How does the WHO define the following?
- Young people
Adolescence - 10-19 years old
Youth - 15-24 years old
Young people - 10-24 years old
Adolescence - biological developments
Adolescence - psychological developments
Adolescence - social developments
Development of autonomy
Changing relationships with family and peers
What scale grades pubertal development and puts them into stages?
What does the Age of Legal Capacity (Scotland) 1991 Act state?
"A person under the age of 16 shall have legal capacity to consent on his own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending him, he is capable of understanding the nature and possible consequences of the procedure or treatment"
In Scotland, can parents authorise a treatment that a compenent young person has refused to?
If the treatment is in the best interests of a competent young person that refuses treatment, seek legal advice
The HEEADSSS mnemonic helps to remind us of topics that we may want to discuss with young people. What is covered by this mnemonic
H - home
E - education/employment
E - eating
A - activities
D - drugs
S - sex
S - suicide
S - safety
What are the top 5 causes of mortality in under 5s in...
- specifically Sub-Saharan Africa?
- Preterm birth complications
- Intra-partum related complications
- Congenital abnormalities
- Preterm birth complications
- Intra-partum related complications
According to the WHO, what are the 6 most important preventable causes of mortality in children under 5?
1. immediate and exlcusive breast feeding
2. skilled attendants for antenatal, birth and postnatal care
3. access to nutrition and micronutrients
4. family knowledge of dangers to a child's health
5. water, sanitation and hygiene
What is the treatment for TB?
2 RIPE 4 RI
2 months of rifampcin, isoniazid, pyrazinamide and ethambutol
step down to 4 months of rifampicin and isoniazid
What are the 4 areas used to chart the progress of child development?
Fine motor and vision
Langauge and hearing
Social behaviour and play
Name some of the primitive motor reflexes
By when should these reflexes be lost?
Sucking and rooting
Palmar and plantar grasp
ATNR (asymmetric tonic neck reflex) a.k.a. the "fencing reflex"
Moro - abducting and adducting the arms, as well as crying if the baby loses support
Stepping and placing
Most of these reflexes are lost by 3-4 months, with some remaining for a little longer (e.g. ATNR is lost at 6 months)
By what age are the following gross motor skills typically developed?
- head control
- balance while sitting
- stairs (two feet on each)
- stairs (one foot on each)
Head control - 3 months
Balance while sitting - 6 months
Crawling - 9 months
Standing - 1 year
Running - 18 months
Stairs (two feet) - 2 years
Stairs (one foot) - 3 years
Hops - 4 years
By what age are the following fine motor and vision skills typically developed?
- hand regard in midline
- grasps toy with hand
- scissors grasp
- pincers grasp
- tower of 3/4 bricks
- tower of 6/7 bricks/scribbles on paper
- tower of 9+ bricks/copies a circle on paper
- draws a simple man shape
hand regard in midline - 3 months
grasps toy with hand - 6 months
scissors grasp - 9 months
pincers grip - 1 year
tower of 3/4 blocks - 18 months
tower of 6/7 blocks/scribbles on paper - 2 years
tower of 9+ blocks/copies a circle - 3 years
draws a simple man shape - 4 years
By what age are the following hearing and language skills typically developed?
- Imitates sound
- Knows name
- 2 body parts/5-20 words
- Simple instructions/50+ words
- Complex instructions/asks questions
- Can tell stories of experiences
Vocalises - 3 months
Babbles - 6 months
Imitates sound - 9 months
Knows name - 1 year
2 body parts/5-20 words - 18 months
Simple instructions/50+words - 2 years
Complex instructions/asks questions - 3 years
Can tell stories of experiences - 4 years
By what age are the following social behaviour and play skills typically developed?
- Social smile
- Pleasure on friendly handling
- Plays with feet/friendly with strangers
- Plays peek-a-boo/stranger awareness
- Drinks from cup/waves bye-bye
- Feeds with spoon
- Symbolic play/puts on some clothes
- Pretend interactive play/toilet-trained
- Understands turn-taking/dresses fully
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 - 1 year
Feeds with spoon - 18 months
Symbolic play/puts on clothes - 2 years
Pretend interactive play/toilet-trained - 3 years
Understands turn-taking/dresses fully - 4 years
What are the different patterns of abnormal development? How are common are they?
Delayed - global and specific
Deviation e.g. autism
Regression e.g. Rett's syndrome
These are common - 1% of children on autistic spectrum, 1-2% have mild learning disability, 5-10% have a specific learning disability
What are some red flags regarding child development?
Asymmetry of movement
Not reaching for objects by 6 months
Unable to sit unsupported by 12 months
Unable to walk by 18 months
No speech by 18 months (should be able to do 5-20 words)
Concerns regarding vision or hearing
Loss of skills
What consititutes "global developmental delay"?
Significant delay in 2 or more of the following...
- gross/fine motor, speech and language
- cognition, social/personal, activities of daily living
In what condition is Gower's manoeuvre seen in? What is it?
