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New notes

  • This course contains a lot of embryology and physiology

Scenarios

  • Catherine – failure to thrive
    • Nutrition and growth in babies and children
    • Gastrointestinal system
  • Alex & William – childhood development
    • Normal development and behaviour in babies and children to 5 years
    • The ear and hearing
    • Otitis media and other common childhood infections
    • The endocrine system and sexual development
    • Psycho-social issues re sexuality and gender
  • David - Teenage Mental Health
    • Puberty and adolescence
    • Interactions between stress, personality and mental illness in teenagers
    • Introduction to psychiatry

+ lots of embryology & physiology ...

Assessments

  • Assignment
  • New group project (with SPSS)
  • Practical examination
  • EOC, 2 hours - will include 40 MCQs like with SH EOC
  • EOP, OSCE and Portfolio exams at end of the year

Introduction to the scenario

  • Child health is very different to adult health
  • Failure to thrive = child who is having difficulty putting on weight
  • Click here for the video

Aims

  • Nutrition and Growth
  • Understanding of gastrointestinal tract structure and function
  • Normal cognitive and language development in the first year
  • Hard to get a lot of patients for paediatrics, because children don't get sick these days
  • The ear and hearing

Key concepts

  • GI tract development structure and function
  • Caloric requirements for normal growth
  • Normal growth
  • Ear anatomy and physiology, audiometry and hearing loss
  • Families and parenting

Notes from the video

  • Whinging baby and a toddler as well
  • Started a week ago, difficult to get her settled
  • Sniffling, runny nose, can't drink easily, not eating, mother decided to stop breastfeeding (though she wasn't doing it right)
  • She hasn't been putting on a lot of weight generally, but it's worse now
  • Temperature: has been hot
  • Bottles every four hours - doesn't drink it easily or doesn't drink it all
  • Looks very alert
  • Nose is crusted - had a cold for quite a few days
  • Accessory muscles of breathing are being used - having trouble breathing
  • Chest sounds crackley
  • 3 months old
  • Has started smiling (at 9 weeks)
  • Has a viral infection, baby breathes through nose, when they're trying to feed it can be difficult because she is trying to breathe.
  • Decided to keep a close eye on her
  • Really noisy with the child and baby - sends them outside
  • Sniffling, coughing, not feeding well, hasn't been keeping milk down
  • Baby has loose stools, in the last 2 days
    • New nappy every couple of hours
    • Nappies are wet - not dehydrated
  • Issue is with feeding, not hydration
  • May need help to look after baby. Husband is working and doesn't have time to look after the baby. Mother tries to do it herself but it's hard to juggle looking after the house, the toddler and the baby

Genogram

  • See diagram

Catherine

  • 3 month old baby
  • Difficulty feeding and vomiting
  • Concerns about recent growth
  • Unsettled especially at night
  • Viral respiratory tract infection
  • Loose stools
  • Normal pregnancy and delivery
  • Normal developmental milestones
  • Sibling (Alex aged 3) who has had a cold and otitis media
  • Also a fussy eater, nutritional deficiency
  • Mother taking care of two young children and is very stressed

Questions

  • What questions do you have about?
    • Paediatric assessment
    • Families and parenting
    • Nutrition and growth
    • Infant development

History taking

  • Taking history from parent - reporting symptoms
    • This is from an observer who may be stressed and may see things differently
  • Differences between children and adults - introduction to a children’s hospital
  • Birth history, immunisations, growth and development
    • Some parents choose not to immunise their children
  • Range of ages: premature/mature newborn, through to 16

Examination

  • Importance of observation in children
  • Difficulty of examining infants and children
  • Assessment of general alertness and hydration
  • Sometimes use toys - see how they play
  • Hydration is very important to children compared to adults (e.g. asking about wet nappies)

Parenting

  • Sibling rivalry - can be annoying. Learn to deal with it and know that it's normal
  • Managing a difficult infant
  • Maternal depression/tiredness and supports

Infant feeding

  • Breast and formula feeding (including lactation)
  • Assessment of a child’s intake and hydration
  • Behaviour and feeding
  • Expansion of an infant’s diet

Infant nutrition

  • Normal caloric requirements for growth
    • Need a lot of nutrition to grow (unlike adults, who eat too much)
  • Biochemistry/enzymes
  • Normal vitamin and mineral requirements
  • Eating behaviours in older children

The GI tract

  • Embryology
  • Anatomy of oral cavity, pharynx and upper GIT
  • Exocrine glands in upper GIT
  • Upper GI histology
  • Physiology of digestion and absorption Gut motility/swallowing
  • Reflux and vomiting
  • The autonomic nervous system

The primary purpose of paediatrics

  • To deliver an adult who has developed and grown to their maximum potential
  • Secondary purpose
    • Get paid to be immature

Infant growth

  • Importance of monitoring growth in children
  • Accurate measurements
  • See growth charts
  • Determinants of growth
    • Nutrition
  • Endocrine factors
  • Genetics
  • Emotional input

Infant development

  • Milestones - ranges
  • What affects the attainment of milestones Emotional environment
  • Normal neural development

Infant language

The ear and hearing

  • See diagram

Summary

  • Scenario 1 is an introduction to further explore
    • The fundamentals of paediatrics (Growth and Development)
    • Nutrition
    • The gastrointestinal tract
    • Language and cognitive development
    • Principles of paediatric assessment

Old notes

Scenario themes

  • GIT
  • Growth and nutrition
  • Normal infant growth and development
  • Childhood infections
  • Caloric requirements
  • Families and parenting

Scenario

  • Mother goes to see doctor with a young child (4-5) and baby
  • Baby:
    • Crying, unsettled, hard to make happy for 1 week
    • Worse in the last 2 days
    • Full term with no complications
    • Symptoms
      • Bad nose, vomiting, runny stools
      • Not feeding well, can’t drink easily
        • Stopped breast feeding because baby not putting on weight
      • Feed every 4 hours, baby doesn’t drink all of feed
  • Examination:
    • Alert, nose crusted–had a cold for a few days
    • Accessory muscle use on breathing
  • Baby’s breathe through their noses
    • If sick, can’t breathe through nose when feeding, therefore don’t feed properly and don’t put on weight
    • Hydration is important to be aware of
  • Jealousy, sibling rivalry
  • Developmental milestones
    • When started smiling?
    • Other than sickness, developmentally normal
  • Social support
    • Quite hard at home with 2 young children
    • Husband is working and is tired when comes home
    • Offers of outside help
    • Postnatal depression
  • Child taken away temporarily to allow talking

Summary

  • 3 month old baby with a viral respiratory infection and mild gastroenteritis
  • Difficulty feeding and vomiting
  • Concerns about recent growth

Questions and topics

  • Viral infections
    • Eg:common viral infections in newborns
  • Paediatric assessment
    • Eg:importance of milestones and evaluation of growth
  • Families and parenting
    • Eg:what support services are available?
  • Nutrition
    • Eg:breast feeding vs formula
  • Growth and development
    • Eg:significance of smiling