Paeds 3a Flashcards
(93 cards)
1
Q
Detail the paediatric immunisation schedule
A
2 MONTHS
- 6 in 1
- rotavirus
- PCV
- men B
3 MONTHS
- 6 in 1
- rotavirus
4 MONTHS
- 6in 1
- PCV
- MenB
1 YEAR -Hib/ MenC -MMR PCV Men B
2-8 YEARS OLD
-flu vaccine
3 YEARS 4 MONTHS
- DTP/P
- MMR
GIRLS 12-13
-HPV
14 YEAR OLD
- DTP
- Men ACWY
2
Q
what is screened for in the Guthrie test
When is the Guthrie test carried out?
A
Guthrie test- 5-8 days
- congenital hypothyroidism
- sickle cell disorders
- CF
- 6 inherited metabolic disorders- PKU, MCADD, maple syrup urine disease, isovolaemic aciduria, homocysinuria, glutaric aciduria
3
Q
how will a left to right shunt congenital heart disease present and what are the common causes?
A
Breathlessness
- VSD
- PDA
- ASD
4
Q
how will a right to left shunt congenital heart disease present and what are the common causes?
A
cyanotic
5Ts Truncus arteriosus Transposition of the great arteries tricuspid atresia tetralogy of fallot TAPVC
5
Q
what type of congenital heart disease is common in Downs syndrome?
Signs?
A
Ventricular septal defect
pansystollic murmur
palpable thrill left sternal edge
pulmonary hypertension
Heart failure after 1 week if large
6
Q
Which congenital heart disease?
Continuous machine murmur
treatment?
A
PDA
NSAIDs to close duct
7
Q
List the features of tetralogy of fallot
A
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Vental septal defect
8
Q
which congenital heart defect is associated with each genetic condition? Williams Turners Downs Marfans
A
Williams- aortic stenosis
Turners- coarctation of the aorta
Downs- ASD/ AVSD
Marfans- aortic regurgitation
9
Q
How does heart failure present in infants?
A
Breathlessness on exertion- on feeding
FTT, tachypnoea, tachycardia, sweating, poor feeding, recurrent chest infections, murmurs
10
Q
Difference between stridor and wheeze
A
Stridor- upper resp tract obstruction, inspiratory wheeze
Wheeze- end expiratory polyphony, lower respiratory tract obstruction
11
Q
presentation of croup
common causative agent
treatment
A
<6yo, barking cough, stridor, hoarseness
worse at night
recent fever
red flags: drowsy, cyanosis, altered consciousness–> respiratory distress
cause: RSV or parainfluenza
Treatment: dexamethasone
adrenaline nebuliser if respiratory distress
12
Q
epiglottitis presentation
cause
management
A
2-7yo, sudden onset continuous stridor, child unable to speak or swallow, drooling, little/no cough, muffled voice, respiratory distress, toxic and fever
HiB
Get anaesthetist to intubate
IV cefotaxime
13
Q
Bronchiolitis presentation
cause
management
prophylaxis
A
1-9 months old
coryzal, cough, wheeze, fever, tachypnoea, inspiratory crackles, poor feeding, tracheal tug, cyanosis on feeding
CXR shows hyperinflated lungs
RSV
Management:
most sent home- supportive treatment
humidified oxygen, NG feed, fluids if neccessary,
bronchiodilator nebs
Prophylaxis
Palivizumab
14
Q
Whooping cough presentation
Cause
Diagnosis
Management
A
infants
inspiratory whoop, bouts of coughing ending in vomiting, worse at night, cyanosis, apnoea
Prolonged cough >2weeks
epistaxis (nose bleeds) and subconjunctival haemorrhage
Bordetella pertussis
diagnosis with PCR nasal swabs
management NOTIFIABLE DISEASE azithromycin +/- erythromycin if >1 mo cough if severe admit and isolate vaccinate patient and contacts
15
Q
Describe the pathology of asthma
A
chronic inflammatory disorder causing reversible airway obstruction
- Bronchospasms
- mucosal swelling
- inflammation
- increased mucus production
16
Q
diagnosis of asthma
A
clinical symptoms
Fev1:FVC <70%
bronchodilator reversibility
17
Q
management of asthma
A
STEPWISE
1) inhaled SABA PRN- Beta 2 agonist eg salbutamol
2) inhaled steroid daily- low dose bethamethasone
3) add LABA- salmetarol
4) increased steroid dose
5) oral steroid- prednisolone
18
Q
acute asthma attack management
A
Escalate as neccessary: ABCDE High flow O2 salbutamol nebuliser IV hydrocortisone/ prednisolone IV magnesium sulphate Ipratropium bromide nebuliser IV aminophylline HDU
19
Q
cystic fibrosis gene defect and diagnosis (x3)
