Flashcards in Nutrition and developmental medicine Deck (56):
define the age of infant?
28 days corrected to 12 months
what are some key respiratory characteristics we need to remember for an infant?
more compliant chest wall
heavily reliant on diaphragm for breathing
resp rate is higher than adults due to heightened metabolic rate
less type 1 fibres in respiratory muscles and so easily fatigued
infants become bradycardic with hypoxia
at what age can we palpate the anterior and posterior fontanelles of an infant?
anterior- up until 12-18 months
posterior- up to 2 months
when does the epiphyseal plate fuse?
when the child reaches skeletal maturity after puberty
why do babies have a slightly flexed posture with some tone?
often for thermoregulation as increase SA causes them to lose heat easily
what might you think if a baby doesn't have a slightly flexed posture?
may be preterm or unwell
what are some normal behavioural characteristics of a newborn
Wake regularly for feeds
Suck strongly on the breast
Rousable to normal activity
Normal sounding cry
flexed posture with some tone
when can we introduce solids for a baby?
what is the major determinant of a child's growth, development and adult health status?
at what age is low fat milk appropriate for a toddler?
from 2 yrs
what is the normal weight gain rate for a baby who is between 0-3 months
what is the normal weight gain rate for a baby who is between 3-6 months
what is the normal weight gain rate for a baby who is between 6-12 months
what is a difference between infant formulas and breastmilk that might increase risk of future adiposity and metabolic risk?
More protein in the infant formulas than in breastmilk
this may be a contributor to future metabolic risk
--> early protein hypothesis
at what age should the child eat what the parents eat?
what are some general estimations of the amount a child should eat?
meat- the size of child's palm
carb- size of the child's fist
vegetables- 1/2 a plate or more
if not animal protein- half a plate is required of lentils/chickpeas etc
Describe what 'catch down growth' refers to?
a baby may drop a few centiles on the growth chart but this is not called failure to thrive bc their weight drop correlates with their genetics (e.g. parents may be small)
Hence parental measurements important
what does failure to thrive generally imply?
failure to gain weight with height and head circumference being initially well preserved
what are some prenatal causes of failure to thrive?
maternal factors- smoking, alcohol, medications, malnutrition, infections
prematurity with complications
what are the general groups of causes for failure to thrive postnatally?
1. increased metabolic demand
2. inadequate intake
3. poor absorption
4. non-organic causes e.g. child neglect/abuse etc
what are some causes of poor absorption, that can ultimately lead to failure to thrive?
inborn errors of metabolism
GI structural/functional abnormality
how does 'short stature' relate to centiles?
weight centile > height centile leading to a higher BMI centile
what is the first sign of puberty in a boy?
how do we determine the bone age of a child?
left wrist x-ray which is then compared with the radiographic bone atlas
a mother says that her 6 yr old boy is going through puberty. What do you need to do?
precocious puberty in a boy is always pathological--> refer to specialist paediatric endocrinologist
what are some causes of delayed bone age?
what are some causes of accelerated bone age?
obesity, early puberty, hyperthyroidism and androgen excess
what are the main gastrointestinal conditions that can cause failure to thrive?
what might clinicians miss in an infant with symmetrical lower limbs and hip?
bilateral irreducible dysplasia of the hips
what are some causes of late presentation of hip dysplasia
Causes of late presentation of unstable hips: missed diagnosis from clinicians of unstable hips from birth
OR inappropriate posturing of the baby causes to abnormal adduction of hips--> acetabulum dysplasia.
what are the risk factors for developmental hip dysplasia
Family history of DDH
Breech presentation- extreme flexion --> acetabular dysplasia
--> think get OFF FB baby!
Postnatally, wrapping an infant in an extended position can also increase risk in DDH.
describe the barlow test for hip dysplasia.
Barlow test= identifies instability--> flex hip to 90 degrees while stabilising the pelvis with other hand. Adduct hip 10-20 degrees, then gentle pressure towards the back is applied. Put fingers over the greater trochanter.
Instability= gliding sensation felt and fingers over greater trochanter will move laterally. --> subluxating --> dislocation
describe the ortolani test for hip dysplasia.
Ortolani test= is used to reduce a dislocated hip, and identifies a dislocation.
Both hips and knees are flexed to 90 degrees and your thumbs should grasp the inner knees and other fingers around the greater trochanter. Abduct hip. If a 'clunk' is FELT (not just heard)= hip reduces. Then adduct the hip again and if the leg shortens, the joint has dislocated.
how good are the barlow and ortolani tests for hip dysplasia?
good for infants less than 6 months old but not very sensitive for older infants.
