W06 - PAEDS: Approach to assessing children; Children are not small adults; Adolescent Health; SUDI Flashcards
Physiological differences and risks to children
dt diff SA:vol, water content, metabolic activity
more at risk of
- hypothermia
- dehydration
- hypoglyc.
Wt and food amounts conversion
0.45lb = 1kg
1 ounce = 29.6 ml
Developmental Red Flags
Loss of developmental skills
Referral elsewhere
Hearing loss (simultaneous referral for audiology/ ENT)
Persistent low muscle tone/ floppiness
No speech by 18 months, esp if no other communication (simultaneous referral for urgent hearing test)
Asymmetry of movements/ increased muscle tone
Not walking by 18m/ Persistent toe walking
OFC > 99.6th / < 0.4th / crossed two centiles/ disproportionate to parental OFC
Clinician uncertain/ thinks that development may be disordered
Areas of development
Fine motor skills
Gross motor
Social & self-help
Language & Comms
Child Health Screening
Primary care w/ midwives. Recorded in red book.
SUDI: triple risk model
a
SUDI
The sudden and unexpected death of a child under 1 for which no adequate case is found after a thorough post mortem and case report
Significance of Back to Sleep Campaign
Since the 1980s onwards, campaign highlighting awareness of certain practices which saw a decrease in cot deaths.
- potentially preventing rebreathing when baby is left to lie on front
NOW:
- chaotic, lower socioeconomic, high parity, inappt. sleeping conditions, illicit drugs, alcohol, LATER NEONATAL AGE than before
SUDI vs SIDS
SIDS subset of SUDI, where no suspicious circumstances or untoward features are found.
* SIDS incidence is decreasing
whereas SUDII = leaves room for potential explanation for death to appear later. In practice, more commonly used etc.
SUDI better than ‘unascertained’ for optics, and leaves case ‘open’.
Significance of increasing complexity of investigating SUDI
positive findings will arise the more tests are ran d/t the nature of variability in testing results, however minor they may be.
*consider impacts of continuous testing and results
3 typical cases of SUDI
OBVIOUS HOMICIDE
* suspicious circumstances:
* evidence of fractures
* genetics contribute to PREDISPOSITION not CAUSATION
NATURAL CAUSE IDENTIFIED
*congenital
* SEPSIS
UNKNOWN CAUSE
* most common
*
Methadone withdrawal in infants
- excessive feeding, highly irritable, mouthing a lot prior to death.
Milestones
- social smile ~2mos onwards
- sitting ~3mos onwards, ~6mos +/- hand support, 8mos: w/o support
- walking ~9mos pull to stand, ~12mos walking development
- first words: ~9mos sounds, then ~12mos simple single words
*refer if not walking by 18mos
Developmental Assessment
a
6-8w Review (GP & HV)
ID, feeding, parental concerns, development, measurement, examination, sleeping position