A
autosomal recessive defect of CTFR gene on Ch 7
Diagnosis:
- Gutherie heel prick- raised immunoreactive trypsinogen
- sweat test- raised chloride ions
- low faecal elastase
20
Q
presentation fo CF in infancy
A
meconium ileus (vomitting, abdo distension, failure to pass meconium) FTT steatorrhoea malabsorption recurrent chest infections prolonged neonatal jaundice
21
Q
name a mucolytic drug
A
carbocysteine
22
Q
<1yo
regurgitation, distress after feeds, apnoea, aspiration pneumonia, FTT, food aversion, infant ‘spells’- seizure like, haematemesis
Investigations to diagnise
A
GORD
Investigations:
sometimes endoscopy and measure pH
PPI test- give antacids + symptoms improve
23
Q
presentation of pyloric stenosis
metabolic disturbance
A
2-7 weeks of age males>females PROJECTILE VOMMITTING- increasing frequency and force. Not bile stained, no diarrhoea hunger weight loss
Hypochloraemic, hypokalaemic metabolic alkalosis
24
Q
diagnosis and management of pyloric stenosis
A
diagnosis
-test feed and ultrasound- see L–>R peristalisis and olive shaped pyloric mass
management
- IV fluids
- pyloromyotomy
25
intersussuption presentation
3mo-2 years boys>girls
paroxysmal abdo colic pain, knees drawn up to chest, pale, screaming in pain
vomiting- may be billious
mucus and blood in stools- RED CURRENT JELLY STOOL
RUQ abdo mass- SAUSAGE SHAPED
26
Intersussuption investigations and treatment
investigations
- ultrasound abdo: doughnut shape
- X ray: distended small bowel and absence of gas in large bowel
Treatment
Fluid resus
rectal air enema
surgical intervention
27
Necrotising enterocolitis presentation
Management
PREMATURE BABIES
1st few weeks of life
abdo distension, pain, fresh blood in stools, billous vomitting, feeding intollerance
risk of progressing quickly to abdominal discolouration, perforation and peritonitis.
fed with cows milk increases risk
Xray showing gas in gut wall pathomneumonic= pneumatosis intestinalis
also asymetrical dilated bowel loops, bowel wall oedema
MANAGEMENT
Stop feeding, Abx, parenteral nutrition, surgery if perforation
28
Presentation of coeliac disease
Diagnosis
Management
= gluten intollerance causing enteropathy (villous atrophy and crypt hyperplasia)--> malabsorption
2yo, failure to thrive following introduction of cereals into diet
general irritability, diarrhoea, abdo distension and buttock wasting, anaemia
DIAGNOSIS
Jejunal biopsy- flat mucosa
gluten withdrawal--> symptom resolution
Serological tests- IgA and endomysal antibodies
Gluten free diet
29
Presentation of Hirschsprungs disease
presentation
Investigation
=congenital absence of ganglia in segment of colon- poor innervation of bowel
CONSTIPATION
failure to pass meconium within 48 hours of life
older children- abdo distension and constipation
common in DOWNS and M>F
investigations
PR exam- causes explosive discharge of stool and gas
30
List some causes of jaundice
a) in first 24 hrs of life
b) 24hrs-2weeks of life
c) Prolonged
<24 HOURS
- haemolytic disorders- rheusus (coombes test +ve)
- congenital infections- syphilis, herpes, rubella
24 HOURS- 2 WEEKS
- physiological- as fetal RBC lifespan shorter than adults and hepatic bilirubin metabolism less efficient
- breast milk jaundice
PRLONGED- SERIOUS
- infection-sepsis
- hypothyroidism
- billary atresia
- CF
- Hepatitis
31
complication of jaundice
Kernicterus
Bilirubin crosses blood brain barrier--> deposited in basal ganglia- neurotoxic- encephalopathy
seizures, learning difficulties, cerabal palsy, death
32
Signs of dehydration
sunken fontanelle, decreased consciousness, eyes sunken, tearless, dry mucosal membranes, decreased CRT, tachypnoea, tachycardia, low BP, low tissue turgor, oliguria
33
Management of dehydration formulas for children
RESUSITATION
20mls/kg of 0.9% NaCl
CORRECTION OF DEHYDRATION
% dehydration x weight x 10
dehydrated= 5%= 50mls/kg
shocked= 10%= 100mls/kg
MAINTENANCE FLUIDS
100mls/kg for 1st 10 kgs
50mls/kg for next 10 kgs
20mls/kg 20kgs+
add correction and maitenance fluids for amount per 24 hours--> give as vol/hr
34
Which fluid to use?
