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Year 4 - Paediatrics > Paeds - Safeguarding > Flashcards

Paeds - Safeguarding Flashcards

1
Q

What steps should you take if you have any suspicion of NAI in a child?

A
  1. Seek an explanation - from both the carer and the child for any injury / presentation
  2. Record - what was said, by whom and when and note any concern of NAI and why that is your impression
  3. Discuss - your concerns with one of the following:
    • More experienced colleague
    • Peadiatrician
    • Designated proffesional for child safeguarding
    • Child & adolescent mental health service colleague
  4. Refer - if there are continuing cues that child maltreatment is occuring then under advisment refer the child/young person to children’s social care
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2
Q

Which organisms are most likley to cause Meningitis for the age range, neonate - 3 months?

A
  1. Group B Streptococcus
    • Usually acquired from the mother at birth
    • More common if; 1) low birth weight babies or 2) following prolonged rupture of the membranes
  2. E. coli & other Gram -ve organisms
  3. Listeria monocytogenes
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3
Q

Which organisms are most likley to cause Meningitis for the age range, 1 month to 6 years old?

A
  1. Neisseria meningitidis (meningococcus)
  2. Streptococcus pneumoniae (pneumococcus)
  3. Haemophilus influenzae
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4
Q

Which organisms are most likley to cause Meningitis for the age range, older than 6 years up to 60 years?

A
  1. Neisseria meningitidis (meningococcus)
  2. Streptococcus pneumoniae (pneumococcus)
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5
Q

What organism can cause meningitis in immunosuppressed patients?

A

Listeria monocytogenes

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6
Q

What are 5 signs of raised ICP are contraindications to doing a LP to test for meningitis in a child?

A

Signs of raised ICP:

  1. Focal neurological signs
  2. Papilloedema
  3. Significant bulging of the fontanelle
  4. Disseminated Intravascular Coagulation (DIC)
  5. Signs of cerebral herniation
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7
Q

How is meningitis managed in a child?

A
  1. Abx
    1. < 3 months –> IV amoxicillin + IV cefotaxime
    2. > 3 months –> IV cefotaxime
  2. Steroids
    1. < 3 months –> NO steroids (NICE guidelines)
    2. IV Dexamethasone if LP shows any of the following:
      1. Frank purulent CSF
      2. CSF WBC count > 1000/μL
      3. Raised CSF WBC count + protein concentration > 1 g/L
      4. Bacteria on Gram stain
  3. Fluids - any shock –> treat with colloid
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8
Q

Why is IV Dexamethasone given in meningitis?

A

To ↓ risk of neurological sequalae via

anti-inflammatory action

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9
Q

A patient is suspected of having meningitis but is also diagnosed with meningococcal septicaemia - LP or no?

A

Pt has meningococcal speticaemia = NO LP

do blood cultures + PCR for meningococcus

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10
Q

What subsequent (sequalae) can meningitis cause?

A
  • Sensorineural hearing loss (most common)
  • Epilepsy
  • Paralysis
  • Infective –> sepsis, intracerebral abscess
  • Pressure –> brain herniation, hydrocephalus
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11
Q

What are some common features of meningitis?

A
  • headache
  • papilloedema
  • drowsiness
  • decreased / change in conciousness
  • neck stiffness
  • fever
  • purpuric non-blanching rash (particularly with meningococcal disease)
  • nausea & vomiting
  • photophobia
  • seizures
  • Kernig’s sign - pt supine, thigh flexed to 90, straightening leg at knee is met with resistance
  • Infants: poor feeding, irritability, hypothermia, bulging fontanelle
  • Rare: focal neurological deficit, facial palsy, balance problems (CN VIII)
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12
Q

What is ‘Shaken Baby Syndrome’?

A

Caused by intentional shaking of a child (0-5 years old)

Triad of:

  1. Retinal haemorrhages
  2. Subdural haematoma (see pic)
  3. Encephalopathy
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13
Q

What is meningitis?

A

An infection of the subarachnoid space which subsequently causes meningeal inflammation

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14
Q

What investigations might you suggest for a pt with suspected meningitis?

A
  • FBC
  • CRP
  • coagulation screen
  • blood culture
  • whole-blood PCR
  • blood glucose
  • ABG or VBG
  • Lumbar puncture (if no signs of raised ICP)
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15
Q

If you suspect shaken baby syndrome what agencies need to be contacted?

A
  1. Child safeguarding
  2. Social services (they will contact police if needed)
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16
Q

Which rare metabolic disorder predisposes patients to subdural haematoma (thus needs to be checked for in shaken baby syndrome)?

