Introduction Flashcards
1
Q
What is the UN definition of a child?
A
Every human being below age of eighteen
2
Q
Locally, what age falls under paediatric services?
A
<16 years
3
Q
Locally, what age falls under paediatric services for people with learning disabilities?
A
<25 years
4
Q
In what ways are children not small adults?
A
Physical differences
Physiological differences
Psychological differences
Pathology differences
5
Q
Describe some physical differences in children
A
Smaller and disproportionate
6
Q
What is the definition of failure to thrive?
A
Failure to achieve expected growth
7
Q
Why should you not use absolute BMI in a child?
A
Need the context of age
8
Q
What physiological differences are more easily acquired in a child?
A
Cold
Dehydration
Hypoglycaemic (eg Ketotic hypoglycaemia)
9
Q
What differences exist in resp rate in children?
A
Faster resp rate
10
Q
What differences exist in pulse rate in children?
A
Faster pulse rate
11
Q
What differences exist in blood pressure in children?
A
Lower blood pressure
Maintained for longer, until very shocked
‘Falling off a cliff’
12
Q
Roughly when do maternal immunoglobulins die off after birth?
A
4 months
13
Q
What periods of psychological changes can be observed in children?
A
'Terrible twos' Latent phase (6-11) Adolescence
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
15
Q
List some chronic conditions that have a childhood onset
A
Asthma Autism Cerebral palsy Cystic fibrosis Gastroschisis Hirschprung's disease Spina bifida
16
Q
List some reasons for reduced childhood mortality
A
Obstetric care improvements Better housing Better nutrition Immunisations ?Antibiotics? ?NHS?
17
Q
What is done for most acute admissions of children in hospital?
A
Nothing. Watch and wait!
18
Q
What effect does birth weight have on development of impaired glucose tolerance?
A
Low birth weight linked to IGT in later life
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
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
21
Q
How much is a pound in g?
A
~450g
22
Q
How much is an ounce in g?
A
~30g
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
Roughly how much feed should a baby take?
140-180 ml/kg/day
| Or 100ml if ill
26
What should be asked about in terms of bowel movements?
- 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
What can be observed in children in an examination?
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
What are the general approaches to assessing children?
- 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
What are some of the recognised phases of childhood?
- Neonate (<4w)
- Infant (<12m/1y)
- Toddler (~1-2y)
- Pre-school (~2-5y)
- School age
- Teenager/ Adolescent
30
What is the average weight roughly of a newborn?
3.3kg
31
What are some of the things that take place during childhood development?
- 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
What are the 5 key development fields in childhood development?
- Gross Motor
- Fine Motor
- Social and self help
- Speech and language
- Hearing and vision
33
What are some of the skills roughly gained by 6 months?
- 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
What are some of the skills roughly gained by 12 months?
- 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
What are some of the skills roughly gained by 24 months?
- 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
What is the median age for walking?
12m
| Refer if not walking by 18m
37
What influencing factors may affect development?
- Genetics (Family, race, gender)
- Environment
- Positive early childhood experience
- Developing brain vulnerable to insults (Antenatal, Postnatal, Abuse and neglect)
38
Give some examples of antenatal adverse environmental factors?
- Infections (CMV, Rubella, Toxoplasmosis, VZV)
| - Toxins (Alcohol, Smoking, Anti-epileptics
39
Give some examples of postnatal adverse environmental factors?
- 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
What are some red flags in child development?
- 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
What are the three main components of child health screening?
- Health promotion
- Developmental screening
- Immunisation
42
List conditions screened for in newborn blood spot screening
```
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
When does newborn hearing screening take place?
By day 28
44
When does newborn orthoptist vision screening take place?
4-5years
45
What areas are explored in a 6-8w review of a child?
- 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
What areas are explored in a 27-30m review of a child?
- Identification data
- Development
- Physical measurements (height and weight)
- Diagnoses / other issues
47
What 3 physical measurements are made in growth monitoring
- Weight (grams and Kgs)
- Length (cm) or height (if >2y)
- Head circumference (OFC) (cm)
48
What is the average weight of a 12 months old?
10kg
49
What is the average OFC for a newborn child
35cm
50
What is the average OFC for a 12 month old child
45cm
51
What is the average length of a 12 months old?
50cm
52
What doed FTT mean?
Supply of energy < Demand for nutrients
53
What are some maternal causes of failure to thrive in early life?
- Poor lactation
- Incorrectly prepared feeds
- Unusual milk or other feeds
- Inadequate care
54
What are some infant causes of failure to thrive in early life?
- Prematurity
- Small for dates
- Oro palatal abnormalities (e.g. cleft palate)
- Neuromuscular disease (e.g. cerebral palsy)
- Genetic disorders
55
What are some metabolic (^Demand) causes of failure to thrive in early life?
- Congenital lung disease
- Heart disease
- Liver disease
- Renal disease
- Infection
- Anemia
- Inborn errors of metabolism
- Cystic fibrosis
- Thyroid disease
- Crohn’s/ IBD
- Malignancy
56
What are some metabolic (^Loss) causes of failure to thrive in early life?
-Gastro oesophageal reflux
-Pyloric stenosis
-Gastroenteritis (post-infectious phase)
-Malabsorption
(Food allergy, Persistent diarrhoea, Coeliac disease, Pancreatic insuffiency, Short bowel syndrome)
57
What are some non-medical causes of failure to thrive?
- 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
