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Biochemistry of Human Milk

Key Points Human milk is a highly complex composition of nutrients for infant growth, consisting primarily of fat, carbohydrates, and proteins, as well as minerals, vitamins, and other nutrients. The delicate balance of nutrients and the dynamic lactation process make human milk the only food substance during life that is adequate as the sole source of nutrition. The biochemistry of human milk changes throughout the stages…

Physiology of Lactation

Key Points Lactation represents the completion of the reproductive cycle and occurs as one of the major stages of mammary gland development: (1) embryogenesis; (2) mammogenesis; (3) lactogenesis, or secretory differentiation (stage 1 lactogenesis) and secretory activation (stage II lactogenesis); (4) lactation (or stage III lactogenesis), or full milk secretion; and (5) involution. Hormones play a central role in mammary gland development (estrogen and progesterone in…

Anatomy of the Breast

Key Points The mammary gland, or “breast,” is the only organ that is not fully developed at birth and undergoes dramatic changes from birth to pregnancy, lactation, and involution. The three major structures of the breast are skin, including the nipple, areola, and general skin; subcutaneous tissue; and corpus mammae, which is the breast mass that remains after freeing the breast from the deep attachments and…

Breastfeeding in a New Era

Key Points The long history of breastfeeding has brought us to a better understanding of the crucial role of human breast milk in the nutrition and growth and development of infants and children. Research into lactation, breastfeeding, and human breast milk will guide how we support breastfeeding and the use of breast milk for all children. National and international legislation and policy development are necessary for…

Evidence-based paediatrics

After reading this chapter you should be able to: apply evidence-based medicine to clinical practice interpret a research paper or systematic review appropriately Evidence-based paediatrics requires the paediatrician to use the current best evidence in the assessment of clinical conditions and treatment options and to apply that to the specific needs of the individual young patient. Consequently, an understanding of the scientific evidence that supports clinical…

Patient safety and clinical governance

After reading this chapter you should: be able to apply patient safety thinking understand how human factors detrimental to care can be minimised be able to lead a safe and effective handover Clinical governance This term describes the framework of practice that ensures patients receive the highest possible care from the NHS. All staff—whatever their role and whatever their grade—are required to contribute to the continued…

Ethics and law

After reading this chapter you should be able to: apply legal rights of children and young people within the current UK legal framework Ethics Ethics are the principles by which we live our lives. They are defined by many factors including religion, law and custom. Ethical codes define our moral practice and aim to distinguish between right and wrong, good and evil or fair and unfair.…

Palliative care

After reading this chapter you should understand: the ethics of palliative care in life-limiting conditions and in the withdrawal and withholding of care the application of nonpharmacological and pharmacological interventions in children Two important aspects of palliative care are ethical issues and symptom control. Ethical considerations in palliative care involve: medical decisions on investigations or treatment that have good and bad consequences decision regarding withdrawal or…

Metabolic medicine

After reading this chapter you should: know the biochemical features of metabolic diseases be able to undertake and interpret relevant metabolic investigations understand the clinical presentation and prognosis of metabolic diseases know the screening procedures for inherited metabolic conditions Metabolic medicine cares for those children who present with conditions resulting from absence or disruption of metabolic cellular processes. These processes are dependent upon the specific actions…

Musculoskeletal disorders

After reading this chapter you should be able to assess, diagnose and manage: acute and chronic musculoskeletal disease musculoskeletal inflammatory diseases common vasculitic disorders common inherited bone disorders developmental bone disorders—scoliosis, hip dysplasia, Perthes disease Musculoskeletal symptoms , particularly pain, are common in children and usually relate to injury, overuse, rapid growth, biomechanical or postural abnormalities. Musculoskeletal disorders are less common and they are usually rheumatological…

Ophthalmology

After reading this chapter you should be able to assess, diagnose and manage: visual impairment proptosis and ptosis strabismus and nystagmus glaucoma, papilloedema, eye tumours and cataract Eye and vision disorders affect 10% of otherwise healthy UK children but are much more prevalent in children with underlying neurological or systemic conditions. Eye anomalies often occur as part of a genetic syndrome and may aid recognition of…

Neurodevelopmental medicine

After reading this chapter you should be able to assess, diagnose and manage: developmental disorders and learning difficulties speech and language disorders including autism spectrum disorder neurodevelopmental disorders a child with neurodisability The care of children with neurodevelopmental disorders covers a range of skills provided by different members of a large multidisciplinary team. The prime objectives of this team are the initial identification of areas of…

Neurology

After reading this chapter you should be able to: understand and request suitable neurophysiological and neuroimaging studies. assess and diagnose abnormalities in skull development. investigate and manage headache. assess, diagnose, investigate and manage seizure disorders. assess, diagnose and manage muscular dystrophies, neuropathies, myopathies and myalgia. assess, diagnose and manage ataxia. assess, diagnose and manage stroke. Neurological investigations Neurophysiological investigations Electroencephalogram (EEG) EEG is used in the…

Endocrinology

After reading this chapter you should: know the causes and management of pituitary and hypothalamic disorders be able to assess, diagnose and manage disorders of the adrenal glands be able to assess, diagnose and manage disorders of thyroid and parathyroid glands be able to identify endocrine complications of other diseases and refer appropriately Many complex interactions of normal cellular function are controlled by hormones released by…

Diabetes mellitus

After reading this chapter you should be able to: assess, diagnose and manage diabetes and its complications, including diabetic ketoacidosis assess, diagnose and manage hypoglycaemia in the child with diabetes The diagnosis of diabetes has a significant impact on children, young people and their families. Like all other chronic conditions, it will affect the physical and mental health of the individual and may influence many life…

Dermatology

After reading this chapter you should be able to assess, diagnose and manage: atopic eczema skin infections drug eruptions urticaria skin manifestations of systemic disorders ectodermal dysplasia and epidermolysis bullosa birth marks, neurocutaneous lesions Dermatological disorders in children cover an extensive range of clinical problems and presentations. Primary abnormalities of the skin often have a major impact on a child and their family, and some are…

Oncology

After reading this chapter you should be able to assess, diagnose and manage: leukaemias and lymphoproliferative disorders solid tumours understand the associations of specific syndromes with propensity to malignancy oncological emergencies and understand: side effects of treatment for malignancy risks and benefits of ionising radiation in patient care role of bone marrow transplantation and immunosuppressive therapy services involved in providing shared care Although malignant disease in…

Haematology

After reading this chapter you should be able to: assess, diagnose and manage children with anaemia including bone marrow failure understand the risks, benefits and precautions involved in blood transfusion assess, diagnose and manage coagulation disorders, hypercoagulable states, purpura and bruising assess, diagnose and manage neutropenia A general principle in all paediatric haematology is the need to refer to age-specific normal ranges. Children with haematological problems…

Nephro-urology

After reading this chapter you should be able to assess, diagnose and manage: congenital anomalies of the kidney and urinary tract acute kidney injury and chronic kidney disease urinary tract infections renal tubular disorders nephritic and nephrotic syndrome enuresis Investigations in renal disease Proteinuria Proteinuria above 100 mg/m 2 /day reflects abnormal excretion at either the glomerular or tubular level. Children with heavy proteinuria, as seen…