Quick Reference

Tessa Davis

doi:10.31440/DFTB.948

Inborn errors of metabolism

Disorder	Examples	Basic pathophysiology	Blood gas	Ammonia	Glucose	Ketones	Lactate
Urea cycle disorders	OTC deficiency	Defect in breakdown of nitrogen → ammonia	Respiratory alkalosis/normal	↑↑↑	-	-	-
Amino acid disorders	PKU, MSUD, homocystinuria	Defect in breakdown of amino acids	Metabolic acidosis (↑ anion gap)	↑/-	↓	↑ (MSUD ↑↑↑ urinary ketones)	-
Organic acid disorders	Propionic, MMA	Accumulation of organic acids	Metabolic acidosis (↑ anion gap)	↑	↓	↑	↑
Lysosomal storage disorders	MPS, Pompe, Gaucher, Niemann-Pick	Accumulation of proteins/lipids	-	-	-	-	-
Glycogen storage disorders	GSD types I-IX	Defect in glycogen synthesis	Metabolic acidosis	-	↓	↑	↑
Fatty acid oxidation disorders	MCADD, LCADD, VLCADD	Unable to break down fatty acids → ketones	Metabolic acidosis (↑ acidosis)	-	↓	↓	-/↑
Mitochondrial disorders	MELAS	Insufficient acetyl coA for Krebs cycle → ↓ ATP	Metabolic acidosis	-	-/↑	-	↑↑
Peroxisomal disorders	XL, ADL, Refsum, Zellweger	↓ metabolism of VLCFA, ↓ bile synthesis	-	-	-	-	-

References

UpToDate

Developmental Milestones

Tessa Davis

	Social	Fine Motor/Vision	Gross Motor	Speech and Language
6 weeks	Smiles	Fixes and follows to the midline	Holds head when held in sitting position	Squeals
2 months	Pays attention to faces; starts to cry when getting bored	Fixes and follows past the midline; hands are predominantly open	Lifts head to 45 degrees; starting to weight-bear	Cooing; turns head towards sound
4 months	Likes to play with people; laughs	Reaches with one hand for objects; brings hands together	Full head control; can roll from front to back	Babbling; different cries depending on need
6 months	Recognises familiar faces; may become excited when hearing steps	Transfers objects; palmar grasp; puts objects in mouth	Rolls both ways; starting to sit without support; watches hands purposefully; Drinks from a cup and feeds from a spoon	Responds to his name; makes sounds to show happiness or discomfort
9 months	Stranger anxiety; separation distress; has a favourite toy; plays peek-a-boo	Uses pincer grasp to pick up a cube; looks for hidden objects; releases objects by dropping; bangs two cubes together	Crawls; pulls to stand; stands with support	Understands 'no'; copies sounds
12 months	Waves; exhibits preference for his main caregiver; uses objects correctly (e.g. hairbrush, cup)	Points with index finger; shakes,bangs or throws objects; uses pincer grasp to pick up small objects	Cruises; may take a few steps without support	Says 'mama' and 'dada'; responds to simple requests
18 months	Points to pictures in a book; uses a spoon and cup	Scribbles; builds a tower of 2-3 cubes; turns pages (2-3 at a time)	Throws objects; runs stiffly; kicks a ball	Uses several words; knows three body parts
24 months	Learning to share and take turns; parallel play	Builds a tower of 6-7 cubes; turns page (one at a time); draws a vertical line; circular scribbles	Can walk on tiptoes; runs; up and down stairs (one by one); throws and kicks a ball	uses two word sentences; can follow a simple command;
36 months	Starts to make friends; dresses with supervision	Cuts paper with scissors; copies O and V with a pencil; eats with fork and spoon	Catches a ball; jumps; rides a tricycle	Gives his name, age and sex; knows three colours
4 years	Pretend play (role-playing); cooperative play; dresses without supervision	Can draw a face; uses a knife and fork; builds a tower of 10 or more cubes	Hops; up and down stairs with alternate feet	Asks 'why' and 'how' questions; knows first and last name
5 years	Understands rules; has a sense of humour	Cuts out shapes with scissors; ties shoelaces; colous within the lines	Skips	fluent speech; likes telling stories

