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.HEALTH&SOCIETY Y4 > PAEDIATRICS > Flashcards

PAEDIATRICS Flashcards

1
Q

Proportion of and number of Stillbirth in ENgland a day

A

1 in 200 pregnancies in the UK which is 8 babies a day
3.6 per 1000

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2
Q

Number of stillbirths worldwide annually
Where are the highest rates?
Where are the lowest rates?

A

Up to 3 million every year worldwide
Highest rates - Pakistan, Nigeria and chad
Iceland, Andorra and Denmark

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3
Q

In 1000 lives births how many neonatal deaths in the UK?

A

3 per 1000 live births

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4
Q

How many neonatal deaths globally?
Who has the highest rates?
Who has the lowest rates?

A

18 per 1000 live births - up to 3 million

Highest rates in Sub-Saharan Africa ans then central + South Asia
Lowest rates in Monaco, Iceland and japan

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5
Q

What % of stillbirths and neonatal deaths are for preterm babies?

A

75%

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6
Q

How does socioeconomic status impact risks of stillbirth and neonatal deaths?

A

Women living in the most deprives areas are 80% excess risk compared to women living in the least deprived areas

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7
Q

Which ethnicities are at highest risk of stillbirths and neonatal mortality?

A

Black African and black Caribbean
Pakistani ethnicities
(Stillbirth rates are 60% higher than white ethnicity babies and mortality rates are 45% higher)

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8
Q

Definition of still birth

A

Baby born dead after 24 completed weeks of pregnancy

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9
Q

Risk factors perinatal mortality

A

Prematurity - biggest!!

OtherS:
Maternal - maternal age <18 or >35, obesity, maternal health conditions, placental abruption, preeclampsia and other pregnancy complications, inadequate prenatal care, smoking/alcohol/substance use in pregnancy, multiple gestation
Foetal - postmaturity, forceps, IUGR, congenital anomalies
Environmental - low socioeconomic status, exposure to toxins/pollution, limited healthcare access e.g, rural residence

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10
Q

Strategies in UK to reduce perinatal mortality

A

Saving babies lives care bundle
Child death reviews
International stillbirth alliance conference
MBRRACE-UK and Each Baby Counts - research
Improvements in anatenetal care particular with hard to reach groups
Ensuring postnatal care
Not discharge mum and baby too soon
Improving treatment for premature babies
High quality post-birth care
Health promotion in pregnancy - encouraging avoidance of smoking, alcohol or drugs, not sleeping on back after 28 weeks, taking folic acid before pregnancy etc

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11
Q

What is the saving babies lives care bundle?

A

NHS England produced this guidance as a part of the plan to half the rates of stillbirth from 4.7 per 1000 to 2.3 per 1000 by 2030
They realised that whilst the majority of women recieve high quality care, there is 25% variation in stillbirth rates across England. They use this guidance to address this variation by bringing together 4 key elements of care based on the best available evidence:
- reducing smoking in pregnancy
- risk assessment and surveillance for foetal growth restriction
- raising awareness of reduced foetal movement
- effective foetal monitoring during Labour

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12
Q

What is a child death review?

A

When a pt under 18 dies, the death will be reviewed to understand what happened and identify lessons that can be learnt to prevent future deaths
These must be carried out for all children regardless of the cause of their death!

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13
Q

What is the international stillbirth alliance conference?

A

opportunity to engage with a diverse community of bereaved parents, academics, researchers, clinicians, and policy makers engaged in prevention, bereavement care, and advocacy for reducing stillbirths and newborn deaths. It represents a rich platform for spreading knowledge and sharing local, national and international strategies for stillbirth prevention, as it highlights multi- disciplinary approaches to preventing stillbirths in all its complexity.

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14
Q

What are some ways we can predict preterm breaths?

A

We can measure the length of the cervix using a transvaginal USS measurement - a short cervix is associated with an increased risk
We can measure foetal fibronectin levels in vaginal secretions as the increased presence of this is correlated with an increased risk of spontaneous preterm delivery

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15
Q

Risk factors for a preterm birth

A

Previous preterm birth
Multiple preganncy
Tobacco or substance misuse during preganncy
Short inter preganncy interval i.e. <18 months between pregnancies
Women with certain anomalies of reproductive organs e.g. short cervix
Low pregnancy associated plasma protein-A
Infections e.g. UTI or STI
Certain maternal health conditions e.g. diabetes, hypertension etc
Placenta problems
Stress and other psychological factors

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16
Q

Ways of preventing preterm births

A

Improving antenatal care and increasing access
Vaginal progesterone supplementation
Cerclage
Steroids for lung improvement
IV magnesium sulphate for neuroprotection of baby if preterm birth is expected within 24 hours

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17
Q

How do we assess and predict a low birth weight baby?

A

USS to track foetal growth and identify deviations from expected growth curves
Inadequate weight gain by mother can also be a sign (8.9kg)
Previous preterm baby or LBW baby
Anaemic mother

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18
Q

How can be reduce low birth weight babies?

A

Optimise maternal health
Nutritional support
Reduce smoking and substance use in preganncy
Reduce stress
Monitor and intervene for foetal growth restriction
Vitamin D supplementation or aspirin (in the case of pre-eclampsia)

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19
Q

Short term complications of prematurity?

A

Resp - apnoea of prematurity, RDS, bronchopulmonary dysplasia
Cardiovascular - PDA< intraventricular haemorrhage
GI - NEC
Hypothermia
Infections
Jaundice
Anaemia

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20
Q

Long term complications of prematurity?