0.45% sodium chloride + 5% dextrose
or 0.9% sodium chloride + 5% dextrose
if hypoglycaemic- 10% dextrose 2mls/kg stat
35
Neonate- which fluid to use and formulas
10% dextrose (no saline)
```
Days old:
1- 60 mls/kg/day (think like 1 hour)
2- 90mls/kg/day
3- 120mls/kg/day
4+ 150mls/kg/day
```
36
Most common cause of UTI in children
E.COLI
klebsiella
proteus
37
Investigations of a UTI
urine analysis- raised nitrites and leucocytes
urine microscopy
ultrasound- structural abnormalities?
DMSA- shows renal scarring of vesoureteric reflux
38
Treatment of UTI
<3 months
IV amoxicillin + gentamycin
>3 months
trimethoprim/ nitrofurotonin/amoxicillin
39
Presentation of nephrotic syndrome
Cause
Management
```
aged 2-5
nephrOtic
-prOteinuria
-Oedema
-hypOalbuminaemia
-hyperlipidaemia
```
facial, scrotal/vulval, periorbital oedema, ascities
Frothy urine, recurrnent infections, fatigue, malaise
80% caused minimal change disease
MANAGEMENT
-if minimal change- Prednisolone oral 60mg/m2
40
Haemolytic uraemic syndrome presentation
Investigations
Management
most common cause of AKI in children
```
<3yo
prodrome of bloody diarrhoea- E.coli
triad of
-acute renal failure
-thrombocytopaenia
-microangiopathic haemolytic uraemia
```
investigations
FBC and film- fragmented red blood cells- burr cells
U+Es- renal functioning
Stool culture
Management
SUPPORTIVE- not antibiotics
fluid and electrolyte management
41
Presentation of Henoch-schonlein purpura
IgA mediated small vessle vasculitis
Seen in children following an infection- usually URTI
4-6yo
- palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
- abdominal pain
- polyarthritis
- features of IgA nephropathy may occur e.g. haematuria, renal failure
42
what are the 4 areas of development assessed
1) gross motor
2) fine motor and vision
3) speech and language
4) social
43
```
What are some developmental milestones at
6 weeks
6months
9months
12 months
18 months
2 years
3 years
4 years
5 years
```
6 weeks- smiles, stabilises head, eyes track movement
6 months- sits unsupported, palmar grasp, babbles
9 months- crawls, pincer grip, waves bye bye, aware of strangers
12 months- walking, one or two words, understands multiple words
18 months- run, scribbles, 6-12 words
2 years- puts words together in sentences
3 years- draws a circle
4 years draws a square
5 years- hops, throw and catch, count to 10
44
What are the primitive reflexes and when should they be grown out of?
