Paediatrics Random Source Flashcards
Gross motor milestones
Milestone
3 months Little or no head lag on being pulled to sit
Lying on abdomen, good head control Held sitting, lumbar curve
6 months Lying on abdomen, arms extended Lying on back, lifts and grasps feet Pulls self to sitting Held sitting, back straight Rolls front to back
7-8 months Sits without support (Refer at 12 months)
9 months Pulls to standing
Crawls
12 months Cruises
Walks with one hand held
13-15 months Walks unsupported (Refer at 18 months)
18 months Squats to pick up a toy
2 years Runs
Walks upstairs and downstairs holding on to rail
3 years Rides a tricycle using pedals
Walks up stairs without holding on to rail
4 years Hops on one leg
Features of intusussception
Usually affects 6- 18m , boys > girls
paroxysmal abdominal colic pain
during paroxysm the infant will characteristically draw their knees up and turn pale
vomiting
blood stained stool - ‘red-currant jelly’
sausage-shaped mass in the abdomen
Mx 3 m child with fever >38
Admit!
Features of pertussis
2-3d of coryza and then –
coughing bouts: usually worse at night and after feeding, may be ended by vomiting & associated central cyanosis
inspiratory whoop: not always present (caused by forced inspiration against a closed glottis)
persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures
symptoms may last 10-14 weeks* and tend to be more severe in infants
marked lymphocytosis
Features of measles
RNA paramyxovirus
spread by droplets
infective from prodrome until 5 days after rash starts
incubation period = 10-14 days
Features
prodrome: irritable, conjunctivitis, fever
Koplik spots (before rash): white spots (‘grain of salt’) on buccal mucosa
rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Most common cause of nephropathy in childrem
Minimalchange disease ~ 80%
Features of eppiglottitis
Hib? Have they had full vaccinations
rapid onset
unwell, toxic child
stridor
drooling of saliva
Most common type of congenital diapragmatic hernia
Congenital diaphramatic hernia (CDH) occurs in around 1 in 2,000 newborns. It is characterised by the herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm. This can result in pulmonary hypoplasia and hypertension which causes respiratory distress shortly after birth.
The most common type of CDH is a left-sided posterolateral Bochdalek hernia which accounts for around 85% of cases.
Only around 50% of newborns with CDH survive despite modern medical intervention.
Rfs for ddh
female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity
Infant with fever followed by macpap rash?
Roseola infantum (also known as exanthem subitum, occasionally sixth disease) is a common disease of infancy caused by the human herpes virus 6 (HHV6). It has an incubation period of 5-15 days and typically affects children aged 6 months to 2 years.
Features
high fever: lasting a few days, followed by a
maculopapular rash
febrile convulsions occur in around 10-15%
diarrhoea and cough are also commonly seen
Other possible consequences of HHV6 infection
aseptic meningitis
hepatitis
Rfs for sids
Most common cause of death <1y, most commonly at age 3m
prematurity parental smoking hyperthermia (e.g. over-wrapping) putting the baby to sleep prone male sex multiple births bottle feeding social classes IV and V maternal drug use incidence increases in winter
Define enuresis
Enuresis may be defined as the ‘involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract
Mx enuresis
look for possible underlying causes/triggers (e.g. Constipation, diabetes mellitus, UTI if recent onset)
advise on fluid intake, diet and toileting behaviour
reward systems (e.g. Star charts). NICE recommend these ‘should be given for agreed behaviour rather than dry nights’ e.g. Using the toilet to pass urine before sleep
NICE advise: ‘Consider whether alarm or drug treatment is appropriate, depending on the age, maturity and abilities of the child or young person, the frequency of bedwetting and the motivation and needs of the family’.
Generally:
an enuresis alarm is first-line for children under the age of 7 years
desmopressin may be used first-line for children over the ago 7 years, particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family
please see the link for more details
Bronchiolitis babies referred to hosp when
poor feeding (< 50% normal) lethargy apnoea respiratory rate > 70/min nasal flaring or grunting severe chest wall recession cyanosis oxygen saturation < 94% uncertainty regarding diagnosis
