Community Paediatrics Flashcards
(81 cards)
1
Q
Who assesses children in the community?
A
GPs - it makes up 20% of their work!
2
Q
Wht common things do GPs deal with in paediatrics?
A
Immunisation
Screening
Child protection concerns
Minor illness
3
Q
What is the key to a good GP-child interaction?
A
Good communication and trust development with the child
4
Q
What can we class as behavioural problems in children?
A
- Poor sleeping
- Poor eating
- Soiling
- Over activity/poor concentration
- Unusual/repetitive behaviour
- Worries and fears
- Disobedience/argumentative
5
Q
How common are mental health disorders in children (up to 15 years old)?
A
1 in 10 children have a mental health disorder.
6
Q
How does the rate of mental health disorders in children change with age?
A
Increasing rate with age.
7
Q
What factors can contribute to childhood behavioural problems?
A
- Genetics
- Gender
- Intellectual ability
- Development
- Temperarment
- Chronic illness
- Family influence
- Environment
8
Q
What kinds of family influences affect childhood behavioural disorders?
A
- Early attachment
- Divorce/marital discord
- Family structure
- Parental style
- Parental illness/mental illness
9
Q
What environmental factors influence childhood behavioural disorders?
A
- Social class
- Neighbourhoods
- Physical abuse/neglect
- Sexual abuse
- School/Day care
10
Q
What complaints may a parent have for the GP regarding a childs sleep patterns?
A
- Refusing to go to bed
- Frequently waking at night
- Parasominas
- Medical problems (rarer)
11
Q
What are parasomnias?
A
Episodic sleep behaviours - a disorder characterized by abnormal or unusual behaviour of the nervous system during sleep.
12
Q
What kinds of parasomnias are common?
A
Head banging Sleep walking Bruxism Nightmares Night terrors
13
Q
What are the 4 types of abuse a child may experience?
A
- Physical
- Sexual
- Emotional
- Neglect
14
Q
What child factors (that are in no way the child’s fault) put a child at increased risk of abuse?
A
- Being unplanned/unwanted
- Low birth weight
- Prematurity
- Crying persistently
- Under age 4
- Chronic health problems
- Disability
15
Q
What adult factors put a child at increased risk of abuse?
A
- Mental illness
- Lack of socail or medical support
- Drugs/alcohol/crime
- PHx of abuse
- Financial difficulty
- Learning disability
16
Q
What is physical abuse?
A
Intentionally causing physical harm to a child
17
Q
What might you notice in a hx where you suspect physical abuse?
A
- Mechanism and injuryitself are not compatible
- Childs developmental age isn’t compatible with injury sustained
- Little/no explanation
- Inconsistencies
- Recurrent presentations, especially to A&E
- Delay in presentation
- Parental reaction is not as expected
18
Q
A child presents with suspicious bruising.
What features of the bruising might make it suspicious?
A
- Location - soft parts of body, or hidden areas such as behind ears.
- Shape - may be shaped very specifically, e.g. like a hand.
- Colouration - if multiple with different colours, but only one explanation given.
19
Q
If a child presents with bruises but you aren’t convinced abuse is involved, what can you do?
A
Ring safeguarding team for advice.
Investigate differentials possible.
20
Q
What differentials are there for bruising, other than abuse?
A
- Bleeding disorder
- Birth marks
- Vasculitic disorder
- Infection (-> rash that looks like a bruise)
- Drug related (NSAIDs)
- Malignancy
21
Q
Do unmobile children get bruises?
A
No, very very uncommon if a child isn’t mobile.
22
Q
If you see a bruise on a child and abuse is a differential, what should you add to the notes?
A
A body map and photographs of the bruises seen.
23
Q
What should we consider if a child presents with a suspicious burn?
A
Physical abuse or neglect, or both.
24
Q
What about a burn on a child can make it suspicious of abuse?
A
Shape - small and circular -> cigarette.
Location - glove and stocking, involving creases, symmetrical, bilateral, involving buttocks.
25
A child presents with a scold affecting his head and shoulders.
What are the possible mechanisms of injury here?
Child pulled a pan of the over over it's own head - accidental, ?neglect but not always.