```
Moro (drop head, arms fling out)
Palmar and plantar grasp
atonic neck reflex
rooting
stepping
```
grow out by 6 months
45
Risk factors of cerebral palsy
preterm birth, twins, maternal infection, difficult delivery, vascular occulsion antenatally, meningitis, head trauma, encephalitis, hypoglycaemia
46
Autism presentation
```
communication and language impairment
impairment of social relationships
ritualistic and compulsive phenomenon
hypersensitivty
poor imagination
```
47
Core behaviours of ADHD
| Management
Hyperactivity, inattention, impulsivity
Methylphenidate/ atomoxetine/ dextroampheamine
48
Describe the presentation of each seizure + appropriate management
```
tonic-clonic
absence
West syndrome/ infantile spasms
myclonic
status epilepticus
juvenile myoclonic seizure
febrile convulsion
```
TONIC CLONIC
-limbs stiffen then jerk, LOC-->Valporate
ABSENCE
-brief pauses, eyes roll up, unaware, brought on by hyperventilation (windmill test)-->ethosuxamide (carbamazepine contraindicated
INFANTILE SPASMS
5months, head nodding, arm jerk, eeg shows hypsarrythmia, associated with progressive mental handicap--> prednisolone
MYOCLONIC
suddenly thrown to ground--> valporate
STATUS EPILEPTICUS
>5 mins, not regaining consciousness--> ABCDE, bucal midazolam/lorazopam, recovery postion, give O2
JUVENILE MYOCLONIC SEIZURE
G>B, aged 8-16yo, clumsy in the morning, myoclonic, tonic clonic and absence seizures, worse when tired-->valporate/ lamotrigine
FEBRILE CONVULSION
Single tonic-clonic symetrical generalised seizure lasting <15 mins, high fever, normal developing child 6mo-5 years--> if >5 mins give IV lorazepam. Unlikely to lead to epilepsy
49
Name 2 diagnostic antenatal genetic tests
chorionic villous sampling
done at 11-13 weeks
placental biopsy of fetal cells
2% risk of miscarriage
amniocentesis
15-20 weeks
amniotic biopsy
1%risk of miscarriage
50
List some autosomal dominant diseases
usually structural proteins
Huntingtons, PKD, achondroplasia, marfan syndrome, osteogenesis imperfecta
50% chance of passing it onto kids
51
List some autosomal recessive diseases
often metabolic
CF, sickle cell disease, congenital adrenal hyperplasia, thalassaemia, homocystinuria
52
Presentation of duchenne muscular dystrophy and genetic inheritance pattern
x linked recessive
3yo boy, delayed milestones, poor mobility, climbing up legs with hards to stand up, hypertrophy of calf msucles, fatigue, raised CK
53
Presentation of Downs syndrome
Trisomy 21
intellectual disability, stunted growth, round face, flat nasal bridge, epicanthic folds, brushfield spots om iris, small mouth and protuding tongue, small ears, single palmar crease, gap between toes, short neck
AVSD, visual and hearing problems, hypotonia, increased infections, early onset dementia
54
Presentation of Edwards syndrome
trisomy 18
survival 15 days
digit overlapping, wide head, rockerbottom feet, heart and renal malfunction, small chin and head
55
Pataus syndrome
trisomy 13
polydactylity
cleft lip and palate, heart defects, small eyes, global developmental delay
56
presentation of turners syndrome
45 X
female, delayed puberty, webbed neck, amenorhoea, coarction of aorta, thyroid, horseshoe kidney, low set ears, ejection systolic murmur
Tx: growth hormone and oestrogen replacement therapy
57
Tests for developmental dysplasisa of hip and risk factots
screen 6-8 week old babies
ortolani and barlow test- dislocation and subluxation?
risk factors
female, breech, FHx, 1st born, birth weight .5kg, twins
58
Presentation of developmental dysplasia of hip
Painless limp, walk on toes on affected side, limited abduction when fully flexed, leg dragging
59
```
Differential diagnosis of limping child: typical presentation of
trauma
transient synovitis
septic arthritis
juvenile idiopathic arthritis
developmental dysplasia of hip
perthes disease
slipped upper femoral epiphysis
rickets
```
- trauma- history diagnostic
- transient synovitis- acute onset, viral infection, more common in boys aged 2-12yo
- septic arthritis- unwell child, high fever
- juvenile idiopathic arthritis- joint inflammation for at least 6 weeks, may be systemic (daily fever), psoriatic etc
- developmental dysplasia of hip- usually detected in neonates, 6x more common in girls
Perthes disease- age 4-8. Avascular necrosis of femoral head
Slipped upper femoral epiphysis- 10-15yo, displacement of femoral head
