what conditions can occur alongside ADHD
- autism
- oppositional defiant disorder
- conduct disorder
- tics and tourettes
what are the 4 groups of developmental milestones
gross motor
fine motor & vision
hearing and language
social skills
3 steps in managing chronic fatigue syndrome
- anchor wake up time
- don’t oversleep
- limit physical activity
when do children start and stop ‘headbanging’
start 12m and stop around 3yrs
two types of disordered attachment
- insecure avoidant attachment
2. insecure disorganised
Management of cows milk intolerance
replace milk feeds with hydrolysed formula then reintroduce milk with the milk ladder
signs that a child is ready for solids
- putting fists/toys in mouth
- watching you eat
- hungry between feeds
3 stages of weaning
- smooth textures- start runny then thicken
- lumpy textures (mashed)- 9m
- chopped family food- 12m
(still need about 600ml milk)
causes of faltering growth
- reduced intake- neglect, GORD, refusal
- malabsorption
- increased metabolic demand- chronic disease, malignancy
causes of delayed puberty
- consitutional delay
- systemic disease
- Genetic syndromes- kallmans, turner’s klinefelters
causes of short stature
- cushings syndrome
- hypothyroidism (esp autoimmune)
- chronic disease (CF)
- GH deficient
common cause for subdural haematoma in children
NAI
Immediate management of meningitis
> 3m- im benpen and admit to hosp for iv ceftriaxome
<3m- admit for cefotaxime + amox
what medication would you give alongside antibiotics for a child who has pneumonia caused by H.influenzae
Dexamethasone
which type of spina bifida has no neuro signs
meningocele
myelomenigocele does
clinical features of NF-1
- > 5 cafe au lait spots
- neurofibromas (along path of any peripheral nerve)
- axillary freckling
- optic glioma
clinical features of tuberous sclerosis
- ash leaf depigmented lesions
- adenoma sebaceum on face
- infantile spasms/epilepsy
name 3 types of epilepsy in childhood (that we need to know)
- childhood absence 2-10yrs- provoked by hyperventilation–> sodium valproate
- childhood epilepsy with centrotemporal spikes –> no tx needed
- juvenile myoclonic epilepsy- 7-10yrs provoked by sleep deprivation, can occur in the morning - life long sodium valproate
what is Gower’s sign
when children turn prone to rise from seat normal until 3m
what is malrotation of the gut associated with
- congenital diaphragmatic hernia
- duodenal atresia
- causes volvulus
Hirschsprung disease
- definitive diagnosis
- initial treatment
- definitive treatment
- full thickness rectal biopsy
- bowel irrigation
- anorectal pull through operation
classic presentation of mesenteric adenitis
central abdominal pain following URTI
in which conditions does meconium ileus commonly present
- Hirschsprung disease
- CF
Main cause of prolonged jaundice with conjugated bilirubin
Biliary atresia (will eventually need liver transplant)
AXR sign of intussception
Donut sign- concentric circles of hypoechogenic and echogeneic loops of bowel
pathogneumonic sign of nec (AXR)
Intramural gas
what disorders are screened for at d5 heel prick
- CF
- Hypothyroidism
- PKU
- MCADD
Heart defects
- Down’s Syndrome
- Edward’s syndrome
- Patau’s syndrome
- Turner’s syndrome
- William’s syndrome
- Noonan’s
- Marfans
- AVSD
- VSD
- VSD
- Coarctation of aorta, bicuspid aortic valve
- SVAS
- Hypertrophic cardiomyopathy
- aortic dissection
sx of DKA
- pear drop breath
- kussmauls breathing
- vomiting
- dehydration
- abdo pain
- drowsiness
Rx of DKA
- Fluids- correct SLOWLY 48-72hrs
- insulin (sc or iv)
- monitor K+ and supplement when needed
causes of hypoglycaemia
- insulin excess (diabetics)
- Inborn errors of metabolism
- CAH
define perthes disease
avascular necrosis of epiphyses of the femoral head
what is osgood schlatters
osteochondritis
presents in physically active young men which knee pain after exercise which can swell, improves with rest
needs physio
main association of toricolis
sternocleidomastoid tumour
initial treatment of encephalitis
likely cause in kids is herpes so high dose aciclovir
what is Nikolsky sign
- in SSSS where areas of epidermis separate on gentle lateral pressure
really bad complication of a staph/strep infection
Toxic shock syndrome
best diagnostic test in babies with HIV infected mothers
ideally within 3 months of birth HIV DNA PCR after 2 weeks of ART
Sx of malaria
- fever
- D+V
- Jaundice
- Flu-ey
- anaemia
Sx of typhoid
- worsening fever
- headache
- abdo pain & malaise
- rose coloured spots
when does infantile haemangioma present
not at birth- usually around 4 weeks
triad of sturge weber syndrome
- port wine stain in V1-V3 distribution
- epilepsy
- ipsilateral ocular abnormalities
presentation of scarlet fever
- fever
- headache
- strawberry tongue
- maculopapular rash that starts on chest and abdo and has a ROUGH sandpaper feel
most common presentation of herpes in kids
- herpetic gingivostomatitis- ulcerative lesions of gingiva and mucosa of mouth with a black crust
associated with multiple congential melanocytic naevi
- neurocutaneous melanosis
sx of measles
TRIAD: conjuctivitis, coryza, cough
Koplik spots on mucosa
rash starts post-auricular and descends down body and desquamates by week 2
when are complications of measles more likely
if vitamin A deficient
risk factors for upper UTIs
- non-ecoli UTI
- recurrent fevers
- FH of vesicoureteric reflux
- enlarged bladder
define hypertension
BP >95th centile for height, age, sex
treatment of AKI
- hyperkalaemia- calcium gluconate/insulin
- acid-base: rectify
- fluids if pre-renal: fluids if renal: fluid restrict
causes of chronic kidney disease
- structural malformation
- glomerulonephritis
- hereditary nephropathies
- systemic disease
when is night time continence usually achieved
by 3-4 years
differences between hernia and hydrocele
both due to patent ductus vaginalis in hydrocele its more constricted
hernia: unilateral, tender, intermittent swelling on straining
hydrocele: asymptomatic bilateral bluish and can transilluminate
causes of anaemia in the newborn
- red cell aplasia
- congenital infection- parvovirus b19
how does immune thrombocytopenia present
in 2-10year olds
typically after viral infection with petechiae, superficial bruising
three main thromophilias in kids
1) protein c deficiency
2. protein s deficiency
3. Factor V Leiden
Management of viral croup
oral dexamethasone and steroid nebs
when to R–>L babies present
Day 2 of life- when duct closes
baby with congenital heart disease presents with 3d fever- what are you worried about?
endocarditis
cause of heart failure in older children
dilated cardiomyopathy- usually post viral
common cause of sudden death in young adults
hypertrophic cardiomyopathy