Paediatrics

• Appearance: blue or pale / peripheral cyanosis / pink
• Pulse: absent / <100 / >100
• Grimace to stimulation: absent / feeble / cry or pull away
• Activity: flaccid / some flexion / active flexion resisting extension
• Respiration: absent / weak, irregular or gasping / strong cry

Maximum score is 10

>7 is normal, especially immediately after birth when cyanosis is common

<3 is critical, intubation may be indicated

90 + age (years)

over

55 + age (years)

(age in years + 4) x 2

• 3 months - 6kg
• 6 months - 8kg
• 9 months - 9kg
• 12 months - 10kg

• 1 month - 60
• 1 year - 30
• 10 years - 15

• Bonding
• Reduced solutes - sodium, phosphate and proteins
• Eczema - lower incidence
• Allergy protection - including reduce intolreance of cow's milk
• Sterilisation not required
• Taurine - promotes development
• Macrophages
• IgA and higher IQ
• Lactoperoxidase, lysosyms, lactoferrin, long-chain fatty acids
• Kot death reduction

• Symptom-free
• Systolic
• Split second sound
• Sternal edge (left)
• Small area (pulmonary only)
• Soft

• RV --> aorta
• LV --> pulmonary artery trunk
• duct-dependent circulation
• unwell
• cyanosis and acidosis when duct closes
• switch operation required for definitive management

• narrow mediastinum
• egg-on-side appearance of heart

• non-cyanotic
• shock
• poor perfusion of limbs distal to coarctation
• absent femoral pulses

• cyanotic heart disease
• presents in teenage years
• septal defects
• over time, the right ventricle hypertrophies
• RVH --> reversal of flow --> L to R shunt --> cyanosis

• loud machinery-like murmur
• heart failure

• transposition of the great arteries
• coarctation of the aorta
• critical aortic stenosis
• hypoplastic left heart syndrome

heart failure during first week of life

left outflow obstruction means blood only reaches systemic circulation via PA --> ductus

• VSD
• ASD
• PDA
• shunts are BACKWARDS!

• breathless
• blood is being shunted backwards
• volume overload in lungs and right heart
• pulmonary oedema
• systemically poor perfusion
• septal defects or PDA

• tetralogy of Fallot
• transposition of the great arteries
• shunts are FORWARDS, bypassing lungs

• blue
• blood bypasses the lungs
• poor oxygenation
• heart failure at greater than 1 week old

• < 8 in girls
• < 10 in boys
• brain MRI, gonadotrophin levels, sex steroid levels

• normal sequence suggesting intact HPG axis
• commoner in girls
• more likely to be pathological in boys
• > 80% idiopathic
• intracranial pathology: tumours, haemorrhage, hydrocephalus, neurofibromatosis, cerebral palsy
• primary hypothyroidism

• abnormal sequence
• girls: hair + growth without breast buds
• boys: puberty features but small testes
• gonadotrophin-independent
• usually extra-cranial

• adrenal virilizing tumours
• congenital adrenal hyperplasia
• Cushing's syndrome
• testicular or ovarian malignancy
• gonadotrophin secreting tumours (hepatoblastoma)
• McCune-Albright syndrome

• sporadic genetic condition
• ovarian cysts --> oestradiol --> precocious puberty
• cafe-au-lait spots
• polyostotic fibrous dysplasia (normal bone replaced by cysts)

presence of pubic hair without other signs of puberty

appearance of breast tissue without maturation of the nipple or other signs of puberty

• 1. none (< 10)
• 2. small amount, downy (< 11.5)
• 3. coarse, curly (< 13)
• 4. extends across pubis (< 15)
• 5. medial thighs (> 15)

• 1. <1.5ml (< 9 )
• 2. < 6ml, skin thins (< 11)
• 3. <12 ml, scrotum enlarges (< 12.5)
• 4. < 20ml, scrotum enlarges further (< 14)
• 5. > 20ml, adult scrotum and penis (> 14)

• 1. no glandular tissue, areola follows skin contour (< 10)
• 2. buds, areola widens (< 11.5)
• 3. breast elevates and extends beyond areola (< 13)
• 4. increased size, areola and nipple form secondary mound (< 15)
• 5. adult size (> 15)

• weight loss 5% (infant) or 3% (teenager)
• thirsty
• everything else normal

• weight loss 10% (infant) or 6% (teenager)
• thirsty, restless, lethargic, irritable, drowsy
• tachycardia
• weak pulses
• orthostatic hypotension
• slightly decreased skin turgor and sunken fontanelle
• dry mucous membranes
• deep respirations
• oliguria

• weight loss 15% (infant) or 9% (teenager)
• drowsy, limp, cold, sweaty, cyanotic, comatose
• tachycardia and hypotension
• decreased pulse
• poor perfusion, mottled
• reduced skin tugor
• very dry mucous membranes
• sunken fontanelle
• absent tears
• deep and rapid breathing
• anuria