rickets- vit D deficiency, bowing of legs, hypocalcaemic seizures, irritable and reluctant to weight bare, dark skin, poverty
60
Presentation of respiratory distress syndrome
prevention
management
premature babies- surfactant deficiency
shortly after birth
increased work of breathing, tachypnoea >60/min), grunting, nasal flaring, intercostal recession, cyanosis
CXR shows ground glass appearance
Prevention: dexamethasone given to mothers at risk of preterm birth
management
O2, CPAP, mechanical ventilation
Surfactant therapy
61
What is protective against necrotising enterocolitis in neonates
Breast feeding
| cows milk increases risk
62
give some risk factors of neonatal sepsis and likely causative agents
RISK FACTORS
maternal infection, PROM, mum group B strep carrier, preterm, fetal distress
ORGANISMS
ecoli, GBS, listeria, herpes simplex, chlamydia
63
Presentation of hypoglycaemia in newborns
common in 1st 24 hours in premature
jittery, seizures, irritable, cyanosis, apnoea, hypothermia, drowsiness
nb prolonged hypoglycaemia can cause long term neurological damage
feed within 24 hours of birth and give IV glucose infusion if necessary
64
Presentation of Measles
complications
Management
C
cough, coryza, conjunctivitis, koplick spots (white spots on buccal mucosa)
rash starting behind ears and spreading over whole body
complications
otitis media, croup, trachitis, encephalitis
management
symptomatic treatment
NOTIFIABLE DISEASE
65
Mumps presentation, complications, management
fever, malaise, parotitis (facial swelling)
usually mild and self limitting
complications- orchitis, viral meningitis, encephalitis, hearing loss
management
symptomatic treatment
NOTIFIABLE DISEASE
66
rubella presentation/ complications/ management
low grade fever
maculopapular rash on face
lymphadenopathy
dangerous in pregnancy- causes fetal cateracts, deafness, congenital heart disease
management
symptomatic treatment
NOTIFIABLE DISEASE
67
Erythema infectosum= parvovirus
facial rash-slapped cheek
fever, headache, myalgia
rash progesses to maculopapular rash
complications rare in children. Spreads by droplet- increased in close communities
68
roseola infantum
9-12months old
previous good health, sudden onset fever for 3 days, then rapid drop of fever, followed by mild pink maculopapular measles-like rash
supportive treatment
69
varicella zoster virus
chicken pox, shingles is reactivation of dormant virus
fever, vesicular rash on head, spreads all over body. Papules-vesicles-pustules-crusts
very infectious
complications
secondary bacterial infection, encephalitis, pulpura fulminans, necrotising fasciitis
70
kawasaki disease
management
complication
vasculitis
high grade fever >5 days
bright red cracked lips, red palms and soles that peel, strawberry tongue, conjunctival infection
MY HEART
M muscosal involvement (dry cracked lips and strawberry tongue)
H hands and feet oedema and desquamation
E eyes- non purulent bilateral conjunctivitis
A- adenopathy
R- rash
T- temp for more than 5 days
management
high dose aspirin- anti-inflammatory and antiplatelets
IV immunoglobulin- dampens immune response
complication
- coronary artery aneurism- do echocardiogram on admission and then at 5-6 weeks
71
scarlet fever
management
```
Staph pyogenes
sore throat, short fever, malaise
rough rash starting on neck, pinpoint dark red spots on general red area
area around mouth pale and face flushed
strawberry tongue
```
management
penicillin/ azithromycin
72
common causes of meningitis in
neonates
older children and adults
NEONATES
ecoli
group B strep
listeria monocytogenes
INFANTS
- strep pneumonia
- h.influenzae
- staph aureus
- group A strep
- Neisseria meningitidis
```
OLDER- NHS
Neisseria meningitidis
Haemophilus influenzae
strep pneumonae
Group A strep
staph aureus
```
73
management of suspected meningitis
close contact prophylaxis
<3months old
IV amoxicillin and cefotaxime
> 3 months cefotaxime
stabilise, dexamethason to prevent hearing loss and neurological impact
close contact prophylaxis- ciprofloxacin/ rifampicin
74
Presentation of diabetes mellitus
age 5-7/ just before puberty
polyuria, polydipsia, lethargy, weightloss, infections, poor growth, ketosis
fasting >7mmol/L
Random > 11.1 mmol/L
75
presentation of ketoacidosis
```
listless, confusion, vomiting, polyuria, polydipsia, abdo pain
dehydration
kassmaul respiration- deep and rapid
ketotic- fruity smelling breath