Asymmetry is more important in older infants.
how might we assess for asymmetrical hips (hip dysplasia) in an infant?
Look for asymmetrical creases, shortening of the limb, limitation of hip abduction in flexion.
Asymmetrical creases is a 'soft sign' and is not diagnostic itself of DDH.
Galleazi test for limb shortening- keep the pelvis level and flex both hips and knees to 90 degrees and assess whether one knee is higher than the other.
Most sensitive sign of DDH in an older infant is limitation of abduction in flexion. Flex hips to 90 degrees and slowly abduct the hips together. Feel for any resistance and assess degree of rotation.
what are some associated conditions to screen for in infants with DDH?
Dysmorphic conditions such as Down syndrome, Arthogryposis, Larsen syndrome, plagiocephaly, torticollis, scoliosis, spina bifida, hyperextended knees, calcnaeovalgus, metatarsus adductus, club foot
how might we manage confirmed hip dysplasia in a child?
Depends on the time frame for diagnosis:
Hip dysplasia dx less than 6 weeks treated with bracing or watch and wait
Hip dysplasia dx 3-6 months- arthogram is performed with infant under GA. This will see whether the hip can be reduced safely or not. --> Hip spica +/- open reduction.
If diagnosis is delayed post walking, bony adaptations would have already occurred. --> open reduction of the hip (pelvic or femoral osteotomy) --> more invasive procedure and end result is still not a normal hip.
Adolescents with hip dysplasia may present with pain and a limp --> OA --> early joint replacement
what ix can we order for suspected hip dysplasia in an infant?
less than 6 months= u/s
> 6 months= plain radiograph
define cerebral palsy.
A group of disorders where there is a primary motor disability +/- other forms of disability
this usually presents early up to 2 yrs.
Motor deficits noticed post 2 yrs may be called acquired brain injury
what are the causes of cerebral palsy?
Most causes of CP (80%) are antenatal in origin (vascular insults to the brain, hypoxia, genetic disorders/syndromes, infection)
10% is due to hypoxia during delivery
10% postnatal cause (acquired brain injury, meningitis, hydrocephalus etc)
what is dyslexia?
disorder in reading skills disproportionate to child's IQ
What type of HS reaction is cows milk allergy in infants
Non-IGE mediated allergy so delayed response
What medications might we use in autism spectrum disorder?
Risperidone for aggression if needed, stimulants for ADHD if needed, SSRI for anxiety/depression
what are the long term complications of disorders of sexual development?
what is the most sensitive indicator of growth failure in a child?
plotting the height velocity overtime, and if it is below the 25th centile then that is ABNORMAL
what are some causes of microcephaly?
insult to developing brain like perinatal hypoxia, hypoglycaemia, meningitis
what does encopresis mean?
faecal incontinence or soiling
What is the first line treatment for nocturnal enuresis
Bed wetting alarms
What are the important characteristics on history must you elicit regarding an infant with failure to thrive
History should focus on intake and losses.
For intake what is consumed; when solids where commenced. Output: amount of vomit, stool frequency and consistency.
Birth: weight, gestation, complications
Past history: chronic illness, recurrent infections
when is toe walking abnormal, and what might it indicate?
toe walking is abnormal past 3 yrs old and should be ix.
there are many causes toe walking.
-congenital short achilles tendon
-some sort of muscular dystrophy
what are some causes of global developmental delay?
Chromosomal abnormalities: Down syndrome, fragile X syndrome, other dysmorphic syndromes.
• Prenatal injury: teratogenic drugs, infections, alcohol (fetal alcohol syndrome).
• Perinatal injury: hypoxic‐ischemic insult (cerebral palsy)
• Postnatal injury: meningitis, non‐accidental injury, neglect.
• Central nervous system malformations: neural tube defects, hydrocephalus.
• Endocrine and metabolic defects: hypothyroidism, inborn errors of metabolism.
• Neurodegenerative syndromes
• Neurocutaneous syndromes e.g. tuberous sclerosis.
• Pervasive developmental disorders e.g. Autism.
what are the signs and symptoms of gastroesophageal reflux disease in infants?
pronounced irritability with arching
refusal to feed
weight loss or crossing percentiles
chronic cough, wheeze
how might we manage physiological GOR in an infant?
what is the risk of precocious puberty?
final short stature due to early growth spurt and premature epiphyseal closure
when should we start actively treating nocturnal enuresis?
when the child is > 6 yrs generally
children under 6 generally become dry in their own time
if a child is bedwetting > 10 yrs, then urgent treatment is required.