A

Retinopathy or prematurity
Chronic long disease of prematurity
Neurodeveleopment disorders - CP, sight and hearing issues
Growth and developmental delays
Cognitive and neuromotor impairments
Behavioural and psychomotor problems

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21
Q

How a mother can reduce her risk of a stillbirth

A

not smoking
avoiding alcohol and drugs during pregnancy – as well as increasing the risk of miscarriage and stillbirth, these can seriously affect your baby’s development
attending all your antenatal appointments so that midwives can monitor the growth and wellbeing of your baby
making sure you’re a healthy weight before trying to get pregnant
protecting yourself against infections and avoiding certain foods – see causes of stillbirth
reporting any tummy pain or vaginal bleeding to your midwife on the same day
being aware of your baby’s movements and reporting any concerns you have to your midwife straightaway
reporting any itching to your midwife
going to sleep on your side, not on your back

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22
Q

Definition of LBW?

A

<2500g

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23
Q

What % of term babies have LBW?

A

3%

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24
Q

What is neonatal mortality rate?

A

Deaths that occur within the first 28 days of life following a live birth per 1000 births

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25
Q

What is perinatal mortality?

A

Deaths occurring from 24 weeks to the first 7 days of life (includes stillbirths and early neonatal deaths) per 1000 births

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26
Q

What is infant mortality rate?

A

The number of deaths occurring within the first year of life per 1000 births

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27
Q

Risks of climate changes on children’s health?

A

Food scarcity - poor growth and development, neurological/immune system under-development
Water, sanitation
Air pollution - >90% of children worldwide are exposed to poor air usability - linked to respiratory conditions
Forced migration - mental health concerns and wellbeing impacts of displacement
Pollution and sites of natural resource extraction - insults to lung development
Economic and political instability - poverty, destitution

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28
Q

Links childhood disadvantage and asthma?

A

Children living in disadvantaged circumstances such as deprived areas or overcrowding housing increases the likelihood of developing persistent asthma by 70% with almost 60% of the risk being attributable to early life exposure before the child reaches 3

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29
Q

Impact of childhood asthma on primary care

A
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30
Q

What are health inequities?

A

systematic differences in the health status of different population groups.

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31
Q

“Inequities in health are just a manifestation of inequities in power”

A

Inequities in political power - differential agency and participation in decisions about their health and the circumstances of them e.g. children not having a say in politics
Inequities in economic power - differential distribution of the material conditions needed for a healthy life
Inequalities in social power - a society that disadvantages and marginalises opportunities for health along the axis of race, gender, class, disability etc

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32
Q

How has childhood vaccination changed over time?

A

Decline in uptake in the last couple of years
No vaccinations met the 95% target set by the WHO
Regional uptake of MMR and polio was at its lowest in polio

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33
Q

4 As for the 4 dimensions of the food environment?

A

Accessibility
Affordability
Availability
Acceptability

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34
Q

You’re an F1 in paediatrics, parents com in asking for advice about caring for their baby. What do you do?

A

Direct them to NHS infrom
Ensure they’re in touch with their named community midwife for follow up
Offer them leaflets/infromation on community group meetings
Write letters to local council about concerns e.g. power plant, mould etc
Reach out to other healthcare workers who have had similar consultations

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35
Q

Why a doctor’s voice is distinctive and powerful?

A

Health workers are witnesses to the injustice
Health workers have high public trust
Health workers can interfere with some elements of the system e.g. support cases or engage decision makers
Health workers mostly have some level of privilege which enables them to engage with these issues.

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36
Q

Our role as health workers in public health issues of children?

A

Bearing witness to their conditions and listening to their testimony - to write letters to local authorities, attend public health board meetings etc
Support tenants and members of the community
Collaborating with legal experts to mount a class action lawsuit against unaccountable corporate landlords
Participating in potensts
Undertaking research

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37
Q

What is Fridays for future?

A

A youth-led and organised movement that began in august 2018 after Greta Thunberg and other young activists sat in front of the Swedish parliament every school day for 3 weeks to protests against the lack of action on the climate crisis

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38
Q

Facts on environmental risks to children currently:

A

90% are exposed to poor air quality
29% do not use safely managed drinking water
55% do not use safely managed sanitation services
40% do not have basic handwashing at home
40% live in houses that depend on polluting fuels for cooking/lighting/heating and are exposed to household air pollution

920 million highly exposed to water scarcity
820 million highly exposed to heatwaves

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39
Q

What % of all deaths in children under 5 were caused by ambient and household air pollution causing lower RTI?

A

16%

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40
Q

Issues of poor access to water and sanitation?

A

Diarrhoeal diseases
Long travelling distances to collect water - risk of physical and sexual assault
Mental health repercussion

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41
Q

How will climate change impact food security?

A

Directly - variable rainfall, excessive temperatures, increased pest prevalence, decreased pollinators, poor livestock adaptation, ocean warming and a indication
Indirectly - flooding, forest fires, human migration, conflict, disrupted distribution systems and increased poverty

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42
Q

“The climate crisis is a child rights crisis”

A

Millions of children in the UK and globally do not have access to their determinants of health, including clean air, safe water, sanitation, affordable and nutritious food, and shelter. These are fundamental rights as enshrined in the United Nations Convention on the Rights of the Child, and the importance of children’s rights is recognised in the Paris Agreement and the United Nations Framework Convention on Climate Change, and states have the responsibility to take action.

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43
Q

Roles of paediatricians in the issue of climate change?

A

Engage with urgent issues of climate change and support RCPCH in calling on governments to take action
Keep up to date on climate change and child health
Reduce their own carbon footprint
Consider how they can promote sustainability in their work place
Consider introducing the importance of climate change and sustainability into consultations where appropriate and be able to advise simple, positive steps that families can take to help
Take steps to ensure they educational sessions they attend are sustainable e.g veggie preominent, using tap water, online teaching wherever possible

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44
Q

How many SUDI a year in the UK?

