3a > Paediatrics > Flashcards

Paediatrics Flashcards

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1
Q

How long is exclusive breast feeding recommended for?

A

6 months

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2
Q

What could cause issue with breast feeding? and what does this lead to?

A
  • Poor milk supply, discomfort or pain for mother => inadequate nutrition for baby
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3
Q

Is overfeeding more common in bottle or breast?

A

Bottle

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4
Q

Breast milk benefits (baby + mother)

A
  • contains Ab that protect neonate from infection => reduce infection in neonatal period
  • improved cognitive development
  • decrease risk of SIDS
  • Decrease risk of obesity
  • Mother: reduce risk of breast and ovarian cancer
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5
Q

How much formula feed vol per day?

A

150ml of milk per kg of body weight (from day 4 onwards)

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6
Q

How much weight loss is acceptable in neonate? (breast + bottle) when should the weight be back?

A

acceptable for breast fed to lose <10% and formula fed up to 5% of their body weight by day 5
- then back at birth weight by day 10

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7
Q

What is most common cause of weight loss in neonate?

A

dehydration due to underfeeding

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8
Q

What is weaning? when?

A

transition from milk to normal food
- around 6 months

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9
Q

What does growth chart plot? (x + y axis?)

A

y axis: child’s weight, height + head circumference
x axis: age (and sex)

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10
Q

what do the centiles on a child’s growth chart indicate

A

where the Childs growth compares against normal distribution for their age and sex

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11
Q

What are the different phases of growth in children (3). what does it depend on?

A
  • First 2 years: rapid growth driven by nutritional factors
  • 2 years-puberty: Steady slow growth
  • Puberty: rapid growth spurt driven by sex hormones
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12
Q

What counts as child as overweight? obese?

A

Overweight: BMI > 85th percentile
Obese: BMI > 95th percentile

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13
Q

Child is short and obese. What could this indicate?

A

Possible endocrine issue
(Usually overweight/obese children are tall for age)

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14
Q

causes of failure to thrive (5)

A

anything that lead to inadequate energy and nutrition
- Inadequate nutritional intake
- difficulty feeding
- malabsorption
- increased energy requirments
- inability to precess nutrition

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15
Q

Failure to thrive: causes of inadequate nutritional intake? (5)

A
  • maternal malabsorption if breastfeeding
  • Iron deficiency anaemia
  • Family or parental problems
  • Neglect
  • Availability of food (poverty)
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16
Q

Failure to thrive: causes of difficulty feeding? (3)

A
  • Poor suck (e.g. cerebral palsy)
  • Cleft lip of palate
  • pyloric stenosis
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17
Q

Failure to thrive: causes of malabsorption?

A
  • CF
  • Coeliac disease
  • Cows milk intolerance
  • Chronic diarrhoea
  • IBD
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18
Q

Filaure to thrive: causes of increased energy requirements? (3)

A
  • Hyperthyroidism
  • Chronic disease (congenital heart disease, CF)
  • Malignancy
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19
Q

Failure to thrive: cause of inability to process nutrients properly?

A

type 1 diabetes

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20
Q

what is defined as short stature? what does it depend on

A

height more than 2 standard deviations below the average for their age and sex

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21
Q

how do you work out a child predicated height? girl? boy?

A

Boys: (mother height + fathers height + 14cm)/2
Girls: (mother height + fathers height - 14cm)/2

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22
Q

what could cause short stature?

A
  • familial short stature
  • Constitutional delay in growth and development
  • Malnutrition
    Chronic diseases (coeliacs, IBD, congenital heart disease)
  • Genetic disorders (downs syndrome)
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23
Q

What are the 4 categories of the developemtnatl milestones

A
  • Gross motor
  • Fine motor + vision
  • Language, hearing + speech
  • Social, emotional, behavioural
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24
Q

