Flashcards in week 1 Deck (91):
what is important in GP Hx of sick child?
History of the symptom
define the neonatal period
first 4 weeks of life
what are the common PC for neonates?
failure to thrive
what are the red flags for sepsis in children?
Unresponsive to social cues/ difficult to rouse
Health professional very worried
Weak, high pitched or continuous cry
Grunting respiration or apnoeic episodes SpO2 < 90%
Severe tachypnoea + Severe tachycardia/ bradycardia [< 60]
No wet nappies/ not passed urine in last 18 h
Non-blanching rash or mottled/ ashen/ cyanotic
Temperature < 36oC
If under 3 months, temperature > 38oC
what is prolonged jaundice?
>14days in infants or >21days (if preterm)
what are the causes of jaundice in neonates?
urinary tract infection/ hypothyroidism/ galactosaemia/ breast milk jaundice/ biliary atresia
what are the causes of vomiting in neonates?
reflux/CMP intolerance/pyloric stenosis/sepsis/duodenal atresia
common paediatric resp PC
Infant not feeding
common causes of resp problems in kids
Croup (barking cough)
Asthma (new or exacerbation)
rare causes of resp problems in kids
Acute Epiglottitis (rate lowering due to HiB vaccine)
how to assess resp system in kids?
Nasal flaring/Intercostal recession/subcostal recession
ENT exam (tonsils, epiglottitis...)
adult resp rates?
>20 = unwell
>24 = critically ill
children resp rates?
different to adult:
GI problems in children PC
common GI problems in children
rarer GI problems in children
Intuscception, volvulus <5years
appendicitis, trauma, ovarian/testicular torsion if older.
what is a complication of rotavirus vaccine? treatment
intussception (intestine folds into section next to it). enema then surgery ASAP
sign of abdo pain in young child?
draw knees to chest
MSK PC in children
causes of MSK problems in children
Joint pains:inflammatory arthritis/perthes disease/slipped femoral epiphyses/osgood slatters/growing pains/bone tumours
Limp – DDH/perthes
Trauma – sprain/fracture/NAI
public health in GP
Childhood Development Screening – GP 6-8 week check/health visitors
Red light reflex (retinoblastoma)
Genitalia (undescended testes or ambiguous gentiles)
Femoral pulses (for coarctation of aorta)
Disease Notification (TB, HIV...)
in children how is obesity measured?
BMI for age (percentile)
what should you do if child is of short stature and high BMI?
consider endocrine referral
what are some endocrine causes of childhood obesity?
growth hormone insufficiency
excessive corticosteroid administration
what should be seen in children who follow the lifestyle advice?
NOT weight loss but maintain weight tad height means lower BMI
to see progress measure Z score/Standard deviation change
what are the recommended lifestyle changes that children should make if overweight?
1hr exercise a day
2hr max of screen time
3 balanced meals
when can orlistat be prescribed to kids?
only for severely obese adolescents (BMI >99.6th percentile) with comorbidities attending a specialist clinic.
can surgery be recommended for kids?
Bariatric surgery can be considered for post-pubertal adolescents with very severe to extreme obesity (BMI >3.5 SD above mean on UK 1990 charts) and severe co-morbidities
what is the tanner scale?
a scale of physical development in children, adolescents and adults.(breasts, pubic hair, penis, testicles)
what is different about adolescent consultation?
health issues differ (eating disorders, functional disorder, drugs, alcohol, sex, chronic fatigue, mental health...)]
people at different stages of looking after their own health (parents less involved)
what factors influence normal development?
how do we assess child development
-Normal variations (EG: many types of crawling )
-Developmental age (weight, potential milestones) v chronological age
what are the 4 areas of development?
Fine motor and vision
Language and hearing
Social behaviour and play
what are the percentages for the median age and limit age for milestone?
50% - average
97.5%. - potential problem
examples of children primitive reflexes? why is it a problem if don't lose?
Sucking and rooting
Palmar and plantar grasp
Stepping and placing
cerebral palsy possible
what are the milestones for Gross motor development?
Head control 3 months
Sitting balance 6 months
Crawling 9 months
Standing 12 months
Runs 18 months
Stairs – 2 feet/tread 24 months
Stairs – alternate feet 36 months
Hops -48 months
what are the milestones for Fine motor and visual development?