A

~200

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45
Q

Risk factors for SUDI?

A

Young age
Male
Second or later born
SGA or prematurity
Prone and side sleeping position
Unsafe bedding - soft, fluffy, blankets, stuffed toys
Overbuilding or dressing baby in too many layers
Formula fed
Febrile illness past 2-3 weeks
Parental smoking
Unsafe sleeping places e.g. bed sharing

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46
Q

Guidance for parents to prevent against SUDI?

A

Breast milk
Immunise baby
Sleep in same room but different bed for the first 6 months
Putting baby to sleep on back
Baby’s head and face uncovered with no pillows/toys/blankets in the bed
Place baby in feet to foot position
Firm, waterproof mattress

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47
Q

Outline the newborn screening programme?

A

NIPE within 72 hours of birth and is repeated at 6-8 weeks
Newborn hearing test - automated otoacoustic emission test or sometimes automated auditory brainstem response test
Newborn blood spot test - sickle cell, CF, congenital hypothyroidism, inherited metabolic diseases, severe combined immunodeficiency

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48
Q

Outline the screening for congenital dysplasia of the hip?
Why is it important?
Hiw common is it?

A

Screens for DDH in newborns and at 6 week check with ortolani and Barlow manoeuvre.
If 1st degree FHx of hip problems in early life, multiple pregnancy or breech at or after 36/40 then USS is done also
If infant >4.5 months then XR is first line

Important so conservative measures can be taken to treat it e.g. pavlik harness. Otherwise if older they may require surgery. It should reduce the burden of hip dysplasia-related disabilities
DDH affects 1-3% of newborns

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49
Q

What is chemo prophylaxis?

A

the administration of a medication for the purpose of preventing disease or infection e.g. ciprofloxacin/rifampicin for meningitis

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50
Q

What vaccines does a child get at 8 weeks?

A

6 in 1 vaccine (diphtheria, hep B, Hib, polio, tetanus, pertussis)
Rotavirus
Men B

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51
Q

What vaccines does a child get at 12 weeks?

A

6 in 1 vaccine (diphtheria, hep B, Hib, polio, tetanus, pertussis)
Rotavirus
Pneumococcal

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52
Q

What vaccines does a child get at 16 weeks?

A

6 in 1 vaccine (diphtheria, hep B, Hib, polio, tetanus, pertussis)
Men B

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53
Q

What vaccines does a child get at 1 year?

A

Hib/Men C
MMR
Pneumococcal
Men B

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54
Q

What vaccines does a child get at 3 years 4 months?

A

MMR
4 in 1 pre-school booster (diphtheria, polio, tetanus, pertussis)

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55
Q

Common concerns about vaccination

A

Immune system being weakened by relying on vaccines
The vaccine gives the child the disease
Their kid not needing vaccines because all other kids in school are immunised
Getting lots of vaccines at once can harm the baby
Why do healthy kids need to be immunised
Vaccines causing bad reactions
Vaccines causing autism
Thimerosal in vaccines causes autism
Will rotavirus vaccine give the baby intussuseption
Vaccines causing SIDS
Why kids need vaccines for diseases that have been eliminated

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56
Q

Outline the effects of altered life expectancy at a time when a young person is becoming independant of parental control?

A

Over-acceptance - letting illness take over
Denial - treatment poorly adhered to
Emotional effects
Family effects - may create tension and long term issues
Social - rebellion, peer relationships and self image affected, side effects of meds affecting appearance e.g. short stature
Life expectancy can influence life choices and decision making processes
May lead to delayed milestones e.g. marriage, parenthood, career
Can impact long term planning leading to prioritisation of goals
Psychological effects
Influences parental attitudes towards their child’s independance
Parents may adjust their guidance based on societal perceptions of life experience e.g. encouraging more risk taking behaviours

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57
Q

Outline the optimum transition from children’s to adult services?

A

Start planning for this transition at 13-14 years old
Starting the transition between 16-18
Involve all the services e.g. health and social care, mental health, education, finances, work, housing
Transition is an ongoing process and tailored to suit the child’s needs
(Look at lecture notes from scarbs placement)

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58
Q

MDT for a child with developmental delay?

A

Paediatrician in Child Development and Neurodisability
Nursing Co-ordinator
Orthoptist (eye test)
Speech and Language Therapist
Physiotherapist
Occupational Therapist
Clinical Psychologist
Educational specialist in SEN
Social worker
Family members

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59
Q

What are the top 3 causes for hopsital admission due to childhood accidental injury?

A

falls, poisoning, injury from object

Drowning and thermal injuries are also high up
Related to socioeconomic deprivation

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60
Q

What is the concept of advocacy for a healthy lifestyle in children and young people and the protection of their rights?

A

Advocacy is supporting a child to express their own needs and views and to make informed decisions on matters which influence their lives. Children and young people have the right to access serources and opportunities that enable them to live healthily
Protects rights to health, safety, education and development

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61
Q

Legal issues regarding consent and confidentiality in children?

A
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62
Q

Ethical issues regarding consent and confidentiality in children?

A
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63
Q

What is the healthy child programme?

A

It is a public health initiative that aims to promote the health and well being of children aged 0-19. Delivered by an MDT of HCP
Provides a framework for delivering preventative health services and support to families to ensure children have the best start in life
It includes antenatal care, newborn health checks, immunisations, developmental monitoring, health education and promotion, early intervention and supportm promotes oral health, reduces childhood obesity, make sure children are prepared for school, support development of healthy relationships and good sexual and reproductive health

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64
Q

Role of health promotion programmes in preventing dental decay in children?

