NEONATOLOGY CLINIC:

Questions to as in History for a congenital heart defect:

HPI:

- Poor feeding? Does the child sweat during feeds, not staying long on the breast, gasping?
- SOB
- Level of activity: lethargy or cyanosis occurs?
- Able to sit up/ roll to the side?
- Cooing or talking?

FHx:

- Relatives with heart probs?

- Are other siblings/ did other siblings achieve milestones better?

BIRTH Hx

- was baby premature?

PHYSICAL EXAM:

- Ensure you check for ‘growth parameters’ as failure to thrive may occur
- Signs of respiratory distress
- Signs of heart failure eg: hepatomegaly, creps to lung basses, tachycardia and tachypnea,
peripheral edema

 When is it failure to thrive? When it’s Less than -2 OR crossing two percentiles
 Birth asphyxia: an APGAR <7 is associated with poor milestones
 Certain drugs like aminoglycosides (gentamicin, amikacin) can cause ototoxicity/neurtoxicity
 You can also do an eye test to test for retinopathy of prematurity
 Transfontanelle ultrasound is done to detect bleeding
 NEUROLOGY CLINIC- DAVIDSON

In approaching a patient with seizures

1) Was is a seizure or not?

2) Was it due to a primary or secondary cause
3) What type of seizure: focal/ generalized or an epileptic syndrome?  prognosis: seizures will
recur.

Focal seizure: aura is present, patient knows they’ll have a seizure. Patient may have multifoci but at
time of seizure only one may be manifesting.

Bilateral convulsions may be:

Aspects of adherence that patients must know:
- Focal with bilateral convulsions
- Generalized bilateral convulsions - Don’t switch formulations
- Stick to brands
- Don’t miss dates and double up
Reasons for recurring seizures? - Take drug at the ‘correct frequency’
- Take the correct dosage
- Non- adherence to drugs
- Secondary causes of seizures eg: infection, trauma

Reasons for recurring seizures in the absence of secondary causes AND drugs are adhered to:

- Pathology may be evolving, so more than one drug may be needed

- Drug may not be adequate for age / weight

Side Effects of Carbamazepine (tegretol): Steven- Johnson syndrome, MI, hepatic, failure, bone
marrow suppression, dizziness, ataxia, drowsiness, nausea/vomiting.
After seizure  post- ictal phase. Duration of the post-ictal phase indicates the duration of the
seizure.

Things to ask in the History:

o Frequency and duration of seizures

o Turning blue
o Salivation Shaking: was it the whole body? Do the
o Sweating upper limbs go out and in? how do the arms
o stopped breathing and legs move?
o incontinence
o shaking
o eyes open/ closed or rolled back?
o Do seizures occur predominantly in the day or night? (some seizures can be induced by sleep-
focal nocturnal seziures- this is more in adolescents)
 o If it’s more common at nights, would the child be awake longer in the day or would they be
drowsy?
o If it occurs in the day, does it affect function? Eg: are they still able to go to school?
o Is there a FHx of seizures
o Assess the child’s ability in school- ask for the report card
o If the child is gaining a lot of weight- ask if they’re on valporic acid (VA).

Side effects of VA:

- Excess weight gain Therapeutic dose of VA:

- Alopecia 30-60 mg/ kg.
- Liver dysfunction Tablet comes in 200 to 400 mg
- hepatomegaly
- Thrombocytopenia

NORMAL GROWTH: child is supposed to gain-

 25 cm in 1st year
 12 cm in 2nd year
 8 cm in 3rd year
 4-7 cm/ year till puberty (growth spurt occurs in puberty)

NORMAL WEIGHT GAIN: 2.5 kg/ year till puberty

If they’re overweight, consider BMI:

 >85th  overweight
 >95th  obese

Don’t tailor your management to LOSE weight in kids, that’s not the aim. Instead:

- Decrease the RATE of weight gain

- Alter the type of food

Some complications of cerebral palsy:

- Seizures - Contractures
- Cognitive impairment - Decubitus ulcers
- Cortical blindness, strabismus, nystagmus - Decreased bone turnover (impared Ca-PO4
- Deafness metabolism- patient needs FA & MV). Rem:
- Impaired suck/swallow  aspiration bone turnover is worsened by anti-
- Imparired oral hygiene epileptics like tegretol
- Constipation/ GERD - Socioeconomic & psychological issues
- Neurogenic bladder - Developmental delay
- Increased UTI - Behavioural and sleep disorders
- Hip subluxation
DESCRIBING POSTURE:

Are the limbs adducted, extended etc. is the wrist extended, is the hand fisted? Are the hipe flexed,
abducted, is he ankle flexed (eg: plantar flexed), are the toes downward..

Is the posture in keeping with increased or decreased tone? You can say this without even touching the
patient, just from noting their posture.

BULK: If it’s decreased, is this symmectical, is it more prominent proximally or distally.

- Proximal wasting: muscular dystrophy

- Distal wasting: neuro probs (lol) –this is what is said

FASICULATONS: are they spontaneous or induced?

- Flick the muscle to induce a fascilation.

- Fasciculations are assoced with LMN disease

How to advise parents when their child will walk

In normal children: by 15 months. In abnormal children, we may increase the cut off point to about 3-4
years but if they’ve not walked by then, chances are the child will not walk as the brain has already
‘missed’ the ability/ chance to learn this. If the child can’t sit up by 2 to 3 years and balance their head
normal is at 6 months) then they won’t walk 