shock- drowsiness-coma
```
increased risk of cerebral oedema
76
management of ketoacidosis
IV fluids- 0.9% saline
-treat shock, then maintenance- give over 48 hours, if too fast increase risk of cerebral oedema
IV insulin after 1 hour of fluids
Monitor
77
presentation of congenital adrenal hyperplasia
low sodium high potassium
girls- ambiguous genitalia,
adrenocortical crisis- circulatory collapse- early life, after stressor, seizures, nausea, vomitting, lethargy, hypotension
management with glucocorticoid and mineralocorticoid replacement
78
Organisms causes pneumonia in neonates/ infants/ adolescents
```
NEONATES
ecoli
klebsiella
group B strep
TB
```
```
infants
RSV
step pmeuminia
-h.influenza
-staph aureus
-chlamydia
-TB
```
```
ADOLESCENTS
-strep pneumonia
mycoplasm pneumonia
-staph aureus
-TB
```
79
List the clinical features of Downs syndrome
face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small ears, round/flat face
flat occiput
single palmar crease, pronounced 'sandal gap' between big and first toe
hypotonia
congenital heart defects- AVSD (40-50%, see below)
duodenal atresia
Hirschsprung's disease
80
6 features of colitis
```
diarrhoea
abdo pain
urgency
tenesmus
nocturnal stooling
mucus and blood
```
81
causative organism of haemolytic ureamic syndrome
E.coli 0157
82
investigations of diarrhoea
stool sample
urine sample
blood culture
faecal calprotectin - inflammatory bowel disease
83
define failure to thrive
Significant interruption in the expected rate of growth compared with other children of similar sex,
and age. Cross over two centile lines on growth chart.
84
give an example of
- respiratory acidosis/ alkalosis
- metabolic acidosis/alkalosis
respiratory acidosis- low pH, high CO2- severe asthma, decreased respiratory muscle ability
respiratory alkalosis- high pH, low CO2- anxiety, fear, altitude, salicylate poisoning
metabolic acidosis- low pH, low bicarbonate- shock, diarrhoa, ketoacidosis
metabolic alkalosis- high pH, high bicarbonate- eg vomiting, pyloric stenosis, cushings
85
questions to ask when assessing control of asthma
- number of hospital admissions
- number of oral courses of steroids
- how often using blue inhaler
- ITU admissions?
86
what should be done when discharge a child home after an acute asthma attack
check inhaler technique and compliance
87
sepsis definition
life-threatening organ dysfunction caused by a dysregulated host response to an infection
88
outline the management of paediatric sepsis
1) airway management and temp control
- intubate if necessary
- oxygen if <94%
2) IV access and take bloods
3) IV fluids- 20mls/kg bolus as necessary
- maintenance fluids
4)broad spectrum antibiotic eg cefotaxime
5) appropriate escalation as necessary
- inotropes (dopamine, adrenaline, noradrenaline
- cardiac output monitoring
- further fluid balance maintenance
- blood transfusion
- corticosteroids
89
Most common child hood malignancy
Presentation
Acute lymphoblastic leukaemia
2-5 yo
bone marrow failure
anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae
bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
testicular swelling
90
presentation of neuroblastoma
a solid tumour that arises from the developing sympathetic nervous system
children <5 yrs
usually late- symptoms often due to mass effect or mets
-abdo mass, pallor, weight loss, bone pain, limp, hepatomegaly, paraplegia, proptosis Periorbital bruising - 'racoon eyes', constipation, blue-ish lump on neck, jerky eye and muscle movements
91
Presentation of wilms tumour
Most common intra-abdominal tumour in childhood
undifferentiated mesodermal tumour of the intermediate cell mass- nephroblastoma
abdominal mass (most common presenting feature)
painless haematuria
flank pain
other features: anorexia, fever
unilateral in 95% of cases
metastases are found in 20% of patients (most commonly lung)
associated with Beckwith-Wiedemann syndrome
92
list some causes of neonatal collapse
```
sepsis
duct dependent circulation
persistent pulmonary hypertension of newborn
metabolic emergency- hypoglycaemia/ CAH
trauma/ non-accidental injury
```
93
presentation of GORD
management
infancy <1yo
regurgitation (non forceful vomitting after feeds)
distress after feeds, apnoea, pneumonia, FTT, haematemesis, anaemia
conservative
-feed thickening, upright posture, avoid overfeeding
medical
-PPI, renitidine (H2 receptor antagonist), antacids
