Paediatrics

Question 1

What 4 main anatomical reasons result in children being more likely to suffer from respiratory issues

Answer 1

1. Narrower airway
2. Shorter airway
3. Tonsils disproportionately large
4. Epiglottis disproportionately large

Question 2

Why do children have less surface area for gas exchange?

Answer 2

They have fewer alveoli than adults

Question 3

Why does the larynx sit higher and further forward in children?

Answer 3

Because they have a ‘shorter neck’

Question 4

Children are obligate ……….. breathers?

Answer 4

Nose

Question 5

What structure is primarily drives breathing in children?

Answer 5

The diaphragm

Question 6

Why are children’s chest walls easily collapsible?

Answer 6

Cartilaginous skeleton has not fully ossified

Question 7

What can children’s immature neurological reflexes for blood gas lead to more easily?

Answer 7

Acidosis

Question 8

Why do children consume more energy at rest?

Answer 8

Through the work of breathing

Higher BMR

Question 9

How many times more oxygen do children consume compared to adults?

Answer 9

2x

Question 10

What can be triggered by laryngeal stimulation in children?

Answer 10

The aponeic response

Question 11

What four main things can activate the aponeic response?

Answer 11

1. Foreign bodies
2. Airway adjuncts
3. Infection
4. Irritation

Question 12

How are childrens ribs orientated differently?

Answer 12

They are more horizontal - restricting upward movement

Question 13

What two cavities does the diaphragm separate?

Answer 13

The abdominal and thoracic cavities

Question 14

Up to what age approximately are children diaphragmatic breathers?

Answer 14

~5years old

Question 15

Why does the paediatric diaphragm have a reduced range of movement?

Answer 15

It is anatomically flatter than an adults

Question 16

What 2 other properties of the paediatric diaphragm lead to issues?

Answer 16

1. Lack of type 1 muscle fibres (resistance to fatigue and fast reaction)
2. Abdominal organs cause resistance on inspiration

Question 17

Why do chest retractions occur in respiratory distress?

Answer 17

A reduction of pressure in the chest and a less self supporting rib cage

Question 18

What two locations will paradoxical breathing primarily be seen?

Answer 18

1. Substernally

2. Below the scapula

Question 19

What happens to respiratory rate as age increases?

Answer 19

It decreases

Question 20

At birth how much of the heart is made up of myocardium?

Answer 20

~30%

Question 21

What two properties result from there being less myocardium?

Answer 21

1. Less mass

2. Less compliance

Question 22

Why do the myocardium cells have less compliance in children?

Answer 22

There are fewer mitochondria in paediatric myocardium compared to adults

Question 23

Why do children have the capacity for less stroke volume?

Answer 23

Anatomically smaller hearts that are less pliable

Question 24

Is cardiac output higher in children than in adults?

Answer 24

Yes

Question 25

What is the equation for cardiac output?

Answer 25

HR x SV

Question 26

Why is heart rate in children less sensitive to adrenaline and noradrenaline?

Answer 26

Due to the lack of receptors

Question 27

Are heart murmurs common in children?

Answer 27

Yes (innocent murmurs)

Question 28

Why are children at an increased risk of dehydration?

Answer 28

Due to their volume:surface area ratio their loose more fluid Tachypnoeic

Question 29

List some signs and symptoms of dehydration in children

Answer 29

- Lack of wet nappies - Irritable - Sunken eyes - Tachycardia - Lethargy - Dry membranes - Skin turgour (lack of) - Low B.P.

Question 30

What happens to intersitial fluid distribution as a child ages?

Answer 30

It decreases

Question 31

What does increased extracellular fluid in children increase the risk of?

Answer 31

Dehydration

Question 32

How does a childs anatomically large liver impact respiratory function?

Answer 32

Causes pressure on the Diaphragm

Question 33

Why are children more susceptible to hypoglycemia?

Answer 33

Liver enzymes are immature Store less glycogen Limited muscle (less AA stores)

Question 34

What are foetal bones layed down as initially in development?

Answer 34

Cartilage

Question 35

Why must one be cautious when gaining IO access in paeds?

Answer 35

The presence of growth plates in long bones

Question 36

What is the preferred IO site in paediatrics?

Answer 36

Proximal tibia

Question 37

Childrens nervous systems are anatomically complete at birth however what does not occur fully until age 7?

Answer 37

Full nerve myelination

Question 38

Why do paediatric patients have issues with heat retention?

Answer 38

Their homeostatic mechanisms and reflexes are immature

Question 39

What happens to the number of synapses at a young age?

Answer 39

Increases rapidly as new connections are formed

Question 40

What is synaptic pruning?

Answer 40

The elimination of of excess synapses to increase the efficiency of the neural network?

Question 41

By what % does the number of synapses reduce by between the ages of 2-10 years?

Answer 41

50%

Question 42

How are synaptic connections strengthened in children?

Answer 42

Synapses that are frequently used such as those with sensory, cognitive and motor functions

Question 43

Which synaptic connections are 'pruned'?

Answer 43

Those connections that have been weakly reinforced and no longer are needed for normal functioning

Question 44

Young children are generally able to recover better from brain injury. Why is this?

Answer 44

Extra/redundant synaptic connections that have not been pruned can be used in place of damaged pathways to preserve certain functions

Question 45

Why is Intramuscular injection best avoided in children?

Answer 45

Due to their low muscle mass

Question 46

What is the preferred IM injection site in children?

Answer 46

Anterolateral thigh (vastus lateralis)

Question 47

Children have less fat stores than adults. How does this affect doses given?

Answer 47

Less drug is taken up into fat thus the dose of fat soluble drugs given is reduced

Question 48

How does a childs increased ECF volume affect drug doses?

Answer 48

Increased ECF leads to drug dilution | Therefore and increased dose/kg is needed

Question 49

Children metabolise drugs via the liver like adults however why are they at increased overdose risk?

Answer 49

The immaturity of the liver and its enzymes | Higher BMR --> Increased dose/kg

Question 50

What can children have impaired drug excretion?

Answer 50

Immature renal function (increased half life - metabolism poor)

Question 51

Why may the use of glucagon be ineffective when treating a hypoglycaemic paediatric patient?

Answer 51

They store less glycogen... therefore have less to be released