Genetic Syndromes

Tessa Davis

Syndrome	Genetic Abnormality	Facies/body habitus	Medical
Wolf-Hirschhorn	4 deletion	Microcephaly; ocular hypertelorism; downturned mouth; short upper lip; short philtrum; micrognathia; prominent glabella; dysplastic ears; preauricular skin tags.	Developmental delay; cleft lip/palate; hearing impairment; seizures; hypotonia; congenital heart defects; antibody deficiencies.
Williams	7 deletion	Small, upturned nose; wide mouth; full lips; small chin; widely spaced teeth; long philtrum.	Developmental delay; supravalvular aortic stenosis; hypercalcaemia; low birth weight; poor growth; hypotonia; outgoing personality.
Turner	X0 or mosaicism	Short stature; wide carrying angle; short, webbed neck; low hairline on neck; wide-spaced nipples; small lower jaw.	Lymphoedema; coarctation of the aorta; horseshoe kidney; infertility; amenorrhoea.
Rubinstein-Taybi	CREBP gene	Broad thumbs and big toes; downward slanting palpebral fissures; columella extending below the nares; talon cusps; grimacing smile; microcephaly; small mouth; high arched palate.	Developmental delay; cryptorchidism; feeding difficulties; dental poblems; undescended testes; keloid scarring; increased risk with anaesthesia.
Russell Silver	7 and 11	Small, triangular face; prominent forehead; narrow chin; small jaw; down-curbing corners of the mouth.	Low birth weight FTT; clinodactyly; uneven limb growth; developmental delay.
Prader-Willi	15 (paternal) imprinting or deletion	Prominent nasal bridge; almond-shaped eyes; thin upper lip; short stature; obesity; small hands and feet;	Hyperphagia; hypotonia; developmental delay; sleep apnoea; scoliosis; hypogonadism.
Piere-Robin	2, 11 or 17.	Cleft palate; micrognathia; glossoptosis.	Feeding difficulty; noisy breathing; GORD.
Patau	Trisomy 13	Microcephaly; microphthalmia; polydactyly; low set ears; overlapping fingers.	Developmental delay; holoprosencephaly; cataract; optic nerve hypoplasia; omphalocele; cleft palate; cutis aplasia; kidney anomalies; VSD.
Noonan	Linked to several genes (PTPN11, RAF1, SOS1, KRAS, NRAS, BRAF)	Short stature; low hairline at the back of the neck; high hairline at the front of the head; excess skin at the back of the neck; broad forehead; ocular hypertelorism; epicanthic folds; proptosis; small, upturned nose; low set ears; deep philtrum.	Pulmonary valve stenosis; hypertrophic cardiomyopathy; pectus excavatum or carinatum; joint hyperextensiblity; cryptorchidism; development delay; clotting disorders; Arnold-Chiari malformation.
Klinefelter	XXY	Normal facies; tall stature; gynaecomastia; less body hair; broader hips.	Osteoporosis, autoimmune disorders, infertile, weaker muscle strength, gynaecomastia, higher risk of breast cancer.
Goldenhar	Unknown	Incomplete development of ear, nose, lip and jaw.	Scoliosis; hearing loss.
Edwards	Trisomy 18	Microcephaly; micrognathia; cleft lip/palate; upturned nose; palpebral fissures; ocular hypertelorism; underdeveloped thumbs and nails; rocker bottom feet.	Kidney malformations; VSD/ASD; omphalocele; oesophageal atresia; developmental delay; arthrogryposis; choroid plexus cysts; seizures.
Down	21 - non-disjunction causing trisomy 21; or Robertsonian translocation (14;21)	Epicanthic folds; flat nasal bridge; protruding tongue; Brushfield spots; increased space between 1st and 2nd toes; single palmar crease; short stature; low set ears; brachycephaly.	Developmental delay; hypotonia; ASD/VSD; ALL; hypothyroidism; Hirschprung's; infertility; otitis media with effusion; atlanto-axial subluxation.
Di George	22q11 deletion	Hypertelorism; hooded eyelids; small ears and squared upper ear; small mouth, chin and side areas of tip of nose.	Hypoplastic thymus; T cell deficiency; hypocalcaemia; hypoparathyroidism; learning disability; CHD (tetralogy of Fallot and conotruncal malformations); cleft palate; hearing loss.
Crouzon	1st branchial arch	Cranio-facial anomalies; low set ears; cranial synostosis; brachycephaly; exophthalmos; ocular hypertelorism; psittichorhina (beak-like nose); hypoplastic maxilla.	Shorter humerus and femur; Meniere's disease; strabismus; acanthosis nigricans.
Cri du chat	5p deletion	Small head and jaw; wide eyes; skin tags in front of eyes; round face with full cheeks; hypertelorism; epicanthal folds; down-slanting palpebral fissues; flat nasal bridge; down-turned mouth; micrognathia; low-set ears; short fingers; single palmar creases.	Feeding problems; high-pitched cry; poor growth; severe developmental delay; cardiac defects (VSD/ASD/PDA).
Cornelia de Lange	Cohesin complex, CDLS1, CDLS2, CDLS 3	Microcephaly; long eyelashes; long philtrum; synophrys (joined eyebrows); small, wide-spaced teeth; curved 5th finger; excessive body hair.	Low birth weight; developmental delay; nystagmus; GORD; seizures; CHD; cleft palate; hypoplastic genitalia.
Cockayne	ERCC8, ERCC6	Microcephaly; short stature; sunken eyes; look aged.	Premature aging; sensitivity to sunlight; xeroderma pigmentosum; contractures; dental caries; retinopathy; micropenis; tremors; basal ganglia calcifications; hypertension.
Bardet-Beidl (Laurence-Moon-Biedl)	BBS genes in the basal body and cilia	Truncal obesity; polydactyly; normal facies.	Retinitis pigmentosa; hypogonadism; renal failure; diabetes insipidus;diabetes mellitus; Hirschprung; anosmia
Angelman	15 maternal imprinting	Developmental delay (severe); often non-verbal; ataxia; frequent laughter/smiling; hand-flapping movements; short attention span; microcephaly; seizures.	Developmental delay (severe); often non-verbal; ataxia; frequent laughter/smiling; hand-flapping movenets; short attention span; microcephaly; seizures.
Alagille	Jagged1 or Notch 2 mutation	Prominent forehead; deep set eyes; moderate hypertelorism; small pointed chin; saddly nose; traingular facies.	Butterfly vertebrae; biliary ducts narrow and malformed; peripheral pulmonary artery stenosis; Tetralogy of Fallot; ocular abnormalities; stroke/intracranial bleeding; dysplastic kidneys