Deliberate or accidental injury by parent.
Would need to do a thorough history for this one.
26
Which age group are fractures caused by abuse most common in?
Children less than 18 months
27
When would a rib fracture be suspicious?
In the absence of major trauma (97% are abuse)
28
What are the 3 core features of ADHD?
- Overactivity/hyperactivity
- Inability to concentrate/Inattention
- Impulsivity
29
What are the 3 core features of ASD?
Difficulties associated with:
- Social communication
- Social interaction
- Repetative/ritualistic behaviours
30
Roughly how many UK children are affected by ADHD?
1 in 20
31
Can ADHD have a genetic component?
Yes - often runs in families.
32
What age does ICD-10 say ADHD symptoms needs to be observed by?
6 years of age
33
When thinkng about ADHD symptoms, where do these need to be seen for diagnosis according to ICD-10?
Across 2 or more settings (e.g. home plus school).
34
How can you define inattention in ADHD?
- Easily distracted from stimuli
- Forgetful in daily activities
- Difficulty sustaining attention when playing or doing activities
35
How can you define hyperactivity in ADHD?
- Fidgets often (hands, feet, sitting in chair)
- Excessive talking
- Acts like driven by a motor
36
How can you define impulsivity in ADHD?
- Difficulty waiting their turn
| - Keen to answer question before question is finished
37
Why do we need to do a physical examination when ADHD or ASD is suspected?
- To check development is on track
- To check they are otherwise healthy, firstly in case medication needs to be started, and secondly in case there is an underlying co-morbidity
38
What differentials should you have when suspecting ADHD?
- Auditory processing disorder
- Conduct disorder
- Sensory processing disorder
- Depression
- Anxiety
- ASD
39
What questionnaires are available to help with diagnosing ADHD?
Conner's questionaire - school and parent observations.
40
A pre-school child presents with the classic ADHD triad for 6 months or more.
What management is recommended for this age group?
-Not medication.
- Parent training/education
- Inform nursery/pre-school teachers.
- Develop a care and special educational needs plan.
41
A school age child with mild/moderate ADHD needs management.
What can we do?
- Behavioural strategies are first line - parent education.
- CBT and social skills training.
- Training for teachers/special help in school
- Engage the family - very important!
- If unsuccessful, may consider medication.
42
What medication can we use in ADHD?
As a last resort, we can use methylphenidate.
43
How long do we trial ADHD medication for?
Methylphenidate trialled for 6 weeks.
44
With methylphenidate, what needs to be monitored, and how often?
Height and weight, BP, and ECG should be monitored at initiation, following dose adjustments, and every 6 months.
45
Define autism.
A neurodevelopmental disorder affecting social interaction, communication, and behaviour.
46
When do symptoms typically become apparent from in autism?
Before age 3, although diagnosis may be much later.
47
How common is autism?
Prevalence is ~1% of children.
48
What are the risk factors and conditions associated with developing autism?
- Perinatal hypoxia
- Maternal and paternal age
- Prematurity
- FHx
- Fragile X syndrome
- Tuberous sclerosis
- Angelmann syndrome
49
How is autism diagnosed?
Clinically, based on impairment in 3 key areas, and seen across all areas of life (i.e. home and school)
50
What are the 3 key areas of impairment in autism?
- Social interaction
- Social communication
- Restrictive/repetitive activities
51
How might abnormal social interaction manifest?
- Poor eye contact
- Failure to use facial expression or body language
- Difficulty making friends
- Difficulty reading social situations
52
How might abnormal social communication manifest?
- Delay/failure to develop spoken language or sign language
- Echolalia
- Abnormal intonation
- Pitch
- Rate/rhythm of speech
53
How might abnormal restrictive or repetitive activities manifest?
- Need for routine (very upset if disturbed)
- Ritualistic behaviours
- Preoccupation with toys/materials/subjects
- "Motor mannerisms"
54
What sensory issues might a child with autism have?
- Issues with textures or colours of certain foods
- Issues with loud noises
- Issues with physical contact e.g. hair brushing, washing, brushing teeth, clothing.
55
Is it just children with autism who have sensory issues?