A

Free NHS dental check ups
Fluoridation of water to help strengthen tooth enamel and reduce the risk of decay
NHS dental health education resources on proper oral hygiene practices
Childsmile programme in Scotland
Oral health promotion in school
Campaigns e.g. National Smile Month

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65
Q

Role of health promotion programmes in preventing smoking in children?

A

Tobacco and Vapes Bill - This will mean anyone who turns 15 or younger in 2024 will never legally be sold tobacco products. important as 80% of smokers start before the age of 20
Tobacco advertising and promotion act e.g. bans on tobacco advertising
Plain packaging legislation with prominent health warnings and graphic images depicting the harms of smoking
Smoke-free legislation in public places
School=based education programmes
Offering support services for smokers
Tobacco control policies e.g. tobacco tax, restricting sale to minors

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66
Q

Role of health promotion programmes in preventing accidents in children?

A

Child safety week organised by the Child Accident Prevention Truist
Home safety assessments for parents to identify potential hazards
Road safety education
Water safety campaigns
Fire safety education
Playground safety
First aid training for parents/carers/teachers

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67
Q

Role of health promotion programmes in preventing obesity in children?

A

Change4Life campaign
Healthy eating in schools - free fruit and veg etc
Physical activity promotion e.g. daily mile
Sugar reduction campaigns
Family based interventions eg. Cooking classes
Healthcare provider iinput e.g. obesity screening, counselling pt on healthy lifestyle behaviours
Healthy start - vouchers for healthy food

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68
Q

Role of health promotion programmes in preventing SUDI in children?

A

Back to Sleep campaign by the Lullaby Trust
Education for parents and caregivers
Healthcare provider training
Community outreach and support - home visits, supporting bereaved families
Public awareness campaigns

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69
Q

Risk factors for childhood asthma?

A

Antenatal - maternal smoking, viral infection during pregnant e.g. RSV
Low birth weight
Not being breastfed
Maternal smoking around child
Exposure to high concentrations of allergens e.g. house dust mite
Personal or FHx atopy
Hygiene hypothesis - Reduced exposure to infectious agents in childhood prevents normal development of the immune system resulting in a Th2 predominant response

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70
Q

How to identify people with asthma who are at increased risk of poor outcomes?

A

Non-adherence to asthma meds
Psychosocial meds
Repeated episodes of unscheduled care for asthma

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71
Q

What is this window of opportunity to prevent asthma in early life?

A

There is a critical period during infancy and early childhood when interventions may have the greatest impact on reducing the risk of developing asthma or modifying its course. This concept is based on the understanding that early life exposures and immune system development play crucial roles in the pathogenesis of asthma.

Prenatal - e.g. stopping maternal smoking
Early childhood e.g. reduced allergen exposure, resp infections,breastfeeding

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72
Q

Measures in the community to reduce the risk of childhood asthma?

A

Education and awareness campaigns e.g. at school
Indoor air quality improvement eg. Effective ventilation, addressing Mold, smoke free
Reducing environmental pollution
Promoting physical activity
Allergen reduction strategies
Support for smoking cessation
School based interventions e.g. staff training on asthma management, individualised asthma action plans

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73
Q

What are barriers to improving asthma management?

A

Partnership between pt and HCP - poor communication, lack of consistency in advice given by GPs, lack of continuity of care
Issues around meds - pt believing med are unsafe, reluctant to use meds regularly, reluctant to use preventative inhaler, problems accessing meds
Education about asthma and its management - lack of understanding, inability to identify triggers
Health beliefs e.g. not accepting diagnosis, belief that disease is only present when symptomatic, embarrassed to use inhalers in public
Self management interventions - not using action plans
Comorbidities - managing asthma may not be a priority, meds can have undesirable effects on other conditions, may not adhere to meds if too many meds
Mood disorders and anxiety - may neglect sleep management, stress
Social support - family members under/overeact to symptoms, family members nagging about meds, employers may not employ people with asthma, stigma
Non-pharmacological measures
access to healthcare 0 difficult getting appointments, costs etc
Professional factors - school policies can be unclear on how to manage asthma, poor communication between HCPs/parents/teachers, limited aviability of school nurses

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74
Q

What is herd immunity?

A

the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection

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75
Q

2 main reasons for vaccine failure?

A

Failure of vaccine delivery system to provide potent vaccines properly
Failure of the immune response

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76
Q

How can we deal with vaccine related side effects?

A
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77
Q

What is the cut off for diabetic eye screening in children?

A

Age of 12 and older
Unlikely to have it before age 12

78
Q

What vaccines does a child get at 12-13 years?

A

HPV

79
Q

What vaccines does a child get at 14 years?

A

3 in 1 teenage booster (tetanus, diphtheria, polio)
MenACWY

80
Q

How common is hearing loss in babies?

A

1-2 babies in every 1,000 have permenant hearing loss in 1 or both ears
This is 1 in 100 babies who have spent >48 hours in ICU

81
Q

Why is it important to diagnose newborn hearing loss early?

A

Better chance of developing language, speech and communication skills
Helps with their development and interaction with family/carers from a young age

82
Q

When is the newborn hearing test done?

A

In the first 4-5 weeks ideally
Can be done up to 3 months

83
Q

Outline the newborn hearing screening?

A

Automated otoacoustic emission test is done
If this is abnormal then automated auditory brainstem response test is done
Results are given immediately

84
Q

Describe the automated otoacoystic emissions test?

A

A small soft-tipped earpiece is placed in your baby’s ear and gentle clicking sounds are played. The presence of a soft echo indicates a healthy cochlear
This only takes a few minutes

85
Q

Describe the automated auditory brainstem response test?

