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To understand what constitutes an ill child and to quantify illness it is important first to know about the child in a healthy state.


Age definitions

Neonate: 0-28 days

Infant: <1yr


Growth

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


Nutrition

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.

 

Calorific needs

0-1 year: 110kcal/kg/day

1yr +: 1000 + (100 x age) kcal/day


Maintenance fluids

There are 2 main ways to calculate the maintenance fluid needs of a child. Either are generally accepted.

Method 1

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.

Examples:

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

Method 2

First 10kg – 4ml/kg/hr
2nd 10kg – 2ml/kg/hr
Every subsequent kg – 1ml/kg/hr

Examples:

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


Development

  • 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 🙂


Normal observations

Age (years)
<11-22-55-12>12
Respiratory Rate (/min)30-4025-3520-3015-2012-16
Heart Rate (bpm)110-160100-15095-14080-12060-100

Sleep

  • 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.