Flashcards in Gen Peds CPS Deck (228)
What is the Rome III diagnostic criteria for functional constipation?
Criteria must be fulfilled at least once per week for at least 2 months before diagnosis can be made:2 or more of following in a child of at least 4 yo with insufficient criteria for diagnosis of IBS:1. 2 or few defectations in the toilet per week2. At least one episode of fecal incontinence per week3. History of retentive posturing or excessive volitional stool retention4. History of painful or hard bowel movements5. Presence of a large fecal mass in the rectum6. History of large diameter stools that may obstruct the toilet
When are the two periods of time when the developing child is most prone to functional constipation?
1. Toilet training2. Start of school
What is a "fleet enema"?-recommended for what age group?-what are side effects? (3)
Sodium biphosphate and sodium phosphate-recommended for children > 2 years only-side effects:1. mechanical trauma to rectal wall2. abdo distention or vomiting3. hyperphosphatemia, hypocalcemia
What is the potential side effect of use of mineral oil for constipation?-in which group is mineral oil contraindicated?
Lipid pneumonia if aspirated-contraindicated in infants because of this reason
What is distinguishing feature and benefit of Peg 3350 over other laxatives?
Does not cause electrolyte imbalance (only absorbed in trace amounts from the GI tract)
What is the dose of PEG for disimpaction and maintenance?
Disimpaction: 1.5 g/kg/day div BID x 3 dMaintenance: 0.4-1 g/kg/day (start high and then decrease as necessary)
What is a common reason for lack of response to stool softening therapy with PEG?
Inadequate dosing! Start high and then decrease as necessary
What is the evidence for docusate in pediatric constipation?
No evidence that docusate is effective!
What behavioural modification recommendations can be made to parents for treatment of constipation? (3)
1. Routine scheduled toilet sitting x 3-10 min once or twice a day2. Footstool to help increase intraabdominal pressure3. No punishment for not stooling during toileting time; yes praise and reward for stooling and toilet sitting
What is the recommended fibre intake for all children?-what is the evidence for fibre supplementation in children with constipation?
0.5 g/kg/day to max of 35 g/day-no evidence to support fibre supplementation
What is the next step if a child is unresponsive to adequate medical and behavioural management for constipation?
Consider time-limited trial of a cow's milk free diet = CMPI has been associated with chronic constipation
What is considered "normal" for stooling patterns in infants?
Remember that normal breastfed newborns may stool with each feeding or may not stool at all for 7-10 d
How long should children with constipation be treated for with stool softener therapy?
At least 6 months-should have regular BMs without difficulty before considering a trial of weaning maintenance therapy
What is the definition of fever or unknown origin?
Fever > 14 days with no etiology found after routine tests
What are the limitations of a rectal temperature? (5)
1. Can be slow to change in relation to changing core temp2. Accuracy depends on depth of measurement3. May be inaccurate if there is decreased local blood flow or stool presence4. Risk for rectal perforation (1 in 2 million)o 5. Can spread infection
What is the AAP recommendation on route of temp measurement as screen for fever in neonates? And why?
Ax temp due to risk of rectal perforation with rectal temps (even though risk is super low)-only used as a SCREEN since it has low sensitivity and specificity in detecting fever
What are the limitations of PO temp? (2)
1. Easily influenced by recent ingestion of food or drink and mouth breathing2. Relies on mouth being sealed and tongue being pressed down which is hard for young children or unconscious/uncooperative patients
What is the science behind tympanic thermometers?
Measure thermal radiation emitted from TM and ear canal (infrared radiation emission detectors)-amount of thermal radiation emitted is in proportion to membrane's temperature and blood supply to this is very similar in temp and location to the blood bathing the hypothalamus which is the body's thermoregulatory centre-not affected by crying, otitis media or earwax
According to the CPS statement on temperature measurement, what are the normal temperature ranges for:-rectal-ear-oral-axillary
Rectal: 36.6-38Ear: 35.8 - 38Oral: 35.5 - 37.5Ax 34.7 - 37.3
What are the limitations to tympanic temperature?
1. Influenced by ear canal's structure, meatus size and probe positioning (need an adequate seal to protect from ambient temperatures); especially difficult in young children
What is the recommendation for temporal artery thermometry?
May be a useful tool for screening children at low risk in ER but cannot yet be recommended for home use or hospital use when definitive measurements are needed
Overall, what is the recommendation on use of infrared tympanic thermometers?
Accurate, easy and safe to use and so it is an appropriate way to measure temps especially in older children-children
What is the recommended temperature measurement techniques for the following age groups:-birth to 2 yrs-5 yo
-birth to 2 yr: ax as screen rectal as definitive-2-5 yo: ax or tympanic as screen, rectal as definitive-5 yo: ax, tympanic (or temporal artery if in hospital) as screen, oral as definitive
What is the difference between bedsharing and cosleeping?
-Bedsharing: baby shares same sleeping surface with another person-Co-sleeping: baby is within arm's reach of another person but not on the same sleeping surface
Before 18 months, how fast do children's feet grow?-what about toddlers?
When does longitudinal arch development occur in children?-what is flexible flatfoot?
Longitudinal arch development occurs before the age of 6-all children
What 3 characteristics of children lead to higher incidence of flatfoot?
1. Greater laxity of ligaments2. Obesity3. Shoe wearing in early childhood
What is the treatment and prognosis of intoeing, torsions, knock knees and bowlegs?-when should you consider referral to orthopedic surgeon?
Treatment: NOTHING. Orthotics are NOT beneficial in management of these things! Majority of torsional deformities resolve spontaneously by adulthood and rarely cause functional problems-refer to ortho if persists beyond age ~8 and if it causes functional impairment-corrective shoes or other interventions are NOT necessary if asymptomatic
A mom brings in her 6 month old baby and asks you "Does she need shoes?" What do you answer?
NO! Infants do not need shoes until they are walking-they are necessary for protection and that's pretty much it.