A

This involves placing 3 small sensors on your baby’s head and neck. Soft headphones are placed over your baby’s ears and gentle clicking sounds are played. This test takes between 5 and 15 minutes.

86
Q

what are the problems if hearing loss is not detected in a newborn

A

Speech and language delayed
Academic diffiuclties
Social and emotional challenges
Behavioural issues
Missed developmental milestones
Increased risk of accidents

87
Q

how is newborn hearing loss treated

A

Hearing aids
Cochlear implants

88
Q

What is the criteria to be severely sight impaired?

A

visual acuity of <3/60 with full visual field
visual acuity between 3-6/60 with a severe reduction in field of vision
Visual acuity of 6/60 or above but with a very reduced field of vision

89
Q

What support is available to the deaf blind?

A

Teaching alternative communication methods - Deafblind manual, block alphabet, BSL, braille
Training to use a long cane or guide dog or provision of a communicator guide
Vision aids - glasses, task lights, magnifying lenses
Hearing aids and implants
Support groups e.g. Sense and Deafblind UK and National Deaf Children’s Society
Benefits and money - Disabilty Living Allowance, Personal Indepdnance Payment

90
Q

What factors affect the rates of perinatal and noenatal mortality in the UK?

A

Socio-economic deprivation
Ethnicity
Gestational age
Congenital malformations/chromosomal abnormalities
LBW
Maternal age - teenage pregnancies
Maternal smoking
Post natal factors e.g. not breastfeeding

91
Q

Short and long-term complications of LBW?

A

Increased risk of infant mortality
Respiratory disorders e.g. surfactant deficiency
Cardiovascular problems e.g. PDA
Intracranial lesions e.g. hydrocephalus
GI problem e.g. NEC
Retinopathy of prematurity
Chronic lung disease of prematurity
Neurodevelopment disorders e.g. CP, hearing loss, educational difficulties
Raises the risk of diabetes, stroke heart disease in adulthood

92
Q

Role of vaginal progesterone in preventing preterm births?

A

Prophylactic vaginal progesterone can be offered to women with history of spoentsous preterm birth/loss and a short cervix
It’s startedt between 16+0 and 24+0 and continued until at least 34/40
It inhibits contractions of the myometrium

93
Q

Role of magnesium sulphate in preventing preterm births?

A

NICE guidance says give IV magnesium sulphate for neuroprotectin if baby between 24+0-29+6 (consider if 23 weeks or 30-34 weeks) and established preterm labour or planned preterm birth within 24 hours

To reduce risk of CP

94
Q

What does the Guthrie test test for?

A

SCD
CF
Congenital hypothyroidism

Inherited metabolic diseases:
PKU
MSUD
MCADD
IVA
GA1
HCU

In some regions of England they also test for severe combine immunodeficiency

95
Q

What is the criteria to be sight impaired?

A

Visual acuity of 3 / 60 to 6 / 60 with a full field of vision.
Visual acuity of between 6 / 60 and 6 / 24 with a moderate reduction of field of vision, cloudiness in parts of your eye, or your lens has been removed and not replaced with a lens implant
Visual acuity of 6 / 18 or even better if a large part of your field of vision, for example a whole half of your vision, is missing or a lot of your peripheral vision is missing.

96
Q

What is the most prominent risk factor for infant mortlIty?

A

Preterm delivery

97
Q

Primary, secondary and tertiary intervention strategies to reduce the morbidity and mortality of preterm births?

A

Primary (directed to all women) - address maternal nutrition,smoking, alcohol, substance misuse
Secondary (reducing existing risk) - antenatal care accessible to all women
Tertiary - interventions where complications arise e.g. treatment with antenatal corticosteroids, too lytic agents etc

98
Q

What is given for tocolysis and what is the purpose?

A

Give nifedipine to women 26+0-33+6 (consider 24-26 weeks) weeks of grenancy who have intact membranes and are in suspected preterm labour
This is to delay the delivery of the foetus to prevent preterm birth

99
Q

Outline the role of maternal corticosteroids for preterm births?

A

Offer them to women 24-33+6 weeks (consider if 22-24 weeks or 34-36 weeks) who are in preterm labour
Reduces severity of lung disease of prematurity

100
Q

Predictors of childhood asthma?

A

Family history
Allergies e.g. allergic rhinitis, eczema, food allergy
Premature or LBW
Bronchiolitis or croup
Exposure to substances at work
Hormones - after puberty more common in girls. Some women develop late-onset asthma after menopause
Smoking during pregnancy
Air pollution
Obesity or excessive weight gain in young children
Low vitamin D
Widespread use of antibiotics in early childhood and pregnancy

101
Q

Consider the pt pathway when a pt rings 99 with a wheeze. What barriers are in place which delay rapid diagnosis and treatment?

A

Lack of asthma knowledge in families and HCP
Under-use of preventative meds
Non-acceptance or denial about asthma diagnosis
Over-reliance on ED management
Communication problems
Non-adherence to meds
Use of complementary therapies

102
Q

Pathway of care for a child presenting to the Emergency Department when there is a concern of Physical Abuse or Neglect

A

Identify problem
Discuss with senior ans consider any medical cause
Document concern in notes. Explain concern to carers. Make telephone referral to social work. Complete and send a notification of concern
If they have an injury requiring Tx or place of safety, admit under appropriate speciality for shared care with CPS. Otherwise refer to CPS

103
Q

What is gillick competency

A

The principle used to judge capacity in children under 16 to consent to medical treatment
They must be able to understand the issue, the risks, any advice and alternative options. They should be able to explain a rationale around their reasoning and decision making

104
Q

Fraser guidelines

A

These guidelines apply specifically to advice and Tx about contraception and sexual health for children <16

the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).
the young person understands the advice being given.
the young person’s physical or mental health or both are likely to suffer unless they receive the advice or treatment.
it is in the young person’s best interests to receive the advice, treatment or both without their parents’ or carers’ consent.
the young person is very likely to continue having sex with or without contraceptive treatment.

