When does “Weaning” start?
At 6mths usually
When breastfeeding some children may not open bowels often (one or a few days).
List 9 other breastfeeding problems
- Sore/ cracked nipples (position)
- Thrush (Candida enters)
- Tongue-tie
- Baby not getting enough milk
- Making too much milk
- Breast engorgment
- Blocked milk duct
- Mastitis
- Breast abscess
Describe Infantile Colic
- When baby cries a lot but no obvious cause. Common, should improve on its own
- Cry >3hrs a day/ 3days a week for 1 week
- Can start when a few weeks old, usually stops by 6 months
- Curl up/ arch back due to pain
List some key aspects of gait in children
- Asian children tend to walk later
- Normal gait doesn’t represent that of an adult until 3yrs old
- Adult gait and posture occur around 8yrs
List Normal gait variations in kids
- Toe walking, Knock Knees & In-toeing, Internal Tibial Torsion
- Metatarsus Adductus, Bow Legs, Flat Feet, Crooked Toes
List Abnormal gait variations in kids
- Antalgic, Circumduction, Spastic, Stepping, Clumsy
* Ataxic, Trendelenburg, Toe walking with absent heel contact
List Newborn Skin conditions
- Jaundice (Call GP if not eating, making wet diapers often or difficult to wake up)
- Erythrema Toxicum (red spots/ rash, 2/3 days after birth, not warm)
- Milia (White spots or bumps)
- Cradle Cap (Scales)
- Baby acne, Heat rash, Eczema, Mongolian spots, Newborn dry skin
List and compare Paediatric Skin conditions
- Measles: Partially confluent, spreads from behind ears, Koplik’s spots, Conjuctivitis
- Rubella: Non-confluent maculopapular, Spreads from ears
- Scarlet fever: Maculopapular, Partially confluent, Spreads from neck, Groin+Axilla, Perioral sparing, Strawberry tongue
- 5th disease/ Erythrema Infectiosum: Not always rash. Lace pattern trunk+limbs, slapped cheek
- Roseola infantum: Patchy, More on torso, 3 days high fever, sudden temp. drop before rash
- Varicella: Whole body, small red bumps-> Blisters/pustules-> Scabs, “Starry sky” appearance
Describe Transient Synovitis
Synovial inflammation after minor trauma/ vaccination.
Presents with limp, Hip pain
Usually at age of 3-10yrs
What is the normal lifespan of Threadworms?
6wks
Describe Pyloric Stenosis on examination
Pylorus can sometimes feel tight, especially just before about to vomit
List 2 key aspects of a Newborn exam
- Ideally done within first 24hrs of life, then repeated at 6-8 weeks by GP.
- Adjunct to examination is the Guthrie/ PKU Test to look for Phenylketonuria
Outline the Pre-examination of a Newborn Exam
- Examine Notes (Antenatal-USS/ Bloods, Birthing-APGARS, Birth history & complications)
- PMHx, FHx, Social Hx
- Ask parents: Any concerns? Feeding (Formula/ Breast, Quantity)?, Passed Urine and Meconium in 1st 24hrs?
List 10 steps of a Newborn Exam
1,2: Prepare, Inspect
- Head + Eyes
- Mouth
- Ears
- Chest
- Abdomen + Groin
- Hips, Limbs, Back
- Tone + Reflexes (Moro’s, Stepping etc)
- Conclude exam and Plot Weight, Length, OF Circumference on WHO growth chart
In a Newborn Exam, describe the Inspection
General, Posture, Movements, Colour, Skin marks, Dysmorhpic features
In a Newborn Exam, describe the Head+Eyes stage
- Shape: Occipito-Frontal circumference, Palpate suture lines + Fontanelles
- Eyes: Red reflex to exclude Cataracts and Retinoblastoma
In a Newborn Exam, describe the Mouth and Ears stages
Mouth: Suck reflex, Cleft lip/palate
Ears: Mobile Pinna, Patent EAM
In a Newborn Exam, describe the Chest stage
Palpate Clavicle, Shape+Movement, Heart sounds/ murmur, Air entry, HR, RR, Sats
In a Newborn Exam, describe the Abdomen + Groin stage
- Shape, Distension, Respiration use
- Palpate for masses/ hernia, Auscultate for Bowel sounds, Femoral pulses
- External Genitalia (2 testes, Patent Anus and correct position?)
In a Newborn Exam, describe the Hips, Limbs, back stage
- Symmetry
- Hands: Digits, Palmar crease, Grasp reflex
- Legs: Posture, Digits
- Hips: Barlow’s THEN Ortoleni’s tests to exclude Developmental Dysplasia (“Click”-> USS)
- Spine: Curvature particular Sacrum to exclude Spina Bifida, Palpate SPs, Neuro exam
List the usual order of shapes a child can draw
Line, Circle, Cross, Square, Triangle
Outline relationship of Honey and Wheat to Weaning in a child of 7mths
Honey should be avoided before 12mths due to risk of infant botulism. Wheat is safe to try after 6mths
At what age should a child be referred to paediatrician if not begun to walk?
- 18mths.
- Usually begin to cruise furniture around 10-12mths
- Can walk alone by 15mths
Describe Functional Constipation
Can get from switching from Breast->Formula milk or Cow’s-> Actimel
- H2O pulled out of bowel= Hard stool
- Liquid stool leaks out as overflow ‘diarrhoea’
