What are the motor milestones in childhood development?
Newborn - flex limbs
6-8 weeks - tummy time, head to 45 degrees
6-9 months - sit w/o support and crawling
10 months - stand independently, use furniture to walk
12 months - unsteady walk, limit age = 18 months
15 months - walks steadily
2.5 years - run and jump
What are the vision and fine motor milestones?
6 weeks - fixing and following 4 months - reaching for toys 4-6 months - palmar grasp 7 months - toys from one hand to another 10 months - pincer grip 16-18 months - marks w crayons Then moves on to brick building and pencil skills.
What are the hearing, speech and language milestones?
Newborn - startles to loud noises 3-4 months - aa, aa, giggles 7 months - bababalalalal, turns to soft sounds 7-10 months - dada, mama 12 months - understands name, 2-3 words 18 months - 6-10 words, can show parts of body 20-24 months - simple phrases 2.5-3 years - 3-4 word sentences
What are the behavioural milestones?
6 weeks - smiles 6-8 months - puts food in their mouth 10-12 months - peek a boo, bye bye 12 months - can drink from cup 18 months - feed w spoon 18-24 months - symbolic play 2 years - toilet training in day 2.5-3 years - takes turns and interactive play
What is bronchiolitis?
Inflam of bronchioles, most common LRTI in first year - 1in3 infants get it.
What are the clinical features of bronchiolitis?
- Cough w increased work of breathing
- Fever
- Poor feeding
- Lower resp tract signs - wheeze/crackles on auscultation
How is bronchiolitis treated?
Supportive - paracetamol, may need NG/IV feeds or ventilation if baby is admitted. Can also give supplemental O2 in hospital.
What are the clinical features of croup?
- Sudden onset barking cough w stridor and chest wall indrawing
- Sx worse at night and w crying
- Hoarse voice
- More severe = child can show signs of resp distress = agitation, lethargy, asynchronous chest wall movement, pale, cyanosis, RR >70
When does a child w croup need hospital admisison?
- Sternal recession/stridor at rest
- RR>60, high fever
- Comorbidities
- Inadequate fluid intake
How do you treat mild croup?
- Single dose dexamethasone immediately
- Explain that sx resolve in 48 hrs
- Safety net when need to go to hospital - stridor or sternal recession/ambulance if struggling to breath
- Advise to keep calm as distress makes worse
- Simple analgesics
What is chicken pox?
Varicella zoster virus - itchy vesicular rash, preceded by fever and malaise.
What is the treatment of chicken pox in a child?
- Symptomatic - paracetamol not NSAIDs, topical calamine lotion, chlorphenamine for itch >1 yo
- Suspect complication eg. pneumonia, encephalitis, dehydration = admit
- Neonate = need specialist advice
How do you confirm headlice infestation?
- Detection combing on wet or dry hair, need to find a live louse = is quite time consuming if do properly
What is the management of head lice?
- Wet combing to remove all lice eg. BugBuster kit
- Insecticide - suffocate lice, apply twice 7 days apart eg. dimeticone
What is involved in the 6 week post natal check to check the mum?
- Mental health discussion
- Have had period or still having vaginal discharge
- BP check
- Examination to see if stitches healed
- Continence discussion
- How is breastfeeing
- Contraception discussion
What is involved in the 6 week post natal check for the baby?
- Check for birth marks
- Top to toe examination - focus on eyes, lungs, spine, heart, hips and testes in boys
- Check baby has had hearing test
- See if baby is smiling and can follow an object
- Discuss baby’s vaccinations
- Weight, length and head circumference
What is involved in the newborn examination?
- Stripped for assessment
- Posture and babies movements
- Skin colour, marks or rashes
- Shape of the head, feel fontanelles
- Eyes - red reflex = excludes cataract
- Mouth - cleft lip/palate, suck reflex
- Chest - movement, auscultate, peripheral sats on foot
- Abdomen - distension?, umbilicus, palpate
- Groin - femoral pulses, hernias, ex genitalia
- Limbs - grasp reflex, exclude hip dysplasia = don’t want click, curvature of spine
What is Osgood Schlatters?
Cause of knee pain in children - inflam of the epiphyseal plate, boney bump found. In active children due to jumping and running?
What are the sx of Osgood Schlatters?
- Pain increased w activitiy and better w rest
- Swelling at tubercle
- Symptoms after growth spurt, normally self limiting but the bump can stay
What is SUFE?
Slipper upper femoral epiphyses - head of femur slipped backwards = vague pain in hip, groin and knee. Can get possible limb shortening and ex rotated during flexion of hip.
Most commonly pt present w knee pain.
What is Perthe’s disease?
Avascular necrosis of the femoral head epiphyses - reduced ROM in hip.
What are threadworms? What are the sx?
Parasite that affects the large intestine.
- Itching especially at night
- Severe = anorexia, weight loss, bed wetting
How are threadworms treated?
Mebendazole - given to everyone in the household even if they are asymptomatic. OTC treatment.
Encourage good hand washing, clean linens in the house good hygiene to kill the eggs.
What is functional constipation?
Idiopathic constipation - easily treated w laxatives but might need to be taken for several months. Red flag = not passing meconium w/i 48 hours.
