Paeds 6 Flashcards by John Darlington

List some reasons to refer a child who you suspect has developmental delay:

Regression (at any age)
Concerns about vision (tracking, flowing objects)
Hearing loss
No speech by 18 months
Head circumference >99.6th centile
unable sit unsupported at 12 months
walk by 18 months
run by 2.5 years
reach for objects at 6 months
point and share interest by 2 years

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What are some causes of gross motor delay?

Cerebral palsy

Duchene muscular dystrophy

Prolonged illness or hospitalisation during key milestone times

SMA

Chromosomal abnormalities

TORCH infections

*referral to specialist physiotherapist and paediatrician

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What are some causes of speech delay?

Autism

Hearing impairment

Poor social interaction/ deprivation

Down syndrome

*referral to SALT and hearing test

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What professionals in the community are usually involved with a child who requires special needs or has complex difficulties?

Physio

Community paediatrician

SALT

Specialist nurse

CAMHS

Health visitor

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What are the three main domains of ASD?

Social interaction behaviour

Social communication

Repetitive/ Ritualised

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What is the definitions of nocturnal enuresis:

Involuntary bed wetting
x2 weekly
>5 years old

Primary: never managed continence

with daytime symptoms
without daytime symptoms
overactive bladder
structural abnormalities
chronic constipation
neurological deficit

Secondary: previously dry for 6 months

diabetes
UTI

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What are the managements strategies for nocturnal enuresis:

Encouragement
Goals set
Enuresis alarm
Desmopressin - for short term use

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When can global developmental delay be used up till?

5 years old

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What are the most common causes of bacterial tracheitis?

Staph Aureus

Strep

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What type of pneumonia is most common in children and how should it be investigated?

Bronchopneumonia is more common in children

Investigations:

bloods:
- FBC
- WBC
- blood cultures

Orifices:
- throat swab

X-ray :
- CXR

*if pneumonia keeps reoccurring then consider sweat test

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What are some signs of cardiac disease in a baby?

Feeding problems 
Breathless on feeding 
Sweating 
Failure to thrive 
\+/- 
oedema 
cyanotic attacks

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What is the management of severe pneumonia in a paediatric patient?

Oxygen
Secretions sucked out
NG feds (if say to do so)

Antibiotics for severe pneumonia:
- IV cefuroxime
+
- IV gentamicin

*if you suspected staph infection (say following Influenza infection) then add Flucloxacillin

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When carrying out resuscitation breaths in baby - what important practical point must you remember?

Cover over the nose as well as the mouth

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In terms of burns - which get referred and which are sent to PICU?

All burns over 3% are referred

Full thickness burn >1 % is referred

Any over >10% will ned IV fluids

> 30% need PICU

Any burns in genitals, face or joints are referred

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What investigations do you want in a child who has presented with diarrhoea?

Bloods: 
- FBC 
- U&Es 
- CRP 
\+/- 
- Blood cultures

Orifices:

Urine dip (check for ketones)
Stool culture

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What is your fluid replacement for a dehydrated child?

5% dehydrated: 50mls/kg + Maintancing fluid over 48 hours

10% dehydrated: 100mls/kg + Maintancing fluid over 48 hours

*maintenance fluid is over 24 ours but the dehydration fluid is over 48 hours

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What are some of the complications from meningitis?

Cerebral oedema

SIADH

Deafness

Long-term damage:

cerebral palsy
epilepsy

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What is the antibiotics given to a newborns with suspected meningitis?

<6 weeks:

ceftriaxone
Gent
Amoxicillin

6weesk - 3 months:
- IV ceftriaxone

> 3 months:
- Ceftriaxone
+
- Dexamethasone (if no purpura)

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In a neonate how does an UTI present:

Poor feeding 
Vomiting 
Fever 
Jaundice (conjugated) 
Weight loss

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What is the immediate management of child who has swallowed a toxic substance?

Induce vomiting
- fingers down throat
or
- Syrup Ipeacac 15ml + glass of water

**this is contraindicated in volatile hydrocarbons or caustic substances.

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What are some immediate 1st aid managements to do whilst a child is fitting?

Remove anything dangerous around them

Place in prone position
- prevents choking on vomit

Don’t open mouth may cause damage to teeth

Remove restrictive clothing if possible

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What is the scoring system used to assess if a child has septic arthritis and how is a septic arthritis in a child managed?

Kocher's 
- unable to weight bare 
- fever >38.5 
- WWC >12 
- ESR >40 
\+/-
- CRP

IV antibiotics (<5 cefuroxime, >6 is flucloxacillin)
- Sepsis 6
Surgical wash out

*no joint aspiration is done

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What position is the septic arthritic hip usually held in?

Externally rotated and flexed

What is the investigations done into DDH and why is treatment needed?

< 6 months = ultrasound of hips

> 6 months = x-ray

If not fixed the child in later life will almost certainly need a hip replacement

What are some of the signs of Legg-Perthes disease?

Loss of abduction Loss of Internally rotated LLD Low social economic status Maternal smoking Body shape ``` <6 = monitoring, with braces to hold hip in place >6 = may require surgery ```

What disease are children who have synovitis at an increased risk of developing?

Legg - Perthes | - 10% will develop this

What foods would you advise to avoid before < 6 month and a year?