Hand regard in midline 3 months
Grasps toy - palmar 6 months
Scissor grasp 9 months
Pincer grasp 12 months
Tower of 3-4 bricks 18 months
Tower of 6-7/scribble 24 months
Tower of 9 bricks/copies circle 36 months
Draws simple man -48months
what are the milestones for hearing and language development?
Vocalises 3 months
Babbles 6 months
Imitates sounds 9 months
Knows name 12 months
2 body parts/5-20 words 18 months
Simple instructions/50+ words 24 months
Complex instructions/asks questions 36 months
Can tell stories of experiences 48 months
what are the milestones for Social behaviour and play development?
Social smile 6 weeks
Pleasure on friendly handling 3 months
Plays with feet/friendly with strangers 6 months
Plays peek-a-boo/stranger awareness 9 months
Drinks from cup/waves bye-bye 12 months
Feeds with spoon 18 months
Symbolic play/puts on some clothes 2 years
Pretend interactive play/toilet-trained 3 years
Understands turn-taking/dresses fully 4 years
what are the patterns of abnormal development
delay:EGglobal or specific
deviation EG:autism spectrum disorder/ASD
regression: EG Rett's syndrome or metabolic disorders
what are red flags for development?
Asymmetry of movement
Not reaching for objects by 6 months
Unable to sit unsupported by 12 months
Unable to walk by 18 months → check CK
No speech by 18 months
Concerns re vision or hearing
Loss of skills
what is global developmental delay classed as?
Affects 1 – 3% of under 5s
Significant delay in 2+ of
gross/fine motor, speech/language,
cognition, social/personal, ADL (activities of daily life)
what medical screening is undergone in Down's syndrome?
Cardiac (congential HD)
Thyroid function (hypo badly affects development)
Sleep related breathing (apnoea due to reduced upper airway) disorders
what can cause a specific Motor developmental delay?
DMD, cerebral palsy,
what can cause a specific developmental delay in Sensory Deficits and Associated Delay?
what signs are anticipated with DMD?
lumbar lordosis due to pelvic weakness
(early steroid can improve outcomes)
what are the different types of cerebral palsy?
hemiplegic (one side)
paraplegic/diplegic (both legs +/- somewhere else),
quadriplegic (all limbs)
what conditions are associated with cerebral palsy?
Mobility problems, spasticity and orthopaedic problems
what is the autistic triad?
Flexibility of thought/ Imagination
(causes restricted and repetitive behaviours and sensory difficulties)
how would you approach a developmental delay case?
Hx, exam, investigation, assessment
Hx for a developmental delay case?
Concerns – presenting complaint
Past Medical History
Perinatal and Birth
Family & Social
Play and Behaviour
Exam for a developmental delay case?
CNS inc neurocutaneous
investigation for a developmental delay case?
Chromosomes, FRAX & Oligoarray CGH
Neonatal PKU, thyroid studies, CK
- MRI brain
- Metabolic studies
- Genetic consultation
assessment of a developmental delay?
Appropriate Assessment Tool
intervention for developmental delay?
therapy: physio, SLT, OT
referral to other agencies
what is Rett's syndrome?
fine 1st year
then regress (physical and mental)
what are the two types of hearing impairment?
sensorineural (inner ear) and conductive (outer ear)
what is a common conductive hearing loss problem in kids and how treated?
glue ear (Otitis media with effusion/serous Otitis media)
neurofibromatosis type 1 signs?
cafe au lait
freckles in armpit and groin
multiple cutaneous neurofibromas, plexiform neruoma, optic glioma
what is fragile X? signs of fragile X?
genetic syndrome, moderate physical and mental disability
long face, large ears and fingers, large testicles.
what is prader-willi syndrome?
In newborns symptoms include weak muscles, poor feeding, and slow development.
Beginning in childhood the person becomes constantly hungry which often leads to obesity and type 2 diabetes
typically mild to moderate intellectual impairment and behavioral problems. infertile
what is active, passive and herd immunity?