A

Glutaric aciduria type 1 (GA1)

  • Metabolic disorder causing glutaryl-CoA-dehydrogenase enzyme deficiency
  • Predisposed to subdural haematoma
    • proposed to be due to stretching of cortical veins secondary to cerebral atrophy & expansion of CSF spaces
17
Q

What is aplastic anaemia?

A

Characterised by:

  1. Pancytopenia (reduced RBC, WBC and platelets)
  2. Hypoplastic bone marrow (few blood cells vs aplastic which is no cells)

Peak incidence = 30 years old

18
Q

What are the features of aplastic aneamia?

A

Features:

  • Normochromic, normocytic anaemia
  • Leukopenia (lymphocytes relatively spared)
  • Thrombocytopenia
  • Can be the presenting features of acute lymphoblastic or myeloid leukaemia
19
Q

What can cause aplastic anaemia?

A
  • Idiopathic
  • Infections: parvovirus, hepatitis
  • Congenital: Fanconi anaemia, dyskeratosis congenita (DKC)
  • Drugs: cytotoxics, chloramphenicol, sulphonamides, phenytoin, gold
  • Toxins: benzene
  • Radiation
20
Q

What are the different types of child maltreatment?

A
  • Physical
  • Emotional
  • Neglect
  • Sexual
  • Factitious or Induced Injury
21
Q

What risk factors can increase the likelihood of child abuse?

Split into 1) child risk factors and 2) parental risk factors

A

Child risk factors:

  • Younger child
  • Disabled
  • Low birth weight
  • Multiple siblings

Parental risk factors:

  • Younger parental age
  • Mental illness
  • Drug/ alcohol abuse
  • Domestic Violence
  • Lower Socio-economic group
  • Parents were themselves abused
  • Parental criminal history
  • Vulnerable and unsupported parent
  • Previous child maltreatment in members of the family
  • Known maltreatment of animals
22
Q

What features of a history make an injury more likely to be due to NAI?

A
  1. Recurrent injuries
  2. Injuries inconsistent with child’s age, development and mobility e.g. bruising in non-mobile babies
  3. No mechanism of injury offered / not consistent with story given
  4. Delay in seeking medical attention
  5. Inconsistent histories between carers
  6. Inappropriate reaction of parents e.g. unconcerned, excessively distressed, aggressive, elusive
23
Q

What features of fractures might indicate NAI?

A
  1. Metaphyseal fractures
  2. Posterior rib fractures
  3. Complex skull fractures
  4. Fractures of different ages
  5. Long bone shaft fractures in non-mobile child
24
Q

What features of brusies might indicate NAI?

A
  1. Bruises on ; Face, Back, Buttock
  2. Bruise outlines of particular object e.g. hand, belt
  3. Pattern of bruising e.g. fingertips
25
Q

What features of burns might indicate NAI?

A
  • Uniform shape e.g. cigarette burn or lighter top burn
  • Glove-stocking distribution
26
Q

What does this picture show?

A

Retinal haemorrhages on fundoscopy

from shaken baby syndrome (NAI)

27
Q

Social services may decide a Child Protection Medical Assessment is required in suspected NAI - what does this involve?

A
  1. Carried out by at least registrar level paediatrician (with named consultant)
  2. Consists of: full history and examination, Growth Chart, Observations, Body Map, Photography, Investigations as appropriate
  3. Peadiatrician reports on likelihood of injuries being accidental / non-accidental
  4. CHILD MUST BE QUESTIONED AWAY FROM CARERS!
  5. VOICE OF CHILD IS CRUCIAL!
28
Q

What differential diagnoses might there be to NAI for a child with bruising?

A

Point is - there are LOTS!!

  • Accidental injury
  • ITP
  • Meningococcal Septicaemia
  • Henoch Schonlein Purpura
  • Mongolian Blue Spot
  • Leukaemia
  • Haemophilia A
  • Christmas disease
  • Von Willebrands disease
  • Children with hypermobility syndromes eg Ehlers Danlos syndrome (DNA test now available) may bruise more easily
29
Q

What does this picture show?

A

Mongolian blue spot

  • Also called ‘slate-grey naevi’ or congenital dermal melanocytosis
  • Are a pigmented birthmark
30
Q

What could you include in the differential diagnoses to NAI for a child with fractures?

A
  • Accidental Injury
  • Osteogenesis Imperfecta
  • Copper Deficiency
  • Vit D defiency
  • Vit C deficiency
  • Ehlers Danlos and other hypermobility syndromes
31
Q

When is an infant normally weened?

A

~ 4-6 months of age

From breast fed –> bottle / some solid food

Year 4 - Paediatrics (16 decks)

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