Seen in young boys with Duchenne muscular dystrophy
Weakness of the pelvic girdle means child has to prop themselves up on their legs to be able to stand
Describe the features seen in the following types of cerebral palsy
Hemiplegic - one side affected, other side almost or completely normal. Affected side arm will be spastically contracted or floppy, and foot will be up on tiptoes
Paraplegic - Both legs affected only, with the upper body either being completely unaffected or only minorly affected
Diplegic - as with paraplegic but with slight involvement elsewhere
Quadraplegic - all four limbs affected, often never able to walk
What 3 things feature in the "autistic triad"?
- Social interaction
- Flexibility of thought/imagination
Also see restricted, repetitive behaviours and possibly sensory difficulties
When assessing a child for a developmental disorder, what kind of points would you want to cover in the history taking?
Presenting complaint and concern
Past medical history
Perinatal and birth
Family and social
Play and behaviour
When assessing a child for a developmental disorder, what kind of points would you want to cover in the examination?
Observe the child initially
Look for dysmorphism
Take head circumference, height and weight
Vision and hearing
What are some common respiratory problems seen in children presenting acutely?
Croup (barking cough/stridor)
Viral upper resp tract infection
Asthma (new or exacerbated)
What are some uncommon respiratory problems seen in children presenting acutely?
Inhaled foreign body
What is the normal respiratory rate for children at the following ages...
- <1 year
<1 year - 30-40
1-2 - 25-35
2-5 - 25-30
5-12 - 20-25
>12 - 12-20
What age of child might you see either an intussusception or volvulus?
Any time from birth to about 5 years old
What condition in children presents with a bright red rash and a swollen tongue described as being like a strawberry in appearance?
What is the causative organism?
Scarlet Fever, caused by Strep pyogenes (GAS)
Young child presents with their mum to the GP complaining of being a bit off colour. What questions might you ask?
(Watch the child in the waiting room)
Been to the doctor for anything else?
How long is the embryonic period of gestation i.e. at what point is the embryo termed a foetus?
Lasts up until the end of week 8, from week 9 onwards it is a foetus
What is the normal heart rate for children of the following age...
- 1 year old
- 2 years old
- 4 years old
- 10 years old
Birth - 140 +/- 25
1 - 120 +/-20
2 - 110 +/-20
4 - 105 +/- 20
10 - 95 +/- 15
Diagnose the following...
1) 5 year old boy presents with symmetrical rash over buttocks, red swollen and tender knees, and vomiting and diarrhoea
2) 6 year old boy presents with swollen legs, scrotum and puffy eyes. Proteinuria and hypercholesterolaemia seen O/E
3) 2 week old boy presents with projectile vomiting, weight loss, palpable epigastric mass during feeding and visible peristalsis
1) Henoch-Schonlein purpura
2) Nephrotic syndrome
3) Pyloric stenosis
Diagnose the following...
1) A child with Brushfield spots on the iris, low set ears and a prominent tongue
2) O/E you notice this girl has a webbed neck, broad chest with widely spaced nipples and absent secondary sexual characteristics
1) Down's syndrome
2) Turner's syndrome (XO)
By what age should a child be able to do the following...
1) developed head control
2) start to crawl
3) developed social smile
5) draw a triangle
6) build a tower of 3 blocks
7) use two or more words to make a simple phrase
1) 6 weeks
2) 9 months
3) 6 weeks
4) 9/12 months (uses furniture @ 9 months)
5) 3 years
6) 18 months
7) 2 years
Diagnose the following (both organism and disease)
1) 2 year old boy presents with fever, cough, maculopapular rash that first appeared behind his ears and has spread to trunk. Small white lesions also present on oral mucosa
2) 7 year old girl presents with painful lesions around her mouth that have a golden crust
3) 3 year old boy presents with a 1 day history of feeling unwell, high fever and noisy breathing. Noted to be drooling saliva
1) Measles (caused by the measles virus). Classic clues are spreading from the ear and white lesions on mucosa
2) Impetigo (caused by Staph aureus)
3) Epiglottitis (caused usually by Haemophilus influenzae type B). Classic clues are noising breathing and drooling saliva (unable to swallow)
Diagnose the following (both organism and disease)
1) 2 year old boy is admitted at 2am with a cough and stridor. Mum describes him feeling hot and a runny nose for the past 3 days
2) 8 month old boy presents with a dry cough. On auscultation you hear a high-pitched expiratory wheeze and suspect his chest is hyperinflated
3) Infant presents with a 1 week history of a cold with coughing fits. Mother is worried that he appears to stop breathing at the end of these fits
1) Parainfluenza virus a.k.a. croup. Clues are stridor, signs of fever
2) RSV a.k.a. bronchiolitis
3) Pertussis a.k.a. whooping cough (Bordetella pertussis)
4 year old boy comes into the clinic with his mum complaining of a limp and a painful right knee and hip for the past few weeks.
What is on the list of differentials?
What is the treatment for Perthe's disease?
