To understand what constitutes an ill child and to quantify illness it is important first to know about the child in a healthy state.
Neonate: 0-28 days
Viewed in terms of height and weight. Considers hyperplasia, hypertrophy and differentiation of tissues.
Considered to have 4 phases, which are dependent on a variety of factors:
1. Foetal – dependent on uterine environment
2. Infantile – dependent on nutrition, general health and happiness, thyroid function
3. Childhood – dependent on thyroid hormones, growth hormone, general health and happiness, genetics
4. Pubertal – dependent on sex hormones (especially testosterone and oestrogen), growth hormone
Newborn/ infant feeding and nutrition
- Average birth weight ~ 7lb (3.5kg)
- Breastfeeding takes up to 7 days to establish -babies often lose a little weight in this time. (>15% loss is worrying)
- Micturition should occur within 24h & meconium within 48h.
- Infants tend to double their birthweight by 5m, and be ~10kg by 1 yr.
- Exclusive breast or bottle-feeding is advised until 6m
- Formula milk – whey-based. Important to use the correct age range powder.
- Nutramigen: partially hydrolysed cow’s milk. Neocate: just amino acids. Enfamil: thickened, used in GORD.
- Infants need 150ml/kg feed per day until weaning. (30ml=1oz)
- Weaning should not occur before 17 weeks (chewing and swallowing mechanisms)
- When weaning – avoid egg and wheat until ~6m. Avoid honey. “Full-fat” milk advised until 5 years.
0-1 year: 110kcal/kg/day
1yr +: 1000 + (100 x age) kcal/day
There are 2 main ways to calculate the maintenance fluid needs of a child. Either are generally accepted.
1st 10kg = 100ml/kg/day
2nd 10 kg = 50ml/kg/d
Subsequent = 20ml/kg/d
To work out hourly rate, this can be divided by 24.
1. 14kg child – (10 x 100) + (4 x 50) = 1200ml/day
2. 8kg child – 8 x 100 = 800ml/day
3. 21kg child – (10 x 100) + (10 x 50) + (1 x 20) = 1520ml/day
First 10kg – 4ml/kg/hr
2nd 10kg – 2ml/kg/hr
Every subsequent kg – 1ml/kg/hr
1. 14kg child – (10 x 4) + (4 x 2) = 48ml/hr
2. 8kg child – 8 x 4 = 36ml/hr
3. 21kg child – (10 x 4) + (10 x 2) + (1 x 1) = 61ml/hr
- Interaction of heredity and environment.
- Measured in 4 domains: gross motor, fine motor and vision, speech & language, social.
- Development is most rapid in the first 4 years.
- Warning signs for developmental delay – family history, maternal concerns, persisting primitive reflexes, discordant development in the 4 domains, regression.
- Urine continence: dry by day age 2-3yrs. Dry nights 3-4 years. 10% of children aged 5 suffer nighttime eneuresis.
- Encopresis: passage of faeces onto clothes. Considered abnormal after 4 years.
Screening to check growth and development
- Neonatal examination: heart, eyes, hips, hearing test
- 1 week – Guthrie test: PKU, MCAD, hypothyroidism, CF, haemoglobinopathies
- 6-8 week check: heart, eyes, hips, general.
- 4-5 y – orthoptist: Colour vision and acuity. Eyesight should be 6/6 by 5yrs.
Development: See Developmental Stages post 🙂
|Respiratory Rate (/min)||30-40||25-35||20-30||15-20||12-16|
|Heart Rate (bpm)||110-160||100-150||95-140||80-120||60-100|
- Neonates sleep ~16hrs a day.
- 14h by 6m
- 13 h by 2 years
- 12h at 4 years
- Common sleep problems: night terrors (4-7 years), nightmares (8-10 years), sleep walking (5-10 years), sleep onset delay, night awakening, daytime sleepiness.