Medical notes detailing all of Paediatric conditions for medical examinations ranging from neonatal to teenage years. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines.
Look at specialty section and content list for the summary cont...
Description
Recognizing the need for prompt help is a central skill of paediatrics. Use ABC + traffic light assessment to determine.
Note that BP is not always a reliable vital to evaluate.
Green Light Red Light
- Feeding: Most feeds are accepted - Colour: Pale; Mottled; Ashen; Hypoxic
- Colour: Normal colour on lips, tongue + mouth - Social: Does not wake; Apathy; Coma
- Social: Alert or wakens quickly; Normal crying - Vitals: ↓ Skin turgor
- Vitals: ↔ RR (see below) - GRUNTING: See below for signs
Amber Light
- Feeding: Taking ≤50 % of feeds
- Colour: Pale
- Social: Hard to wake; No smiling; ↓ Activity
- Vitals: ↑ RR; Creps; Nasal flaring <1 YO
Vitals by Age
Age (years) Respiration Rate (BPM) Pulse (BPM) Systolic BP (mmHg)
<1 30-40 110-160 70-90
1-2 25-35 100-150 75-95
2-5 25-30 95-140 80-100
5-12 20-25 80-120 90-110
>12 12-20 60-100 100-120
Chest compressions are indicated if Neonates (<4 wks) HR <60 BPM
GRUNTING Signs
- Grunting: Weak or continuous high-pitched cry; Tachypnoea
- Respiration: Rib Recession; Retraction of sternocleidomastoid; Nasal flaring; Wheeze; Stridor
- Unresponsive: Unequal/Unresponsive Pupils: Focal CNS signs; Seizures; Marked hypotonia
- Neurology: Odd or rigid posture; Decorticate; Decerebrate
- Temperature: ≥38oC if <6 months; Cold peripheries
- Intuition: Judgement of need for investigations with child
- Neisseria: Neck Rigidity: Non-blanching rash; Meningism; Bulging fontanelle
- Gastroenterology: Green bile in vomit (Atresia; Volvulus; Intussusception)
,Common Complaints in Infancy
Crying
Description Management
- Prevalence: 20 % report problems in first 3 months - Sleep: Encourage parents to take turns sleeping
- Peaks: Crying peaks at 6-8 weeks old (~3 hrs/d) - Sooth: Tactile; Vocal; Vestibular (rocking)
- NB: Usually subsides by 4 months - Recognise: Recognise feeding vs sleeping needs
Colic
Description Management
- Prevalence: Occurs in 20 % of infants - Movement: May help with soothing
- Sx: Paroxysmal crying with pulling up of legs - Breastfeeding: Allow to finish first breast first
- Duration: Lasts >3 hrs on ≥3d/wk; Worse in evenings - NB: Fisher’s rule; Hind milk easier to digest
- NB: There is no association with feeding difficulties - Signs: May be sign of relationship issues
Cows’ Milk Protein Allergy/Intolerance
Description Management
- Key: Separate from colic - Breastfeeding: Maternal excludes cow milk in diet
- Path: Either IgE or Non-IgE mediated - Formula: Hypoallergenic formula (eHF milk)
Presentation - eHF Milk: Extensively hydrolysed milk formula
- General: Colic-Sx; GORD; Blood/mucus in stool - NB: Continue with eHF milk after breastfeeding
- Allergy: Urticaria; Wheeze; Coughing Prognosis
- NB: May lead to failure to thrive - IgE: 55 % will be intolerant by 5 YO
- Anaphylaxis: Uncommon - Non-IgE: Most children intolerant by 3 YO
Investigations
- Basic: Skin prick or patch testing
- RAST: Initial IgE and specific IgE for Cow milk protein
- Challenge: Usually in hospital (anaphylaxis risk)
Diaper Dermatitis (Nappy Rash)
Presentation Management
- Ammonia: Red, desquamating rash; Spares skin folds - Ammonia: Frequent changes; Sudocrem
- NB: Due to moisture retention - Thrush: As above + Clotrimazole ± Hydrocortisone
- Thrush: Satellite (beefy red) spots beyond main rash - NB: Avoid barrier creams until thrush eradicated
- NB: Candida is isolated from 50 % of diapers - Seborrhoeic: Same as in ammonia dermatitis
- Seborrheic: Diffuse, red, shiny rash; Enters skin folds - Psoriasis-like: Can be hard to treat
- NB: Associated with cradle cap - NB: Types often coexist with one another
- Psoriasis-like: Psoriasis like symptoms
Vomiting
Description Causes
- Posseting: Effortless regurgitation during feed - Common: GORD; Gastritis; Feeding >150 mL/kg/d
- NB: Vomit between meals is also common - Other: Pyloric stenosis (projectile vomiting)
- Emergency: Bilious (green) vomiting (obstruction) - Rare: Pharyngeal pouch; Poison; ↑ ICP; DKA
, Pre-School Wheeze in Children
Description Management
- Prevalence: 25 % experience an episode by 18 MO - Episodic Viral Wheeze
- Path: Viral-induced wheeze is commonest diagnosis o 1L: SABA inhaler + spacer
Classification o 2L: Add intermittent LRTA and/or ICS
- Episodic Viral: Only wheeze during URTI; Episodic - Multiple Trigger Wheeze
- Multiple Trigger: Multi-factors; Exercise; Pollutants o 1L: Trial of ICS or LRTA for 4-8 wks
Tongue-Tie (Ankyloglossia)
Description Types
- Path: Congenital deformity causing ↓ tongue mobility - Anterior: Frenulum anterior to floor of mouth
- Incidence: 10 % of live births - Posterior: Frenulum not visible due to being
- NB: Can cause trouble feeding and speech deeper in the mouth with ↓ tongue lift
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