105
Q

If a 15 year old girl confides in you that she thinks she’s pregnant…
Do you have to report this sexual activity to local safegaurding services?
What if you find out her partner is 18?
Must you inform the parent/legal guardian?
Does she have a right to keep her pregnancy confidential?
Can she have an abortion without a legal guardians consent?

A

You do not have to report this to local safegaurding
Then you must report it to the police as this is child sexual exploitation
You should not inform any carers as she has right to confidentiality provided she is gillick competence so she has this right
Yes she can have an abortion without a legal guardian provided she is gillick competent

106
Q

What health promotion was put in place from the childhood obesity strategy from 2011?

A

Soft drinks industry levy
Doubling primary PE and putting more money a year into school healthy breakfast clubs
Taking out 20% of sugar in products
A new nutrient profile model to determine which products are healthy
Making healthy options available in the public sector e.g. hospitals and leisure centres
Healthy Start Scheme - provides voichers to LIC families which can be exchanged for fresh produce
He;ping all children enjoy 1 hour of physical activity a day
Making school food healthier
Clearer food labelling

107
Q

How has perinatal mortality changed over the last 5 years?

A

Reduced by 15%
Stillbirth and neonatal mortality has reduced

108
Q

Pathway of care for a child presenting to the Emergency Department when there is a concern of sexual abuse

A

Identify
Document concerns. Make referral to social work. Complete and send a notification of concern. Admit.
Refer to CPS
Contact police - social work may do this

109
Q

Definition of overweight in children?

A

If <5… Weight-for-height >2SD above WHO child grow standards median
If 5-19… BMI-for-age >1SD above WHO growth reference median

110
Q

Definition of obesity in children?

A

If <5… Weight-for-height >3SD above WHO child grow standards median
If 5-19… BMI-for-age >2SD above WHO growth reference median

111
Q

How common is childhood obesity?

A

In 2022, 37 million children <5 and 390 million children aged 5-19 where o weight
Prevalence has risen dramatically

Obesity prevalence is about 9% in reception children and 23% in year 6

112
Q

How does deprivation affect childhood obesity prevalence?

A

For children in the most deprived areas, obesity prevalence was 2x as high compared with those in the least deprived areas.

For Reception children living in the most deprived areas the prevalence of obesity was 12.4%, compared with 5.8% of those living in the least deprived areas.
For children in Year 6 living in the most deprived areas, the prevalence of obesity was 30.2%, compared with 13.1% of those living in the least deprived areas.

113
Q

What is The Green Book?

A

A book on immunisation against infectious disease

114
Q

What is primary and secondary vaccine failure?

A

Primary - when the individual fails to make an initial immunological response to the vaccine
Secondary - when the individual responds initially but then protection wanes overtime

115
Q

What are AEFIs?

A

Adverse Events Following Immunisation

116
Q

What are the 4 classifications of AEFIs?

A

Programme-related e.g. wrong dose, beyond expiry date etc
Vaccine-induced - local reactions, fever, anaphylaxis
Coincidental - e.g. if a p developed a cold with coryzal symptoms following flu vaccine
Unknown - not one of the above

117
Q

What are common vaccine-induced AEFIs?

A

Pain, swelling, redness at injection site
Local -
Systemic - fever, malaise, myalgia, irritability, headache, loss of appetite

118
Q

Managing common vaccine-induced AEFIs?

A

Paracetemol or ibuprofen for fever

119
Q

What is thiomersal?

A

A mercury-based compound used as a preservative in the manufacture of some vaccines for many years
In the UK none of the routine vaccines contain this!
Concerns are about hypersensitivity reactions and ??neurodeveliopmental disorders

120
Q

How common is childhood asthma UK?

A

1 in 11
1 million children in the UK are recieving Tx for asthma
12% of UK population have been diagnosed with asthma but some may grow out of condition

121
Q

What % of babies have a LBW?

A

3

122
Q

What % of babies first feed is breast milk?

A

57%

123
Q

When will children’s hearing be tested?

A

Newborn - within 4 weeks
From 9 months-2.5 years
At 4-5 years old

124
Q

What hearing test is used for children 6 months-2.5 years old?

A

Visual reinforcement audiometry

125
Q

What hearing test is used for children 1.5 - 5 years old?

A

Play audiometry

126
Q

What is visual reinforcement audiometry?

A

Sounds are presented to sound and baby is taught to link sound to a visual reward. The volume and pitch of the sound will be varied to determine the quietest sound the child can hear

127
Q

What is play audiometry?

A

Sound is played through headphones or speakers and child will be asked to perform a simple task when they hear th sound e.g. putting a ball in a bucket
The volume and pitch of the sound will then be varied to determine the quietest sound the child can hear

128
Q

What is pure tone audiometry?

A

Aka sweep test
A machine generates sounds at different volumes and frequencies. The sounds are played though headphones and child is asked to respond hence they hear them by pressing a button. By changing the level of the sound the tester can work out the quietest sound the child can hear

129
Q

When hearing test is used for children >5?

A

Pure tone audiometry

130
Q

Which babies qualify for the BCG vaccine?

A

Live in an area of the UK where there is high risk of getting TB (>=40/100,000)
They have a parent or grandparent born in a country where there is high risk of getting TB
They’ll be going to live or stay in a country where there is high risk of TB
They have been living with or in regular contact with someone who has/had TB

131
Q

When does a baby recieve a BCG vaccine if they require it?

