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Paediatrics > Introduction > Flashcards

Introduction Flashcards

1
Q

What is the UN definition of a child?

A

Every human being below age of eighteen

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2
Q

Locally, what age falls under paediatric services?

A

<16 years

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3
Q

Locally, what age falls under paediatric services for people with learning disabilities?

A

<25 years

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4
Q

In what ways are children not small adults?

A

Physical differences
Physiological differences
Psychological differences
Pathology differences

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5
Q

Describe some physical differences in children

A

Smaller and disproportionate

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6
Q

What is the definition of failure to thrive?

A

Failure to achieve expected growth

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7
Q

Why should you not use absolute BMI in a child?

A

Need the context of age

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8
Q

What physiological differences are more easily acquired in a child?

A

Cold
Dehydration
Hypoglycaemic (eg Ketotic hypoglycaemia)

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9
Q

What differences exist in resp rate in children?

A

Faster resp rate

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10
Q

What differences exist in pulse rate in children?

A

Faster pulse rate

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11
Q

What differences exist in blood pressure in children?

A

Lower blood pressure
Maintained for longer, until very shocked

‘Falling off a cliff’

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12
Q

Roughly when do maternal immunoglobulins die off after birth?

A

4 months

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13
Q

What periods of psychological changes can be observed in children?

A 
'Terrible twos'
Latent phase (6-11)
Adolescence
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14
Q

List conditions only usually observed in children

A 
Abdominal migraine
Bronchiolitis
Bronchopulmonary dysplasia
Croup
Enuresis (Bedwetting)
Febrile convulsion
Glue ear
Intraventricular haemorrhage
Necrotising enterocolitis
Non accidental injury
Sudden unexplained death of infants
Toddler's diarrhoea
Vesico-ureteric reflux
Viral induced wheeze
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15
Q

List some chronic conditions that have a childhood onset

A 
Asthma
Autism
Cerebral palsy
Cystic fibrosis
Gastroschisis
Hirschprung's disease
Spina bifida
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16
Q

List some reasons for reduced childhood mortality

A 
Obstetric care improvements
Better housing
Better nutrition
Immunisations
?Antibiotics?
?NHS?
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17
Q

What is done for most acute admissions of children in hospital?

A

Nothing. Watch and wait!

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18
Q

What effect does birth weight have on development of impaired glucose tolerance?

A

Low birth weight linked to IGT in later life

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19
Q

What effect does child BMI have on development of Coronary heart disease?

A

Obesity in childhood associated with increased risk of CAD later in life

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20
Q

What is different in paediatric care?

A
  • Parents present
  • Play is essential and clinically helpful
  • Specialised nursing staff
  • Treatments differ by weight and age
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21
Q

How much is a pound in g?

A

~450g

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22
Q

How much is an ounce in g?

A

~30g

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23
Q

How much weight should a baby gain?

A

~150-200g/week in the 1st 6 months

24
Q

How much is a fluid ounce in ml?

A

~30g

25
Q

Roughly how much feed should a baby take?

A

140-180 ml/kg/day

Or 100ml if ill

26
Q

What should be asked about in terms of bowel movements?

A
  • Children in nappies vs. independent toileting
  • Frequency (per day, week or even month)
  • Size, shape, appearance and consistency
  • Difficulties passing
  • Pain on passing
  • Blood or mucus seen
27
Q

What can be observed in children in an examination?

A

General: Appearance, play, interaction, obs
Resp: Effort, noise, rate, recession, O2, nebs
CVS: Colour, perfusion
GI: Feeding, vomit, abdo distension/ movement
Neuro: Alertness, interaction, play, posture
MSK: Mobility, limbs movements, posture, splints, mobility aids
Other: Rashes, bruises, infusions, tubes, lines

28
Q

What are the general approaches to assessing children?

A
  • Listen well
  • Learn what to ask and how to ask it
  • Build a rapport
  • Be creative, adaptive and opportunistic
  • Be systematic and thorough
  • Communicate well
29
Q

What are some of the recognised phases of childhood?

A
  • Neonate (<4w)
  • Infant (<12m/1y)
  • Toddler (~1-2y)
  • Pre-school (~2-5y)
  • School age
  • Teenager/ Adolescent
30
Q

What is the average weight roughly of a newborn?

A

3.3kg

31
Q

What are some of the things that take place during childhood development?

A
  • Birth to 5y (but brains develop in utero)
  • Fairly consistent pattern but rate will vary
  • Cell growth, migration, connection, pruning, and myelination
  • Sequence of events in each domain
  • School- Cognitive and thought development (early skills become more refined)
32
Q

What are the 5 key development fields in childhood development?

A
  • Gross Motor
  • Fine Motor
  • Social and self help
  • Speech and language
  • Hearing and vision
33
Q

What are some of the skills roughly gained by 6 months?

A
  • Sits with hand support (begins to sit without)
  • Scooting/crawling
  • Reaching and grasping
  • Recognises different faces
  • Responds to mothers voice
  • Makes simple sounds
  • Takes everything to mouth
  • Plays with simple objects
34
Q

What are some of the skills roughly gained by 12 months?