Emergency Calculations

Tessa Davis

All your important calculations in one place…

IV fluid composition

Tessa Davis

Type of fluid	Na+ (mmol/L)	Cl- (mmol/L)	K+ (mmol/L)	Lactate (mmol/L)	Ca++ (mmol/L)	Glucose (g/L)	Acetate (mmol/L)	Mg (mmol/L)
Hartmann's	129	109	5	29	2	-	-	-
4% albumin	140	128	-	-	-	-	-	-
3% (hypertonic) saline	513	513	-	-	-	-	-	-
Plasmalyte	140	98	5			23	27	3
0.45% NaCl with 5% glucose	75	75	-	-	-	50	-	-
0.9% NaCl with 5% glucose	150	150	-	-	-	50	-	-
0.9% NaCl	150	150	-	-	-	-	-	-

Body surface area

Tessa Davis

For body weight under 40 kg

Body Weight (kg)	Surface area (m2)
40	1.3
39	1.3
38	1.2
37	1.2
36	1.2
35	1.2
34	1.1
33	1.1
32	1.1
31	1.1
30	1.1
29	1.0
28	1.0
27	0.97
26	0.95
25	0.92
24	0.90
23	0.87
22	0.85
21	0.82
20	0.79
19	0.77
18	0.74
17	0.71
16	0.68
15	0.65
14	0.62
13	0.59
12	0.56
11	0.53
10	0.49
9.5	0.47
9	0.46
8.5	0.44
8	0.42
7.5	0.40
7	0.38
6.5	0.36
6	0.34
5.5	0.32
5	0.30
4.5	0.28
4	0.26
3.5	0.24
3	0.21
2.5	0.19
2	0.16
1.5	0.13
1	0.10