A

At 28 days old

132
Q

When is the BCG vaccine indicated for children aged 1-16?

A

If they have a parent/grandparent born in a country where there is higher risk of TB
They were born or lived for at least;east 3 months in a country where there is higher risk of getting TB
They have been living with or regular close contact with someone who has/had TB

133
Q

Which people at risk of TB though work may need the BCG vaccine?

A

Health worker working with people with TB
Working in a lab where you may come into contact with TB
You work with animals thta could be infected with TB
You work with people who may be more at risk of TB e.g. homeless people, asylum seekers

134
Q

Who cannot have the BCG vaccine?

A

Pregnant
Already had the vaccine or TB
Any anaphylaxis to ingredients
Babies whose mother had biological medicines to suppress immune system during pregnancy
Babis with weakened immune system
Children and adults with weakened immune system

135
Q

How common are baby’s diagnosed with congenital anomalies?

A

1 baby for every 45 births
1 in 60 live births

136
Q

What % of babies born with a congenital anomaly were born alive?

A

75%

137
Q

What % of babies born with a congenital anomaly had these detected antenatally?

A

65%

138
Q

Total birth prevalence in England for trisomy conditions?

A

Down syndrome 1 in 377
Edwards syndrome 1 in 352
Pataus syndrome 1 in 3707

139
Q

How do rates of genetic congenital anomalies in babies of mothers over 40 compare to women under 20?

A

They are 7 times higher

140
Q

What gender does asthma affect more?

A

In childhood it affects boys more than girls
In teens and early adulthood it affects women more often and more seriously than men.

141
Q

What is thr Children’s Act 1989?

A

This act allocates duties to local authorities, courts, parents and other agencies in the UK to ensure children are safeguarded and their welfare is promoted

142
Q

What is the Children’s Act 2004?

A

An amendment to the 1989 act to state there is an obligation to share infromation and cooperate to safeguard and promote the welfare of children.

143
Q

What is Start4Life?

A

Start4Life is a public health England national programme that delivers NHS advice and practical guidance to pregnant women and new mums. aim Is to give babies the best start to life
it provides information on breast feeding in particular

144
Q

after having the TB vaccine in your arm, how long should you wait before having a vaccine in that same arm? why?

A

3 months
it can cause swelling of the glands

145
Q

outline hearing screening programme different tests

A

newborn - AOAE and AABR
6 months - 2.5 years = visual reinforcement audiometry
1.5-5 years = play audiometry
>3 or school entry = pure tone audiometry

146
Q

congenital infections that can cause hearing loss?

A

CMV
rubella

147
Q

what is the leading charity for blindness?

A

Royal National Institute of Blind People

148
Q

changes you can make to your home to adapt to blindness

A

big button telephones
use of the internet through computer/phone
community alarm
bright lighting
painting the house in 2 tone colour

149
Q

who can help with employment if you are registered blind?

A

the government’s Access To Work Scheme
the Equality Act

150
Q

Role of the school in managing child mental health?

A

Tackling/preventing stigma
Education on mental health topics
Tackling and preventing bullying

151
Q

do stillbirths require a post-mortem?

A

no this is up to the woman and it requires written informed consent
but by law the stillbirth has to be registered within 42 days

152
Q

what is the Children and Young Peoples Transformation Programme?

A

Programme was established improve outcomes and reduce health inequalities for all those aged 0 – 25
had a focus on improving asthma outcomes in the UK

153
Q

Role of the health visitor?

A

specialist community public health nurses, registered midwives or nurses. They specialise in working with families with a child aged 0 to five to identify health needs as early as possible and improve health and wellbeing by promoting health, preventing ill health and reducing inequalities.

154
Q

which congenital anomaly had the highest prevalence?

A
  1. congenital heart anomalies
  2. genetic conditions
155
Q

Role of social services?

A

Social workers receive information (referrals) from other professionals and the public if they are concerned that a child is being harmed or at risk of being harmed. Social workers then have a duty by law to investigate the situation or circumstances that have led to the referral.

156
Q

Role of educational psychologist?

A

concerned with children’s learning and development. They use their specialist skills in psychological and educational assessment techniques to help those having difficulties in learning, behaviour or social adjustment.

157
Q

Impacts of chronic conditions on a child?

A

Time off school and difficulty completing school work -> worse academic performance
Feeling different to friends
Needing to plan the day around meals/meds
Increased dependance on parents at a time when independance is normally developing
Impact on employment
Life expectancy potentially lower

158
Q

What factors affect how a child will react to a diagnosis of a chronic illness?

A

Nature of illness and Sx
Stage of disease
Age of child
Temperament
Family factors
Intellectual capacity

159
Q

What is the harm principle?

A

people should be free to act however they wish unless their actions cause harm to somebody else.

160
Q

Examples of live vaccines?

A

rotavirus
MMR
nasal influenza
shingles
chicken pox
BCG

Yellow fever
Oral typhoid

161
Q

Examples of inactivated vaccines?

A

polio
Hep A
IM influenza

rabies
Japanese encephalitis

162
Q

Examples of toxoid vaccines?

A

Tetanus
Diphtheria
Pertussis

163
Q

Examples of conjugate vaccines?

A

PCV
Hib/Men C
MenACWY

164
Q

examples of recombinant vaccines

A

hep B
HPV
Men B

165
Q

what are live attenuated vaccines?

A

vaccines containing whole bacteria/viruses that have been weakened so that they create a protective immune response but do not cause disease in healthy people

166
Q

what are inactivated vaccines?

A

they contain whole bacteria/viruses that have been killed or altered so that they cannot replicate
they can’t cause diseases against which they protect even in people with severely weakened immune responses. however, they do not always create such a strong or long-lasting immune response as live attenuated vaccines

167
Q

what are subunit vaccines?

