12.09.06 Teaching notes

Paediatric history

• • PC

  • HPC

  • Drug Hx

  • Drug allergies

  • Other allergies

  • PMH

  • Pregnancy + birth Hx

  • Developmental Hx

    • Domains

    • Schooling

      • Mainstream?

      • Statement?

  • FHx

    • Siblings' health

    • Inherited conditions

  • SHx

    • Care during day

    • Childminders

    • Smoking

    • Pets

    • Housing conditions

    • Problems

      • Social workers?

      • Child safeguarding plan?

Unwell baby

• • Causes sieve

    • 1: Sepsis

    • 2: Cardiac

    • 3: Metabolic

      • Often causes metabolic acidosis

  • Approach

    • ABC !!!

Causes of neonatal tachypnoea

• • RDS

  • Congenital

    • Heart

    • Lungs

  • Infection

    • Usually congenital in neonates

  • Meconium aspiration syndrome

    • Tends to be in post-term babies

      • Except when caused by infection (GBS, Listeria)

    • See meconium in amniotic fluid

  • TTN

    • Often in elective caesarian

Resp exam

• • Inspection

    • Chest shape

    • Resp rate

      • Key sign in kids

      • Don't forget not-respiratory causes

        • Heart failure

        • DKA

    • Scars

    • Rash

    • Tug

    • Recession

    • Indrawing

    • Harrison's groove

      • Horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm

      • Usually caused by chronic asthma or obstructive respiratory disease

      • May also appear in rickets

  • Auscultation

    • Don't ask them to breathe - just listen to normal breathing

    • Secretions in the nasopharynx can cause sounds to be transmitted to the chest

Croup

• • Aetiology

    • Caused primarily by parainfluenza virus

  • Presentation

    • Barking cough

    • Stridor

  • Management

    • Oral dexamethasone

    • Budesonide nebs (more expensive)

    • Adrenaline nebs

Paediatric asthma

• • Triggers

    • Allergens

    • Exercise

    • Anxiety

  • Management

    • 10 puffs of salbutamol via spacer

      • Take each puff separately (5 deep breaths)

      • Each one is 100 ug (i.e. 1 mg total)

    • Or 2.5 mg / 5 mg nebulised

    • Oral prednisolone

    • IV hydrocortisone

    • Ipratropium bromide

      • Anti-cholinergic

    • MgSO4 bolus

      • Induces bronchial smooth muscle relaxation in a dose-dependent manner:

        • Inhibits calcium influx into the cytosol

        • Inhibits histamine release from mast cells

        • Inhibits acetylcholine release from cholinergic nerve endings

      • May increase the bronchodilator effect of β₂-agonist by increasing the receptor affinity

    • IV salbutamol

    • IV aminophylline

      • Nonselective adenosine receptor antagonist and phosphodiesterase inhibitor

Notes

• • Tell kids to do stuff; Don't ask them

  • RSV => Supportive care only

  • Foetal distress is a VERY BROAD term

    • PROM

    • Placental insufficiency

    • Many other causes

  • Acrocyanosis

    • Persistent blue or cyanotic discoloration of the extremities

    • Most commonly occurs in the hands, although it also occurs in the feet and distal parts of face

  • Common allergens

    • Spring: Trees

    • Summer: Grass

    • Autumn: Moulds

    • House Dust Mites (HDM) / Pets