This table was calculated using the Boyd equation

For body weight over 40 kg

Body Weight (kg)	Surface area (m2)
40	1.3
39	1.3
38	1.2
37	1.2
36	1.2
35	1.2
34	1.1
33	1.1
32	1.1
31	1.1
30	1.1
29	1.0
28	1.0
27	0.97
26	0.95
25	0.92
24	0.90
23	0.87
22	0.85
21	0.82
20	0.79
19	0.77
18	0.74
17	0.71
16	0.68
15	0.65
14	0.62
13	0.59
12	0.56
11	0.53
10	0.49
9.5	0.47
9	0.46
8.5	0.44
8	0.42
7.5	0.40
7	0.38
6.5	0.36
6	0.34
5.5	0.32
5	0.30
4.5	0.28
4	0.26
3.5	0.24
3	0.21
2.5	0.19
2	0.16
1.5	0.13
1	0.10

This table was calculated using the Boyd equation

If the height is known

Use Royal Children’s Hospital, Melbourne’s BSA calculator.

Exclusion period for infections

Tessa Davis

Illness	Exclusion period
Worms	Not necessary if treatment has commenced
Warts	Not necessary
Viral gastroenteritis	Until diarrhoea-free and no vomiting for 24 hours
Typhoid	Need permission from Health Authority
Tuberculosis	Need permission from Health Authority
Toxoplasmosis	Not necessary
Streptococcal throat	Until has had 24 hours antibiotics and feels well
Shigella	Until diarrhoea-free for 24 hours
Scarlet fever	Until has had 24 hours antibiotics and feels well
Scabies	Until day after commencing treatment
Salmonella	Until diarrhoea-free for 24 hours
Rubella	Until 4 days after onset of rash, or fully recovered
Rotavirus	Until no vomiting or diarrhoea for 24 hours
Ross River virus	Not necessary
Roseola	Not necessary
Ringworm	Until 1 day after starting antifungal treatment
RSV	Not necessary
Pertussis	Until 5 days after starting antibiotics or 21 days from onset of coughing
Parvovirus (5th disease, slapped cheek)	Not necessary
Noravirus	Until no vomiting or diarrhoea for 48 hours
Mumps	9 days after onset of swelling
Mollusum contagiosum	Not necessary
Meningococcal infection	Until appropriate antibiotic treatment has been completed
Meningitis (viral)	Until well
Meningitis (bacterial)	Until received appropriate antibiotics
Measles	4 days after onset of rash
Leprosy	Need permission from Health Authority
Legionnaire's	Not necessary
Influenza	Until well
Impetigo	Until antibiotic treatment has started (cover any exposed sores with a dressing)
Hydatid disease	Not necessary
HIV	Not necessary
Herpes simplex	Not necessary if can maintain good hygiene practice (otherwise until sores are dry)
Hepatitis C	Not necessary
Hepatitis B	Not necessary
Hepatitis A	At least 7 days after onset of jaundice
Head lice	Not necessary if treatment given before the following day at child care
H. influenzae B	Until received at least 4 days antibiotics
Hand, foot and mouth (Coxsackie)	Until all blisters have dried up (usually at least 5 after rash first appeared)
Giardiasis	Until diarrhoea-free for 24 hours
EBV	Not necessary
Diphtheria	Until 2 negative throat swabs (1st swab will be 2 hours after finished antibiotics)
Diarrhoea	Until diarrhoea-free for 24 hours
Cryptosporidium	Until diarrhoea-free for 24 hours
Conjunctivitis	Until eye discharge has stopped (if infectious type of conjunctivitis)
CMV	Not necessary
Chickenpox	Until all blisters have dried up (usually at least 5 after rash first appeared)
Candidiasis	Not necessary
Campylobacter	Until diarrhoea-free for 24 hours
Amoebiasis	Until diarrhoea-free for 24 hours