Always start with physiotherapy and rest, may also need to remove necrotised bone
Casting (with a Spica cast)
Brochiolitis is any acute inflammation of the bronchioles in children that causes difficulty breathing/inspiratory wheeze.
What is the most common cause of bronchiolitis?
RSV causes bronchiolitis in 70-80% of cases
If a child (usually a toddler) presents with a history of being fine one moment while playing and then suddenly developing a cough and difficulty breathing, what is the most likely diagnosis?
Inhaled Foreign Body
The number 6 is important in paediatric presentations! What commonly presents at the following ages?
- 6 weeks
- 6 months
- 6 years
6 weeks - pyloric stenosis, child presents with projectile vomiting
6 months - intussusception. Classic presentation is child pulling knees up, crying a lot and then going limp
6 years - appendicitis (think "the journey into hospital was bad because of going over speed bumps")
Rule of thumb - if a child is unable to jump, they should be admitted
When a child is vomiting up bile, what is the most important initial question that will guide diagnosis and treatment?
What colour is it?
Green bile is bad and needs to be seen urgently
What important feature might allow you to differentiate between a child presenting with pyloric stenosis vs a child presenting with malrotation?
Vomit colour - in PS the vomit just tends to be milky in colour, however in malrotation it might have bile through it and will appear green.
It should be classed as being malrotation until proven otherwise
What is recommended to be taken by infants consuming <500 mls formula a day after 6 months?
Vitamin A, C and D supplements
How many minutes of physical activity should children capable of walking be doing every day? (under 5s)
180 mins (3 hours) throughout the day
How much physical activity should children aged 5-18 be doing a week?
At least 60 minutes/day of moderate to vigorous physical activity
Be doing at least 3 days a week of vigorous intensity physical activity
How long is it recommended that children should be breast fed for?
First 6 months of life
How much full-fat unmodified cow's milk should an infant be having?
Can be used in small amounts in cooking from 6-9 months
Can be gradually introduced as a drink from 12 months
Semi-skimmed should not be given before 2 years
Skimmed should not be given before 5 years
What does the WHO recommend regarding nutrition within the first 6 months of life?
Should be exclusively breast feeding
Better chance of having a higher IQ
Lower risk of obesity for the baby in later life
Lower maternal risk of breast cancer
What is the recommended daily intake of protein for a child between 12-18 months?
What is the mean amount of protein actually being taken by this age group?
What is the Reference Nutritional Intake (RNI) for Vitamin A?
What are some dietary sources of Vitamin A?
Dietary sources - cheese, egg, yoghurt etc.
What is the Reference Nutritional Intake (RNI) for Vitamin C?
What are some dietary sources of Vitamin C?
Dietary sources - oranges, blackcurrents, potatoes
What is the Reference Nutritional Intake (RNI) for Vitamin D?
What are some dietary sources of Vitamin D?
Dietary sources - main source is sun exposure, but also small amounts from oily fish, eggs
What is the RNI for sodium for the following ages...
- 4-6 months
- 7-9 months
- 10-11 months
- 12-18 months
How much sodium is contained in 1g of salt?
4-6 - 280mg
7-9 - 320mg
10-11 - 350mg
12-18 - 500mg
1g salt = 393mg Na+
Clinical scenario - 6 year old girl presents with vomiting over the past 24 hours and increased bouts of bedwetting over the last 4 weeks.
Has lost some weight recently and very recently developed central abdo pain, but no fever, cough, wheeze, chest pain and until very recently has had a normal appetite.
Has been drinking well, with increased frequency in the last couple of weeks.
"vomiting over the past 24 hours"
"increased bouts of bedwetting"
"lost some weight recently"
"drinking well, with increased frequency in the last couple of weeks"
T1DM - vomiting suggests DKA
Children conceived during (summer/winter) months are more likely to develop mental health disorders
Children conceived during the winter months - related to vitamin D deficiency?
How do you assess breathing in a child in the emergency setting? (pretty much the same as an adult...)
Effort of breathing
- resp rate
- any recession - sternal or intercostal? Tracheal tug?
- use of accessory muscles?
- nasal flaring?
Efficacy of breathing
- assess expansion
- any extra noises?
- inspiratory - stridor? stertor?
- expiratory - wheeze
- pulse oximetry
How do you assess circulation in a child in the emergency setting? (again, same as adult)
Heart rate, rhythm, character and volume. Symmetrical?
Effects seen elsewhere - consciousness level, skin colour and temp, urine output
NB - Hypotension is a pre-terminal sign
How do you clinically assess hydration status in a child?
Examine eyes/mucous membranes
Skin turgor - evidence of tenting?
What is the most common reason for acute illness in children?
Sepsis! Variable presentations!
What's more common in children - respiratory failure or circulatory failure?
Which has the higher rate of survival?
Respiratory failure is much more common in children
Resp has a much higher rate of survival
How does child age affect head tilt and chin lift?
If under 1 year old, keep the head and neck in a more neutral position
If over 1 - perform full procedure
What is the difference between decorticate and decerebrate postures?
Which is a worse sign?
Decerebrate is a worse sign