A

these vaccines contain 1 or more specific antigens from the surface of the pathogen
these do not create such a strong or long-lasting immune response as live attenuated vaccines so usually require repeated doses initially and subsequent booster doses
adjutant are often added to help strengthen and lengthen the immune response to a vaccine

168
Q

what are recombinant protein vaccines?

A

these are vaccines made using bacterial or yeast cells to manufacture them. A small piece of DNA is taken from the virus or bacterium against which we want to protect and inserted into the manufacturing cells.

169
Q

what are conjugate vaccines?

A

vaccins made from inactivated versions of the toxins that the bacteria can release

170
Q

what are conjugate vaccines?

A

In most conjugate vaccines, the polysaccharide is attached to diphtheria or tetanus toxoid protein. The immune system recognises these proteins very easily and this helps to generate a stronger immune response to the polysaccharide.

171
Q

What is the valency of a vaccine?

A

The number of disting antigenic components or setotypes a vaccine can protect against
E.g. monovalent vaccines only confer immunity against 1 strain of pathogen e..g measles, whereas the influenza vaccine is a polyvalent vaccine

172
Q

Why can the first dose of rotavirus vaccine not be given after 14+6 and the second dose after 23+6 weeks of life?

A

Risk of intussusception

173
Q

Which route is influenza given in children?

A

Intarnasal (which is a live vaccine)

174
Q

Contraindications of the influenza vaccine?

A

immunocompromised
aged < 2 years
current febrile illness or blocked nose/rhinorrhoea
current wheeze or history of severe asthma (BTS step 4)
egg allergy
if the child is taking aspirin due to a risk of Reye’s syndrome

175
Q

Contraindications to MMR?

A

severe immunosuppression
allergy to neomycin
children who have received another live vaccine by injection within 4 weeks
immunoglobulin therapy within the past 3 months

176
Q

How should you treat a baby born to a mother chronically infected with hepatitis B or those who have had acute hepatitis B during pregnancy?

A

Vaccination within 24 hours, at 4 weeks and 1 year
Hepatitis B immunoglobulin at birth?

177
Q

When is Guthrie test done?

A

On day 5

178
Q

When is the NIPE done?

A

Within 72 hours of birth
At 6-8 weeks

179
Q

What is chemoprophylaxis?

A

Administartion of a medication for the purpose of preventing disease or infection

180
Q

Examples of diseases that require chemoprophylaxis?

A

Malaria
TB
Meningococcal disease
HIV
Pertussis
Neonatal GBS

Diphtheria - rarely due to vaccine
Hib - rarely due to vaccine

181
Q

Risk of giving vaccines to preterm babies

A

The risk of apnoea following vaccination is increased in preterm babies, particularly in those born at or before 28 weeks gestational age.
If babies at risk of apnoea are in hospital at the time of their first immunisation, they should be monitored for respiratory complications for 48–72 hours after immunisation.
If a baby develops apnoea, bradycardia, or desaturation after the first immunisation, the second immunisation should also be given in hospital with similar monitoring.

182
Q

Do you need consent from the parent/carer to make a referral to children’s social care?

A

No!! But its good practice to inform them unless yo have a reason to believe that doing so would increase the risk to the child

183
Q

How is childhood deafness prevented (WHO)?

A

Early identification through good screening programmes
Improved neonatal care to prevent complications which can cause deafness
Good immunisation and infection prevention that can cause up to 30% of cases e.g. MMR
Limit use of ototoxic drugs in pregnant woman and child

184
Q

Fractures which are highly specific to NAI/

A

Metaphyseal fractures
Occult rib fractures, especially posterior
Spiral fractures
Fractures of differing ages and no documentation of caregivers seeking medical attention

Others:
Skull fractures
Scapular fractures
Sternal fractures
Outer 1/3rd clavicle fracture
B/L fracture
Any fractures in children without a medical condition

185
Q

Laws on a child aged 16-17 consenting and refusing treatment?

A

They’re assumed to have capacity and be competent so they can consent to treatment
They can refuse treatment but this can be overrided if parents or doctors think the refusal is not in their best interests. If someone with parental responsibility consents, doctors can give Tx. If the doctor wants to override the child and parents’ refusal of treatment, they must go to the courts

186
Q

If a child aged 16-17 consents to treatment but their family doesnt want them to have this treatment, can they stop this treatment?

A

No a child aged 16-17 is assumed to be competent so parents cannot refuse treatment for them
This is under the Family Law Reform Act 1969

187
Q

Are children under 16 presumed competent?

A

No not until they have proven Gillick competence

188
Q

Laws on children under 16 with gillick competence on consenting and refusing Tx?

A

They can consent to treatment but they cannot refuse treatment

189
Q

Laws on children under 16 who are not gillick competence on consenting and refusing Tx?

A

They cannot consent or refuse treatment
Someone with parental responsibility has to be involved

(Note if someone cannot be reached and its an emergency situation, a Dr should not delay treatment and put the child at risk they should just act in their best interests)

190
Q

If a doctor thinks a child needs a blood transfusion but both the child and person with parental responsibility refuse, what is done?

A

The doctor can go to the court and they can consent on behalf of the child as this is in the child’s best interest

191
Q

When can consent from a child be overruled?

A

If a young person refuses treatment, which may lead to their death or a severe permanent injury, their decision can be overruled by the Court of Protection.

192
Q

Situations where it is not appropriate to involve the parents in safegaurding concerns?

A

If suspected sexual abuse
If it will put anyone in additional risk of significant harm
If suspected fabricated or induced illness
If concerns about FGM

.HEALTH&SOCIETY Y4 (17 decks)

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