No - sensory issues can be a stand alone problem, or overlap with other conditions/learning difficulties.
56
What would you expect to find on examination of a child with suspected autism?
Usually nohing, but there may be signs of an underlying medical or genetic condition.
57
What signs might you find O/E of a child with autism who has an underlying condition?
- Skin stigmata of neurocutaneous syndromes
- Signs of injury
- Dysmorphic features inc. macrocephaly/microcephaly
- Congenital anomalies
58
What important differentials would you want to rule out when suspecting autism?
- Learning difficulties
- Attachment disorders
- Rett's syndrome
- Language disorder
- ADHD
59
How do we manage autism?
MDT and community approach for:
- Behavioural management
- Educational measures
- Treatment of comorbid conditions
60
What behavioural management strategies can be employed to help children with autism?
Use of visual timetables, with preparation and explanation for changes in routine.
61
Why might we use melatonin to help a child with autism?
Good sleep routine can help the child's behaviour and education
62
What si considered normal wrt weight faltering in children?
- Babies crossing centiles within the first year of life.
| - Larger babies cross down growth centiles to reach genetically destined centiles.
63
What is the most common cause of weight faltering?
Environmental or psychsocial factors:
- Eating difficulties
- Disturbed maternal-infant relationship
- Maternal depression/psychiatric disorder
- Neglect may be a factor
64
A mother brings her child in because he hasn't gained much weight in the last year. He also experiences diarrhoea and has frequent chest infections. What is your top differential?
Cystic fibrosis
65
A mother brings her child in because he hasn't gained much weight in the last year. He also have frequent infections (not any specific type). What is your top differential?
Immunodeficiency, even though it's super rare :)
66
A mother brings her child in because she hasn't gained much weight in the last year. The girl has short stature and a webbed neck. What is your top differential?
Turner's syndrome
67
A mother brings her baby in because he hasn't gained much weight in the last year. She says she is worried that the baby doesn't get enough to eat as he vomits/possets frequently. What is your top differential?
Gastro-oesophageal reflux
68
A mother brings her infant in because he hasn't gained much weight in the last year since she introduced solid foods into his diet. He gets a lot of diarrhoea. What is your top differential?
Coeliac disease
69
A mother brings her child in because he hasn't gained much weight in the last year, and is developmentally delayed. She and the father have a long family history of an endocrine disorder. What is your top differential?
Hypothyroidism
70
What history should you get from a parent who is concerned about their child's weight faltering?
- Nutritional history
- Other symptoms - systems review if necessary
- Developmental history
- PMHx inc. birth weight, prenatal problems, recurrent or chronic illnesses.
- FHx - weight problems, genetic conditions, psychosocial
71
What do you need to examine for when a child presents with faltering weight?
- General appearance - neglected, ill, malnourished, mother's interaction with child.
- Growth plotted on a growth chart
- Physical examination to looks for signs of chronic illness
72
If a cild with faltering weight had IUGR, what can you tell the parents?
If all measurements were small at birth, catch-up is less likely.
73
What is a common finding on examination and investigation of a child with failure to thrive?
Anaemia esp. iron deficiency
74
What are the 2 patterns of poor growth?
Steady growth below centiles, and fall-off in growth across centiles.
75
What are the major causes of steady growth below centiles?
- Constitutional/familial short stature
- Maturational delay
- Turner's syndrome
- IUGR
- Skeletal dysplasia (rare)
76
How can constitutional short stature be confirmed?
Short parents, normal hx and ex. No delay in bone age.
77
How can maturational delay be confirmed?
Delay in onset of puberty present, FHx of delayed puberty, and delayed bone age.
78
Is there delay in bone age in Turner's syndrome?
No
79
What are the features of skeletal dysplasias?
Body disproportion with shortened limbs.
80
What are the major causes of fall off in growth across centiles?
- Chronic illness
- Acquired hypothyroidism
- Cushing's disease (rare, but it did happen in that one episode of House)
- Growth hormone deficiency (rare)
- Psychosocial
81
Which of the causes of fall off in growth across centiles have delayed bone growth?
Chronic illness, hypothyroidism, Cushing's, and Growth hormone deficiency.
