أساسيات طب الأطفال
Growth, Erikson, pain scales, newborn care, classic conditions.
طب الأطفال وحديثي الولادة
Growth & development
- Weight doubles by 5–6 months and triples by 12 months (3 kg → about 9 kg).
- Posterior fontanel closes by 2–3 months; anterior by 12–18 months. A bulging fontanel means raised ICP; a sunken one means dehydration.
- Normal newborn: HR 110–160, RR 30–60, systolic BP about 60–80 mmHg.
| Age | Erikson stage | Nursing approach |
|---|---|---|
| Infant (0–1) | Trust vs mistrust | Consistent care; keep parents close |
| Toddler (1–3) | Autonomy vs shame & doubt | Simple choices; routines; separation anxiety (protest → despair → detachment) |
| Preschool (3–6) | Initiative vs guilt | Therapeutic play (doll); may see illness as punishment |
| School age (6–12) | Industry vs inferiority | Concrete explanations, models; involve in care |
| Adolescent (12–18) | Identity vs role confusion | Privacy, peers, body image; risk-taking behaviour |
Pain scales
| Scale | Use |
|---|---|
| CRIES / NIPS | Newborns |
| FLACC | Pre-verbal or non-verbal children (about 2 months – 7 years) |
| Wong-Baker FACES | 3 years and older |
| Numeric 0–10 | About 8 years and older |
Newborn care
- Priorities after birth: airway, then warmth (dry, skin-to-skin, cap). Heat loss: conduction (cold scale), convection (drafts), evaporation (wet skin), radiation (cold walls).
- Vitamin K 1 mg IM in the vastus lateralis (0.5 mg if preterm): the sterile gut cannot make vitamin K. Erythromycin eye ointment prevents gonococcal ophthalmia.
- Caput succedaneum: edema that crosses sutures and resolves in days. Cephalhematoma: blood that does not cross sutures and raises the jaundice risk.
- Physiologic jaundice appears after 24 h (immature liver). Jaundice in the first 24 h is pathologic. Phototherapy: eye shields, frequent feeds, turn every 2 h, no lotions.
- Infant of a diabetic mother: macrosomia and hypoglycemia after birth. SGA/AGA/LGA are defined by weight below the 10th, between, or above the 90th percentile for gestational age.
- Milia (white spots on the nose), Mongolian spots (blue-grey over the sacrum — not bruises), lanugo and vernix are more abundant in preterm babies.
Common conditions
| Condition | Classic signs | Key care |
|---|---|---|
| Pyloric stenosis (2–8 wk) | Projectile non-bilious vomiting, olive mass in the RUQ, hungry baby | Rehydrate; pyloromyotomy |
| Intussusception | Colicky pain with legs drawn up, currant-jelly stool, sausage-shaped mass | Ultrasound; air or saline enema reduction |
| Hirschsprung disease | No meconium in 24–48 h, distension, ribbon stools | Rectal biopsy; watch for enterocolitis |
| TEF / esophageal atresia | Choking, coughing, cyanosis with feeds; drooling | NPO, head up, suction the upper pouch |
| Tetralogy of Fallot | Cyanosis, 'tet' spells, clubbing | Knee-chest position, oxygen |
| Coarctation of the aorta | BP higher in the arms than the legs; weak femoral pulses | Surgical repair |
| VSD | Murmur; left-to-right shunt (acyanotic) | Small defects often close by 1 year |
| Sickle cell crisis | Severe pain in limbs and joints | Oxygen, IV fluids, strong analgesia; avoid cold, altitude and dehydration |
| Nephrotic syndrome | Edema, massive proteinuria, frothy urine | Steroids, low-salt diet, infection prevention |
| Acute glomerulonephritis | Cola-coloured urine, hypertension, edema 1–2 wk after strep throat | Monitor BP, fluid and salt restriction |
| Rheumatic fever | Follows strep throat: carditis, polyarthritis, chorea | Penicillin, aspirin, rest; ASO titre |
| Spina bifida (myelomeningocele) | Sac on the back | Prone, moist sterile dressing, latex-free care, watch head circumference |
| Cleft lip / palate | Feeding difficulty | Upright feeds, burp often; lip repair about 3 months, palate 12–18 months |
| DDH | Positive Ortolani or Barlow, asymmetric thigh folds | Pavlik harness worn continuously |
Immunisation points examiners like
- Hepatitis B (and BCG in Saudi Arabia) at birth. Measles plus meningococcal conjugate at 9 months; MMR at 12 months; hepatitis A from 18 months (national schedule). Check the current MOH schedule for exact visits.
- Routes: IM in the vastus lateralis for infants (DTaP, HepB, Hib, PCV); SC for MMR and varicella; intradermal for BCG and Mantoux; oral for OPV and rotavirus.
- Live vaccines (MMR, varicella, OPV, BCG, rotavirus) are avoided in pregnancy and severe immunosuppression (e.g., high-dose steroids).
- Minor redness or swelling at the site: cool compress. Hajj pilgrims need the meningococcal ACYW135 vaccine.
اختبر نفسك الآن
230 سؤالاً بنمط الاختبار في طب الأطفال وحديثي الولادة، مع شرح لكل خيار. حساب مجاني بدون بطاقة.
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