12.08.29 Assorted notes from the first 2 days

Terminology

• • Term

    • 37-42 weeks

    • Weeks are measured from LMP

  • Preterm

    • <37 weeks

  • Low Birth Weight (LBW)

    • <2.5 kg

    • VLBW <1.5kg

    • ELBW <1kg

  • Small for Gestational Age (SGA)

    • BW <10th centile

  • Neonate

    • First 28 days

Pedigree symbols

IUGR

• • Asymmetrical

    • More common

    • Maternal factors

      • Malnutrition

      • Smoking

      • Pre-eclampsia toxaemia

    • Placental dysfunction

  • Symmetrical

    • Fetal factors

      • Genetic

      • Syndromes

      • Malformations

Neonatal heal-prick test

• • PKU

  • Hypothyroidism

  • Sickle cell

  • MCADD

  • Cystic fibrosis

Puberty - Process

• Adrenarche

  • • Increase of adrenal androgen production

    • Approximately age 7

• Gonadarche

  • • Testicular/ovarian enlargement

    • Approximately age 8

• • Thelarche

    • Approximately age 11 in females

  • Pubarche

    • Appearance of pubic hair

    • Approximately age 12

  • Menarche

    • Approximately age 12.5 in females

  • Spermarche

    • Approximately 11-15 years in males

Precocious puberty

• • Central

    • Gonadotrophin-dependant

    • Normal consonance

  • Peripheral

    • Suppressed LH/FSH

    • Advanced bone age

Congenital Adrenal Hyperplasia

• • Usually due to 21-alpha hydroxylase deficiency

  • So steroids get diverted away from glucocorticoids/mineralocorticoids + into sex steroids

  • Symptoms:

    • Due to inadequate mineralocorticoids:

      • vomiting due to salt-wasting leading to dehydration and death

    • Due to excess androgens:

      • functional and average sized penis in cases involving extreme virilization (but no sperm)

      • ambiguous genitalia, in some females, such that it can be initially difficult to determine sex

      • early pubic hair and rapid growth in childhood

      • precocious puberty or failure of puberty to occur (sexual infantilism: absent or delayed puberty)

      • excessive facial hair, virilization, and/or menstrual irregularity in adolescence

      • infertility due to anovulation

      • enlarged clitoris and shallow vagina

Description of child psychological problems

• • DSM

    • Vulnerability factors

    • Precipitating factors

    • Maintaining factors

    • Protective factors

  • ICD10

    • Acute diagnosis

    • Specific developmental disorder

    • Intellectual level

    • Associated medical conditions

    • Adverse events of psychosocial conditions (z codes)

    • Global Social Function

Diagnosis of autism

• • Poor language + non-verbal communication

  • Difficulties in social interaction

  • Restricted, unimaginative, ritualistic play/activities

Nine temperament characteristics of Thomas and Chess

• Activity

• Regularity

• Initial reaction

• Adaptability

• Intensity

• Mood

• Distractibility

• Persistence and attention span

• Sensitivity

Random notes

• • Haemorrhagic disease of the newborn (HDN)

    • Extremely serious

    • Everyone gets prophylactic Vit K after birth, just in case

  • Retinopathy of prematurity

    • Caused by ROS damage

    • Prevent by limiting O2 (carefully!)

  • Pituitary dysfunction in sickle cell anaemia

    • Frequent blood transfusions => iron overload

    • Treated with chelating agents

    • Complexes deposited in pituitary

  • ODD => Conduct disorder => Antisocial personality disorder

  • ABC analysis of behaviour

    • Antecedents

    • Behavioural traits

    • Consequences

  • ADHD drugs

    • Controlled: Methylphenidate (Ritalin), Dexamphetamine

    • Non-controlled/non-stimulant: Atomoxetine

  • Loss of menstruation is a required feature for diagnosis of anorexia nervosa

  • Fat children

    • Steroids (e.g. Cushings) => Short + fat

    • Food (obesity) => Tall + fat

  • "Faltering growth" not "Failure to thrive"

  • Prader Willi => Can't stop eating

  • Girl < 3rd centile => Check for Turner's

  • Small size at birth

    • Weight deficiency => Short-term problem (e.g. recent malnutrition)

    • Height deficiency => Longer-term, more serious problem

  • Average male-female height difference

    • 14 cm

    • Use to calculate parent's average height, to calculate expected height

      • Or just use average of parent's centiles