Describe the developmental milestones of a 6 month old

A
  • Gross: maintain a sitting position
  • Fine: palmar grasp
  • Language: Makes noises with consonants, responds to tone of voice
  • Personal + social: curious and engaged with people
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25
Describe the developmental milestones of a 12 month old?
- Gross: Stand + begin cruising - Fine: pincer grasp, hold crayon and scribble randomly - Language: says single words, follows v simple instructions - personal + social: engages with others by pointing and handing objects, waves bye bye
26
What is global developmental delay?
child displays slow development in all developmental domains
27
Name some conditions that can cause global developmental delay? (3)
- Downs syndrome - Fragile X syndrome - Fetal alcohol syndrome
28
What age range does puberty start for girls? boys?
puberty stars age 8-13 in girls and 9-14 in boys
29
how long does puberty take form start to finish?
4 years (2-5 yrs)
30
describe the overall development of girls during puberty? what develops first?
starts with breast bud development => then pubic hair => menstrual periods start (about 2 years form the start of puberty)
31
Describe the overall development of boys doing puberty? what develops first?
Starts with enlargement of testicles => enlargement of the penis => gradual darkening of the scrotum => development of pubic hair => deepening of voice
32
Can 16/17 years olds make independent decisions about their health? when can this be overruled?
16 and 17 year olds can make independent decisions bout their health - if they refuse treatment then this can be overruled in certain situations by parents
33
Can children under 16 make decisions about treatment?
they can if they are deemed to have Gillick competence
34
What is the upper + lower age limit of Gillick competence ?
children under 16 (there is no lower limit but unlikely to be less than 13)
35
What are Frazer guidelines?
guidelines for providing contraception to patients under 16 years
36
What is hypogonadism and what does it cause?
lack of the sex hormones (oestrogen + testosterone) => delayed puberty
37
What is hypogonadoprphic hypogonadism? describe the hormone levels? abnormal functioning of what?
Due to abnormal functioning of hypothalamus or AP - Deficiency in LH + FSH => deficiencies in sex hormones (testosterone + oestrogen)
38
Causes of hypogonadotrophic hypogonadism?
- GH deficicnety - Hypothyroidism - serious chronic illness (CF, IBD) - Excessive exercise or dieting - Constitutional delay - Kallman syndrome
39
What is hypergonadoprphic hypogonadism? describe the hormone levels? abnormal functioning of what?
Due to abnormal function of the gonads lack of response to LH + FSH by gonads => no negative feedback => AP produces increased amount of LH + FSh to stimulate the gonads
40
Cause of hypergonadotrophic hypogonadism?
Due to abnormal function of the gonads - Previous damage to gonads - Kleifelters Syndrome - Turners syndrome
41
What counts as precocious puberty ? what age in girls and boys ?
the development of secondary sexual characteristics <8 in girls, <9 in boys
42
What are the 2 general categories for precocious puberty causes ?
- Central (GnRH dependant) - Peripheral (over production of sex hormones)
43
what are some central precocious puberty causes ? (4)
GnRH dependant (dysfunction of hypo or AP) - Tumour - Infection - Cyst - Radiation damage to brain
44
what are some peripheral precocious puberty causes ? (4)
(over production of sex hormones) - cyst/tumour - genetic coditions - Dysfunction of glands 9throid, adrenal) - exogenous sex hormones (meds, creams)
45
How is precocious puberty diagnosed ? (3)
- Tanner scale - GnRH levels - US/MRI (structural abnormalities of brain + gonads)
46
What is adrenal insufficiency ? what hormones ?
when adrenal glands do not release enough steroids hormones (cortisol + aldosterone)
47
Where is cortisol release from ? controlled by what ? describe the pattern of how its secreted
cortisol secreted by 2 adrenal glands (cortex) (above kidneys) controlled by hypothalamus - secreted in pulses in response to stressful stimulus (diurnal variation)
48
briefly describe HPA axis ?
hypo secretes CRH => AP secrete ACTH => adrenal secretes cortisol (-ve feedback on hypo and AP)
49
50
What are the actions of aldosterone ?
acts on nephrons of kidney => Na reabsopred (water follows), increase K secretion, Increase H+ secretion => increase BP
51
What type of hormone is cortisol ? aldosterone ?
- cortisol: glucocorticoid - aldosterone: mineralocorticoid (both steroid hormones)
52
What is primary adrenal insufficiency ? another name for this ? usual cause ?
Addisons: adrenal glands are damaged (=> low cortisol + aldosterone) - usually autoimmune
53
what is tertiary adrenal insufficnety ? causes ?
adrenal insufficney caused by problem with hypo - due to long term steroids => suppression of hypo
54
what is secondary adrenal insufficiency ? causes ?
adrenal insufficiency caused by problem with AP - congenital hypoplasia - surgery - infection
55
features of adrenal insufficiency in babies ? (6)
- lethargy - vomiting - poor feeding - hypoglycaemia - jaundice - FTT
56
what investigations for adrenal insufficiency ?
- Cortisol, ACTH, aldosterone, renin - Short synacthen test
57
describe the cortisol, ACTH, aldosterone + renin in Addisons ? secondary adrenal insufficiency ?
- Addisons (primary): low cortisol, high ACTH, low aldosterone, high renin - Secondary: low cortisol, low ACTH, normal aldosterone + normal renin
58
what is the short synacthen test ?
ACTH stimulation test: give synacthen (synthetic ACTH) and see the effect on cortisol ( to see if primary or secondary adrenal insufficiency)
59
adrenal insufficney Mx? (2) name the drugs and what they are replacing
replacement steroids - hydrocortisone (glucocorticoi to replace cortisol) - fludrocortison (mineralocorticoid to replace aldosterone)
60
what is addisonian crisis ?
adrenal crisis: acute presentation here absence of steroid hormones => life threatening crisis
61
When does s a child start to show hand preference ? when would you be concerned ? what could this indicate ?
usually 2-4 yrs - hand preference before 12 months is abnormal (could indicate CP)
62
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