General Paediatrics
Definitions
Neonate: <28/7
Young child: 1-8yrs
Weight
Infant: <1yr
Adolescent: 13-16yrs
Older child: 8-12yrs
1-10yrs: (age + 4) x 2
5/12  birth weight x2
ETT
>10yrs: age x 3
1yr  birth weight x3
Mm: (age / 4) + 4 (uncuffed)
+ 3 (cuffed)
Length: (age / 2) + 12 (or 15)
Incr temp 1deg  incr HR 10, incr RR 1-2
For 6yr old child, use BP cuff 7cm width
Obs
BP = (age x 2) + 85
Anatomical
differences
Physiological
differences
Developmental
milestones
Parental
presence at
procedures
UO = 2ml/kg/hr in infant, 1ml/kg/hr in child
Smaller airway, loose teeth, undeveloped cricothyroid membrane, flexible trachea prone to collapse, short trachea
(tube easily displaced), higher (C2-4 compared with C5-6) more anterior larynx, small mandible, narrowest diameter
airway at cricoid (vocal cords in adult), large tongue, large head, U shaped epiglottis and floppy, horizontal ribs (loss of
bucket handle movement and reliance on diaphragm), flatter diaphragm more limited in downward excursion, large
stomach (need NG tube as may cause resp depression, may splint diaphragm); decr AP expansion of chest, bladder
intraabdominal (more easily injured); small chest (so BS’s misleading when confirming tube placement)
HI more common; rib # less common; pul contusion more common
Neonate: barrel shaped chest, high airway closing volumes, incr compliance chest wall
Obligate nasal breather until 6/12, elastic inefficient chest, 40% FRC, lower percentage type 1 (slow twitch) muscles
fibres, prone to air trapping, underdeveloped alveoli until 8yrs, relative incr RR, TV 5-10ml/kg, anatomical dead space
2ml/kg, prone to pneumoT, incr pH stomach, higher O2 requirement, cyanosis pre-terminal, UO 1-2ml/kg/hr, incr body
water (80% vs 60%) at birth, incr IVF (70% vs 50%), 3-4x BMR, poor O2 storage, can go blue fast, poor glycogen stores
so at risk of hypoG, susceptible to heat loss (less subC tissue, high SA:weight; 50-70X rate of adult); decr Ca so
susceptible to tetany; hypotension and bradycardia are pre-terminal; CO related to HR
Neonates: muscle fibres less fatigue-resistant
Neonate: lift head, fix for period
6/52: smile, follow past midline
4/12: roll over
6/12: sit, transfer toys between hands
1yr: walking
single words
2 yrs: throw and kick ball, stack blocks, dress
word combinations
3yrs: ride bike, climb, self feed, play in groups
simple sentences
4yrs: hop, copy shapes, toilet trained
make conversation
6yrs: tie shoes, skip, play team games
read and write
Pros: incr parental satisfaction; decr parental anxiety
Cons: rarely attempt to interfere, make doc uncomfortable
Notes from: Dunn
1yr old would be expected to have HR 120
Normal vital signs:
Age
Term
3/12
6/12
Weight
3.5kg
6kg
7.5kg
HR
RR
SBP
110 – 40 –
170
60
50 90
1yrs
2yrs
4yrs
6yrs
10kg
12kg
16kg
20kg
30 – 40
100 – 160 20 – 30
80 – 130 20
65 - 90
70 - 115
8yrs
10yrs
12yrs
14yrs
24kg
30kg
36kg
42kg
70 – 110
60 – 100
75 – 110
80 – 110
85 – 120
90 – 120
70 – 100
PAEDIATRICS (ASSESSMENT AND MANAGEMENT)
Key issues
Critical nature
Likely illness
Potential complications
Likely important aspects of treatment
Weight and age-specific clinical parameters
HR, BP, RR
Preparation
Staff, area, equipment
On arrival allow carer to stay with child
Assessment
History (as above)
Paed specific history: perinatal history: antenatal history, birth details, prematurity, neonatal probs
developmental milestones: height, weight and head circumference
psychosocial history: family structure, school, psych
immunisations, feeding, nappies, siblings
HEADSS screening questions: Home, Educatoin, Activities, Drugs, Sexuality, Suicide, Self
determination
Examination (as above)
Investigations (as above)
Management
Life threats and ABCDE
No life threats, vital signs
Specific treatment (specify doses, vol)
Supportive measures (remember resus fluids, deficit fluids, maintenance fluids)
Disposition
Consider psychosocial issues
Consider NAI
Malignancy is the 2nd most common cause of paediatric death, after trauma.
Most common types of paediatric malignancy: 1. Leukaemias 30% 2. CNS
tumours 22% (majority are infratentorial) 3. Lymphomas 11% 4.
Neuroblastoma 8% 5. Wilm's (nephroblastoma) 5% Most common types of
leukaemia: 1. Acute lymphoblastic leukaemia (ALL) 86%, of which non-T, nonB ALL is the most common type 2. Acute myeloid leukaemia (AML) 13% 3.
Chronic myeloid leukaemia (CML) 1%