<6 months: - unpasteurised milks/ Cheeses - Shell fish - Wheat based food <1 year - honey *try to avoid anything that may trigger allergies

When should the birth weight lost be regained by?

10-14 days

Why are infants at risk of faltering growth?

High energy demands Low storage Smaller in size - increased metabolic turnover Reliance of food from others

What are the main causes of rectal bleeding in a child?

Anal fissure Swallowed blood from epitaxis Mekel's diverticulum Intussusception Gastroenteritis IBD

What is the complication that can occur with Port wine stains?

These are Capillary defects which enlarge as the person grows. 10% are due to Sturge- Weber Syndrome - which affects the V1 branch - Ipsilateral arachnoid and pia of the cortex - learning difficulties and seizures - macrocephaly - glaucoma

What disease in childhood is associated wit the development of diabetes?

Cystic fibrosis Trisomy 21 *note that steroid induced may also be a cause in those suffering with severe asthma

What genetics are associated with diabetes type I? and what percentage of cells need to be destroyed in order for symptoms to be noticed?

DR3/ DR4 >90%

If a child presents with DM-1 diabetes - what addition diseases should you consider screening for?

Addisons Coeliac Thyroid

What specific things do you want to monitor during ketoacidosis?

GCS ECG BP Ketones

What are the causes of CKD in children?

Obstructive causes: - Pelvis uterieric obstruction - Vesicoureteric reflux - PUV's Dysplasia Cystic disease Infection

How is Vesicoureteric reflux treated?

Prophylactic antibiotics Surgical (usually done via cystoscopy) Indication for surgery: - UTI prophylaxis - Progressive scaring - pain on voiding

What are the main questions you want to ask following a heard injury to child?

``` Mechanism? - any large forces involved? Unconsciousness - with any amnesia? Vomiting? NAI - story consistent? Any other injuries? ```

What advice can be given to parents for the return of their child following a head injury?

ACORN - after concussion return to normality *provides info and the do's and don't following concussion in a traffic light system as well as worsening advice.

What are the indications for a CT head scan in a child following an injury?

Witnessed >5 mins loss of consciousness Amnesia >5mins >3 episodes of vomiting Abnormal drowsiness Signs of basal skull fracture Seizure following injury

Generically what order should investigations and examinations be done into a child presenting with stomach pain be done?

``` History Examination Urine dip Bloods Repeat examination US ```

What are the essential bloods that must be done in a child presenting with abdominal pain?

``` FBC U&Es CRP LFTs Amylase Glucose ```

List some specific referral times:

Non-weight baring - 12 months Non- sitting unsupported - 12 months Not walking - 18 months Not running - 2.5 years No babble - 9 months No words - 18 months No symbolic play - 18 months

What are some co-morbities to cerebral palsy?

Learning difficulties Seizures Feeding difficulties - often need a gastrostomy feeding peg Osteoporosis Behavioural problems Deformity - physio - ortho - botulism injections

At what level of spina - bifida will a patient not be able to walk?

What are the tissues that are present in Meckel's diverticulum and what is the presentation?

Gastric Pancreatic Jejunal Presentation: - Haemorrhage (gastric acids) - Obstruction (volvulus) - Diverticulitis (bacterial infection)

What is the special test that can be done to diagnose Meckel's diverticulum?

Meckel's scan | - binds to gastric mucosa

What is a very important point in the history of a child where you suspect NAI to consider with regards to the mechanism of injury, and what will you do in A&E if you suspect NAI?

Is the child old enough to be able to perform such an action which could cause that injury - for example - rolling off a couch at 2 months old is not likely - Inform senior - Admit child - Tell parents what you are doing

In a child who is missing developmental milestones - what things would you want to ask the parents?

History of pregnancy History of peri-natal period Neonatal illness/ prelonged stays in hospital Notable family history of illness - duchenes? cystic fibrosis?

How far can a baby see at 3 months and when is myelination of the optic nerve complete by?

1m at 3 months or 3ft *3 months can see 3ft 24 months myelination complete

How can visual acuity be tested in a baby?

Gratings - 10 weeks old *lines on a baord which a child will follow when compared to a grey board Kay pictures - 3 years old

What are some indications for a gastrostomy and why is used for additional feeds over just increasing food volume?

Any child where an NG tube is likely to be in place for more than >3 months a gastrostomy should be considered. - neurological conditions - oesophageal atresia - increased nutrients requirements advantages of increased nutrients requirements: - continuous feeding as opposed to bolus - night time feeding - still allows food to be ate orally

What type of genetic defect increases the likely hood of parents having another child with Down's syndrome - and what is the most common neurological defect seen in almost all Down's syndrome babies?

Robertsonian Translocation - increases risk of recurrent Down's syndrome Hypertonia is a feature seen in almost all Down's syndrome babies

What is the risk of a further febrile convulsion within the same illness? and what actions can be done to reduce another convulsion? and what advice should be given if there is another seizure?

33% risk of a further convulsion Regular paracetamol Removal of clothing to keep child cool Regular temperature checking Call ambulance if >5mins Remove anything near mouth if seizing Place in recovery position following seizure

How much bacterial growth is needed for there to eb a diagnosis of UTI? and explain how to do a clean - mid- stream catch:

>100,000 bacterial colony forming units/ml of urine Wait until 1 hour after feed, then hold baby up and tap just above the pubis with 2 fingers. - this should trigger micturition