Paediatrics Flashcards
(257 cards)
Developmental Milestones 2 months
- hearing/language
- social/emotional
- cognitive/visual/fine motor
coos and gurgles. turns head to sound
Begins to smile at people. Tries to look at parents. Sucks on hand to sooth
Begins to follow things with eyes
Begins to act bored
Developmental Milestones 8 months
- hearing/language
- social/emotional
- cognitive/visual/fine motor
Understands no. Mamama/dadada sounds
Stranger awareness. Has favourite toy
Transfers from one hand to another
Picks up cereal between thumb and index finger
Plays peek a boo
Developmental Milestones 18 months
- hearing/language
- social/emotional
- cognitive/visual/fine motor
Says 10 words
Says no and shakes head
Temper tantrums
Points to show something interesting
Follows 1 step verbal command
Scribbles on own
Developmental Milestones 3 years
- hearing/language
- social/emotional
- cognitive/visual/fine motor
Understands words such as in/on/under
Carries on a conversation using 2 to 3 sentences
Copies adults and friends
Takes turns in games
Shows concern friend crying
Does jig saw 3-4 pieces
Copies a circle with a pencil
cpr in children
15 compression s to 2 breaths
Croup (laryngotracheobronchitis) presentation and management
Common cause of acute respiratory distress in children 6 months to 3 years
Acute onset of seal-like barky cough in moderate to severe cases accompanied by stridor and sternal/intercostal indrawing
Fever
Viral cause (parainfluenza usually)
note majority of cases mild but if needed…
- oral dexamethasone 0.15 mg/ kg as a single dose
- Nebulised Adrenaline 5mls 1:1000 (mod or severe)
- senior input
symptoms and management of foreign body aspiration
sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral wheezing suggests partial obstruction of the main or distal bronchi
management with flexible bronchoscopy or rigid if fails
signs of respiratory distress
- increased RR
- stridor
- tracheal tug; retraction at the suprasternal notch
- intercostal recession
- subcostal recession
- head bobbing
- grunting
- posture
impending respiratory failure and exhaustion will develop a low respiratory rate (for their age) and breath sounds including added sounds can diminish
differentials child in upper respiratory distress
Viral Croup
Epiglottitis (unlikely with haemophilia influenza vaccine)
Foreign body aspiration
Anaphylaxis
Bacterial tracheitis
laryngeal capillary haemangioma
slowly progressive airway obstruction / stridor since birth, particularly if the child has other capillary haemangiomas
gastro-oesophageal reflux disease in infants
silent symptoms or intermittent distress commonly after feeds and on lying flat, intermittent breathing difficulty with symptoms including stridor, episodes of colour change and / or recurrent chest infections, and behavioural changes such as back arching
stridor present since birth
Laryngomalacia or floppy larynx
soft stridor that worsens with feeds
monitor feeding and growth
epiglottitis
very rare cause of airway obstruction seen most in children 2-7
sudden onset of distressed child with muffled cough and voice, normal temp, drooling and leaning forward
needs emergency airway management
usually bacterial cause
bacterial tracheitis
differenital for epiglottis
younger age; 6 months to 14 months
fever present
sudden onset
hoarse voice and cough
drooling
needs emergency airway
broad spec Abx once airway secured
anaphylaxis presentation
Hypotension, Bronchoconstriction or Airway compromise in the setting of an allergic reaction
child pale and sweating (hypotensive), wheeze, stridor
what type of allergic reaction is a food allergy
type I hypersensitivity
sensitisation to allergen
for an allergy to occur a child must have previously encountered the allergen
Following exposure to an antigen the protein causes cross binding of two bound IgE molecules on the Mast Cell or Basophil surface. This process results in degranulation of the Mast Cell.
Histamine is released immediately causing the reaction
actions of histamine
localised irritation
vasodilation
bronchoconstriction
endothelial cell separation - resulting in urticarial rash
criteria for prescribing an Adrenaline Pen
- History of Anaphylaxis
- Previous cardiovascular / Respiratory involvement
- Evidence of airway obstruction
- Poorly controlled Asthma requiring regular inhaled corticosteroids
- Reaction to a small amount of allergen
- Ease of allergen avoidance
in less severe allergy, having antihistamine available can be sufficient
what is bronchiolitis
acute inflammation of the bronchioles usually caused by RSV
affects infants
initially subtle symptoms which worsen over 3-4 days
usually self limiting and needs supportive care but infants can become more unwell and need admission
symptoms of bronchiolitis
initial coryzal symptoms
progress to some or all of (day3-6)
- increased work of breathing
- typical cough
- poor/reduced feeding
- pallor
- exhaustion
- widespread wheeze and crackles
- fever (low grade)
- apnoea
- reduced oxygen sats
- tachycardia of bradycardia (more worrying)
symptoms bronchiolitis requiring admission
- 50% feeding intake
- pre-existing condition such as prematurity, CF
- RR>70
- O2 sats <92%
- moderate resp distress
- apnoeas
- clinical dehydration
management of bronchiolitis in hospital
maintain oxygen sats
NG feed
if severely worsening; NBM, FBC, blood gas, biochem
IV fluids
orogastric decompression
consider CPAP if very severe
PICU?
consider Abx ?concurrent bac infection
accurate assessment of feeding in an infant
calculate the amount in mls/kg/day not ounces as reported by parents