A
  • Moves and holds head recently
  • Sits well without support
  • Takes steps/walks
  • Passes objects/grasping with thumb and forefinger
  • Understand simple words
  • Begins to use simple single words
  • Begins to do simple things when asked
  • Imitates and copies people
35
Q

What are some of the skills roughly gained by 24 months?

A
  • Running
  • Grasping with thumb and forefinger
  • Looks at small things/pictures
  • Hears clearly, can understand simple language
  • Begins to use words together
  • Likes to be praised after simple tasks
  • Takes off simple clothes
  • Begins to play with other children
  • Points at things when asked
36
Q

What is the median age for walking?

A

12m

Refer if not walking by 18m

37
Q

What influencing factors may affect development?

A
  • Genetics (Family, race, gender)
  • Environment
  • Positive early childhood experience
  • Developing brain vulnerable to insults (Antenatal, Postnatal, Abuse and neglect)
38
Q

Give some examples of antenatal adverse environmental factors?

A
  • Infections (CMV, Rubella, Toxoplasmosis, VZV)

- Toxins (Alcohol, Smoking, Anti-epileptics

39
Q

Give some examples of postnatal adverse environmental factors?

A
  • Infection (Meningitis, encephalitis)
  • Toxins (solvents mercury, lead)
  • Trauma (Head injuries)
  • Malnutrition (iron, folate, vit D)
  • Metabolic (Hypoglycaemia, hyper + hyponatraemia)
  • Maltreatment/ under stimulation/ domestic violence
  • Maternal mental health issues
40
Q

What are some red flags in child development?

A
  • Loss of developmental skills
  • Parental/professional concern re vision
  • Hearing loss
  • Persistent low muscle tone/floppiness
  • No speech by 18 months
  • Assymetry of ovements/increased muscle tone
  • Not walking by 18m
  • Very high/low OFC
41
Q

What are the three main components of child health screening?

A
  • Health promotion
  • Developmental screening
  • Immunisation
42
Q

List conditions screened for in newborn blood spot screening

A 
Phenylketonuria (PKU); 
Congenital Hypothyroidism 
(CHT); 
Cystic Fibrosis (CF), 
Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD) 
Sickle Cell Disorder (SCD).
Maple syrup urine disease
Isovaleric acidaemia (IVA),
Glutaric aciduria type 1 (GA1 ),
Homocystinuria (HCU)
43
Q

When does newborn hearing screening take place?

A

By day 28

44
Q

When does newborn orthoptist vision screening take place?

A

4-5years

45
Q

What areas are explored in a 6-8w review of a child?

A
  • Identification data
  • Feeding (breast/ bottle/ both)
  • Parental concerns
  • Development
  • Measurements (Weight, OFC, Length)
  • Examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex))
  • Sleeping position
46
Q

What areas are explored in a 27-30m review of a child?

A
  • Identification data
  • Development
  • Physical measurements (height and weight)
  • Diagnoses / other issues
47
Q

What 3 physical measurements are made in growth monitoring

A
  • Weight (grams and Kgs)
  • Length (cm) or height (if >2y)
  • Head circumference (OFC) (cm)
48
Q

What is the average weight of a 12 months old?

A

10kg

49
Q

What is the average OFC for a newborn child

A

35cm

50
Q

What is the average OFC for a 12 month old child

A

45cm

51
Q

What is the average length of a 12 months old?

A

50cm

52
Q

What doed FTT mean?

A

Supply of energy < Demand for nutrients

53
Q

What are some maternal causes of failure to thrive in early life?

A
  • Poor lactation
  • Incorrectly prepared feeds
  • Unusual milk or other feeds
  • Inadequate care
54
Q

What are some infant causes of failure to thrive in early life?

A
  • Prematurity
  • Small for dates
  • Oro palatal abnormalities (e.g. cleft palate)
  • Neuromuscular disease (e.g. cerebral palsy)
  • Genetic disorders
55
Q

What are some metabolic (^Demand) causes of failure to thrive in early life?

A
  • Congenital lung disease
  • Heart disease
  • Liver disease
  • Renal disease
  • Infection
  • Anemia
  • Inborn errors of metabolism
  • Cystic fibrosis
  • Thyroid disease
  • Crohn’s/ IBD
  • Malignancy
56
Q

What are some metabolic (^Loss) causes of failure to thrive in early life?

A

-Gastro oesophageal reflux
-Pyloric stenosis
-Gastroenteritis (post-infectious phase)
-Malabsorption
(Food allergy, Persistent diarrhoea, Coeliac disease, Pancreatic insuffiency, Short bowel syndrome)

57
Q

What are some non-medical causes of failure to thrive?

A
  • Poverty/ socio-economic status
  • Dysfunctional family interactions
  • Difficult parent-child interactions
  • Lack of parental support
  • Lack of preparation for parenting/ education
  • Child neglect
  • Emotional deprivation
  • Poor feeding or feeding skills disorder

Paediatrics (18 decks)

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