Walk backward
- Use scissors
- Know address and phone number
- Recognize and recite the alphabet
- Write first name
Outline the role of the Community Perinatal Team in pregnancy & after birth
The Community Perinatal Team (CPT) is the specialist team supporting families, with identified moderate-severe perinatal mental health needs
Also:
- Provide some advice or support for mild – moderately unwell women to prevent deterioration or relapse
- Pre-conception counselling is available for women with a serious mental illness or who have previously had a severe perinatal mental illness
- Provide telephone advice to health professionals in primary and secondary care about managing mental illness in the perinatal period
List the 4 categories of child abuse
Physical Abuse
Emotional Abuse
Sexual Abuse
Neglect
What ages does child safeguarding include?
0-18 years
Outline erythema toxicum in babies
- Developed by 50% of all newborns, usually 2-3 days post-birth
- Usually red and raised initially
- Not harmful to the baby
- Self-resolves within a few days
Outline milia in babies
- Common on the face of newborn skin
- Should be left alone and will self-resolve
List some common breastfeeding problems
- Mastitis
- Breast abscess
- Candida infection
- Too much / too little breast milk production
- Sore or cracked nipples
- Baby not latching properly
- Blocked milk duct
- Tongue tie
Outline the advice for head lice treatment including:
- Detection of lice
- Management techniques
- General advice
Detection:
- Can only be classed as having lice if you find live lice in the hair
Management:
Wet combing - apply lots of conditioner, with detection comb, comb hair from root to tip
Dry combing - medicated lotions and sprays
General advice:
There’s nothing you can do to prevent head lice
- Do not use medicated lotions and sprays to prevent head lice (can irritate the scalp)
- No need to stay off school or to wash laundry on a hot wash
Outline baby colic and how it’s managed
- Colic is when a baby cries a lot but there’s no obvious cause
- Generally thought to be because some babies find it harder to digest food or they have a cow’s milk allergy
- Very common problem
Management:
- Usually passes with time
- Should get better by 3-4 months
- Don’t normally need to see a doctor for it
Outline what weaning actually is and when it should be started, including 3 signs that a baby is ready to wean
Weaning is the introduction of solid foods alongside breastmilk or formula
NHS advice is to start weaning at around 6 months
3 clear signs for weaning
1. Sit up and hold their head steady
2. Coordinate their eyes, hands and mouth so they can pick up food
3. Able to swallow food
Bronchiolitis - state the following:
- Pathophysiology
- Presentation
- Investigations
- Management
Pathophysiology:
- Acute viral infection of the lower respiratory tract
- Most commonly caused by (RSV) respiratory syncytial virus (other causes include: rhinovirus, influenza etc.)
- Inflammation and mucus production leads to narrowing and obstruction of the bronchioles
- Commonly affects babies under 1
Presentation:
- Coryzal symptoms
- Signs of respiratory distress (accessory muscles, intercostal recession, nasal flaring, cyanosis, tracheal tug)
- Laboured breathing (retractions, grunting)
- Wheeze and crackles on auscultation
- Tachypnoea
- Slight fever (38C)
- Irritability
Investigations:
- Must do pulse oximetry (O2 sats)
Management:
Main aim is to maintain oxygenation and hydration
- Can give nasal drops to clear nasal secretions
- May need IV or nasogastric fluids (struggle to drink)
- May need supplemental O2
When should you admit a child to hospital with bronchiolitis
- Under 3 months
- Pre-existing comorbidity e.g. Downs Syndrome, cystic fibrosis
- < 50-75% normal milk consumption
- Clinically dehydrated
- RR > 70
- Oxygen sats <92%
- Moderate-severe respiratory distress
- Periods of apnoea
Croup - state the following:
- Pathophysiology
- Presentation
- Management
Pathophysiology:
- Common respiratory disease of childhood (age 6 months to 6 years)
- Symptoms are a result of upper-airway obstruction, due to generalised inflammation of the airways, as a result of viral infection
- Typically caused by parainfluenza virus 1 or 3
Presentation:
- Sudden onset of a barky cough
Often accompanied by:
- Stridor
- Hoarseness
- Respiratory distress
Management:
Generally a clinical diagnosis
Mild - no stridor at rest: single dose of corticosteroids (Dexamethasone)
Moderate - stridor or sternal indrawing at rest: administer nebulised Adrenaline
If severe - stridor at rest: add supplemental oxygen
Outline the difference in presentation between mild, moderate and severe croup and how you go about treating each one
All forms = barking cough
For all management = Dexamethasone
Mild = barking cough, but no inspiratory stridor
Management: single dose of Dexamethasone
Moderate = barking cough AND inspiratory stridor AND sternal indrawing at rest
Management: nebulised Adrenaline (plus Dexamethasone)
Severe = barking cough AND inspiratory stridor AND sternal indrawing at rest AND cyanosis/decreased consciousness
Management: add supplemental oxygen (plus nebulised Adrenaline AND Dexamethasone)
Viral wheeze (not asthma) - state the following:
- Pathophysiology
- Presentation
- Management
Pathophysiology:
- Episodes of wheezing that are induced by viral infections of the upper respiratory tract
- Common in children < 6 years
Presentation:
- Wheeze (not all year round)
- Presence of coryzal symptoms e.g. runny nose, cough, headache, sneezing
Management:
- May give: controlled O2 and Salbutamol inhaler
- If not responding, consider: Ipratropium Bromide or oral steroids
Threadworms - state the following:
- Pathophysiology
- Presentation
- Investigations
- Management
Pathophysiology:
- Presence of parasite threadworm in the intestines
- Common in children under 10
Presentation:
- Bowel habit changes - may see white worms in stool
- Abdominal pain
- Wheeze
- Weight loss
- Genital itching
Investigations:
- Stool ova and parasites (O&P) examination
- FBC with differential
- Therapeutic trial with ivermectin (in specific situations)
Management:
Need to treat whole household
- At home single dose of drug: Mebendazole
- More complicated if pregnancy/breastfeeding or < 2 years
