CEREBRAL PALSY

Cerebral palsy is a non progressive central motor deficit of posture and movement due to defect in the
developing brain, often associated with MR, special sense organ defects, and epilepsy.
INSTRUMENTS
Lumbar puncture
Bone marrow aspiration needle
liver biopsy needle
Feeding tube/ryles tube
Insulin syringe
Tongue depressor
Resuscitation kit
Endotracheal tube
MDI,Zerostat spacer,Mask
FOOD MATERIALS
Rice polished/parboiled
Ragi
Coconut oil
Sugar/jaggery
Pulse: -Green gram, Bengal gram, Soya bean, Black gram
Banana
Carrot & other vegetables
Egg
Milk
Green leafy vegetable drum stick leaves
Ground nuts

DRUGS & VACCINES

DRUGS
Paracetamol
Prednisolone
IV immunoglobulin
Iron tablets (Ferrous sulfate)
Ceftriaxone injection
Albendazole
Diazepam
Dextrose solution
Azithromycin
IV fluids: - Normal saline, Ringer lactate, isolyte P
ORS WHO ORS formula
VACCINES
DPT, DT
OPV
BCG
DT
HIB
Hep.B
Chickenpox vaccine
IPV

X-RAYS
Rickets
Diaphragmatic hernia
Pleural effusion
Pneumothorax
Pneumonia with pneumatocele
Cardiomegaly with pulmonary plethora
Pneumonia
Hilar nodes
TOF chest X-ray

VITAL SIGNS
PULSE
Palpate all the peripheral pulses, radial pulse & Carotids
Comment Rate/mt, Rhythm regular or not, Character & volume normal or not, any radio femoral delay.
All the peripheral pulses felt or not.
In children less than 4yrs apex beat is located in the 4th intercostals space just lateral to the mid clavicular
line.
4 to 7 yrs it is located in the 5th intercostals space inside at mid clavicular line.
More than 7 yrs like in adult, 5th intercostals space 1.5 cm medial to mid clavicular line.
Capillary filling: - press the nail bed of the finger and if it takes more than 3seconds to refill or flush, it is
suggestive of impending shock or poor circulation ( normal 2 seconds)
RESPIRATORY RATE
The breathing is mostly abdominal or abdomino thoracic in infants
Becomes predominantly thoracic after the age of 5yrs
Age
NB
Infant
Child
Adolescent

Pulse/minute
RR/minute
100-150
40-60
90-120
30-40
70-110
20-30
60-95
14-18

TACHYPNOEA / FAST BREATHING (CSSM)

<2mo
60 or more
2m 12m 50 or more
12m 5yrs

40 or more

BLOOD PRESSURE
Blood pressure cuff width should be between 50 75 % of the circumference of the arm
Age

Systolic pressure

Diastolic pressure

1-3m

75+5

50+5

4-12m

84+5

65+5

1-8yrs

95+5

65+5

9-14yrs

105+5

65+5

Pre hypertension

systolic or diastolic BP 90th - 95th percentile

Hypertension

systolic or diastolic BP >95th percentile

Stage I hypertension

systolic or diastolic BP between 95th percentile and 99th percentile+5mmHg

Stage II hypertension

systolic or diastolic BP >99th percentile +5 mmHg

BP FORMULA
Both systolic and diastolic BP varies with age, gender and height percentiles. BP is also influenced by
physical activity, .anxiety and emotions.
50th centile
90+ (Age X 2)
55 + (Age X 2)
95th centile
100+ (Age X 3)
70+ (Age X 1.5)

5th centile
70+Age X 2

TEMPERATURE
Skin temperature groin or axilla is recorded in infants and preschool children. It is 0.5 oC lower than the oral
temperature,while rectal or ear drum temp is 0.5 oC higher than oral temperature.

Normal
Hypothermia
Febrile
Hyperpyrexia

Centigrade(oC)

Fahrenheit (oF)

36.6 37.2

98 99

<35

<95

>37.2

>99

>41

>106

Three types of fevers

Continuous fever

when the fever is sustained but daily fluctuations are <1oC

(The temperature never reaches normal)

Remittent fever

daily fluctuations exceed 2oC without the temperature touching the base line.

Intermittent fever

if the temperature touches the baseline daily and fever is present for few hours
(fluctuations exceed 1degree centigrade for few hours of a day)

If paroxysms occur daily quotidian, on alternate days as tertian and every two days as quartan
Hectic or septic fever: -type of remittent fever revealing >3degree centigrade fluctuation
Relapsing fevers are separated by intervals of normal temperature.
Biphasic or camel back fever indicates a single illness with two distinct periods of fever over on or more
weeks.
Seen in Poliomyelitis,leptospirosis,and dengue,
Fever with relative bradycardia suggests typhoid fever,brucellosis,leptospirosis,viral hepatitis.