Active immunity is the body's own fighting disease (infection, vaccine)
Passive immunity is the transfer of active immunity, in the form of readymade antibodies, from one individual to another. (mother placenta, artificial human IgG)
Herd immunity stops receiver of disease
types of vaccine
live virus [attenuated organism, replicates in host
e.g. OPV, measles, mumps, rubella, varicella, rotavirus, zoster, flu]
inactivated virus [Suspensions of killed organisms
e.g. whole cell pertussis (whooping cough), whole cell typhoid
e.g. diphtheria toxoid, tetanus toxoid
- polysaccharide attached to immunogenic proteins
e.g. Hib, MenC]
what are some contraindications of giving a vaccine
confirmed anaphylaxis to vaccine component/antigen
pregnancy or immunosuppression = primary, radio toxic, steroid, HIV... (live vaccine)
what causes diphtheria (white throat?)
white adherent membrane in mouth and URTI
what causes meningococcal disease?
(survivors left with persistant neurological defect inc hearing loss, speech, limb loss/paralysis...)
what vaccine available for meningitis?
MenACWY and now MenB.
two peaks in disease <5yrs and 15-24
MMR vaccine what is and when given?
MMR1 and booster - given after 1 year as material antibodies stop
travel related immunisation differs to UK immunisation. name some common travel vaccines?
what is elimination of disease
Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts; continued intervention measures are required. Example: neonatal tetanus.
what is eradication of disease
Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. Example: smallpox.
what is extinct of disease?
Extinction: The specific infectious agent no longer exists in nature or in the laboratory. Example: none.
top causes of under 5 mortality globally?
Preterm birth complications
what simple measures are effective in care for newborns?
-Treatment of maternal infections including HIV
Steroids for preterm labour
Skilled birth attendant present:
-Provide a clean delivery
-Dry baby & keep warm
-Resuscitate asphyxiated babies
-Recognise warning signs for referral
Antibiotics for sepsis and pneumonia
treatment of diarrhoae?
oral rehydration solution, zinc supplements
prevent by clean water, vaccination, good nutrition
(cycle of diarrhoea and malnutrition)
what are ORS?
Oral rehydration salts/ORS = A solution of glucose-based salt solution used in oral rehydration therapy. (Instantly absorbed in jejunum avoiding most of intestine, For mild and moderate dehydration avoids IV fluids)
HIV prevention in children
Maternal lifelong antiretroviral treatment
Screen for and treat other STDs, especially herpes
Infant prophylaxis for 6 weeks or throughout breastfeeding (test child at birth and 6 weeks of age)
Recurrent or severe common childhood illnesses eg otitis media, diarrhoea
Recurrent oral candidiasis not responding to treatment
Recurrent severe bacterial infections eg meningitis
Failure to thrive or growth failure
Generalised lymphadenopathy, hepatosplenomegaly
PCP, Kaposi sarcoma, TB, lymphocytic interstitial pneumonia...
how to diagnose HIV?
<18 months of age: virological PCR for HIV DNA or RNA
>18 months: serological rapid antibody test
(staging done by CD4 count)
HIV treatment [= given to ALL children with HIV]
HAART: Two NRTIs plus one NNRTI or protease inhibitor:
Nucleoside reverse transcriptase inhibitors eg abacavir and lamivudine
Non-nucleoside reverse transcriptase inhibitors eg efavirenz for >3yr olds
Protease inhibitor eg kaletra for <3yr olds
Compliance and side-effects
Immune reconsitution inflammatory syndrome (IRIS): NSAIDS
Co-trimoxazole prophylaxis, routine vaccinations
Chronic cough or fever >2 weeks, night sweats, weight loss, lymphadenopathy…
risk factors for TB
HIV, malnutrition, household contact
Acid-fast bacilli (low yield in children)
Interferon-Gamma Release Assays
Two months of : Isoniazid, Rifampicin, Pyrazinamide +/- Ethambutol
Then four months of isoniazid and rifampicin
Longer if TB meningitis, spinal or osteo-articular disease
”Directly observed therapy” to improve compliance
prevention of TB
BCG + pre and post-exposure isoniazid
malaria causative organism? which is most severe?
Plasmodium parasite from female anopheles mosquito
P. falciparum most severe (can cross Blood brain barrier)
PC of malaria
fever, pallor, non-speicifc malasie. then rapid severe cerebral oedema, seizures and coma
do blood film for microscopy or rapid diagnostic test
Treatment with artemisinin-based combination therapy (ACT) for 3 days
Severe malaria treat with IM or IV artesunate until can tolerate oral
In high transmission areas give preventative treatment to all infants alongside routine vaccinations
Prevention = Long-lasting insecticidal nets (LLINs) [+
Pilot projects for malaria vaccine]
severe malnutrition signs
Mid-arm circumference <115mm
Weight for height