References

Guidance on infection control in schools and other childcare settings, Health Protection Agency (UK)

Immunisation schedule

Tessa Davis

Australian immunisation schedule

Age	Immunisation
Birth	HepB
2 months	HepB, diphtheria, tetanus, pertussis, Hib, polio (6-in-1); pneumococcal; rotavirus
4 months	HepB, diphtheria, tetanus, pertussis, Hib, polio (6-in-1) (2nd dose); pneumococcal (2nd dose); rotavirus (2nd dose)
6 months	HepB, diphtheria, tetanus, pertussis, Hib, polio (6-in-1) (3rd dose); pneumococcal (3rd dose); rotavirus b (3rd dose only needed for some brands)
6 months to 5 years	influenza (in at risk groups only)
12 months	Hib; MenC; MMR
12-18 months	pneumococcal (in at risk groups only)
12-24 months	hep A (in at risk groups only)
18 months	Diphteria, tetanus, pertussis; MMR; varicella
4 years	Diphtheria, tetanus, pertussis, polio
10-15 years	varicella; HPV; diphtheria, tetanus, pertussis
15 years and over	influenza; pneumococcal (in at risk groups only)

UK immunisation schedule

Age	Immunisation
2 months	Diphtheria, tetanus, pertussis, polio, Hib, hep B (6-in-1); pneumococcal; rotavirus; men B
3 months	Diphtheria, tetanus, pertussis, polio, Hib, hep B (2nd dose) (6-in-1); rotavirus (2nd dose)
4 months	Diphtheria, tetanus, pertussis, polio, Hib, hep B (3rd dose) (6-in-1); pneumococcal (2nd dose); men B (2nd dose)
12-13 months	Hib (booster); Men C; MMR; pneumococcal (3rd dose)
2-8 years old	Influenza (every year from September)
3 years and 4 months	MMR (2nd dose); diphtheria, tetanus, pertussis, polio (4-in-1) pre-school booster
12-13 years	HPV (two doses 6-24 months apart)
14 years	Diphtheria, tetanus, polio (3-in-1) booster; Men A,C,W,&Y

USA immunisation schedule

Age	Immunisations
Birth	HepB
1 or 2 months	HepB (2nd dose)
2 months	diphtheria, tetanus, pertussis; Hib; polio; rotavirus; pneumococcal
4 months	HepB (third dose); diphtheria, tetanus, pertussis; Hib; polio; rotavirus; pneumococcal
6 months	HepB; diphtheria, tetanus, pertussis; Hib; polio (6-18 months); pneumococcal; rotavirus (for some brands only)
6 months to 18 years	Influenza (annual)
12-15 months	Hib, pneumococcal; MMR; varicella; HepA (with 2nd dose 6-18 months later)
15-18 months	Diphtheria, tetanus, pertussis; varicella
4-6 years	Diphtheria, tetanus, pertussis; polio; MMR; varicella
11-12 years	Diphtheria, tetanus, pertussis; HPV (2 doses); meningococcal
16 years	Meningococcal booster

New Zealand Immunisation Schedule

Age	Diseases covered & Vaccines
65 years	Diphtheria & tetanus.nInfluenza (annually)
45 years	Diphtheria & tetanus.
12 years, girls only	Human Papilloma Virus (x3 doses)
11 years	Tetanus/Diphtheria/Pertussis
4 years	Diphtheria/Tetanus/Pertussis/Polio.nMeasles, Mumps, Rubella.
15 months	HiB.nMeasles, Mumps, Rubella.nPCV-10
5 months	Rotavirus, Diphtheria/Tetanus/Pertussis/Polio/Hepatitis B/Haemophilus influenzae type b. PCV-10
3 months	Rotavirus, Diphtheria/Tetanus/Pertussis/Polio/Hepatitis B/Haemophilus influenzae type b. PCV-10
6 Weeks	Rotavirus, Diphtheria/Tetanus/Pertussis/Polio/Hepatitis B/Haemophilus influenzae type b (Infrarix-Hexa), 10-valent conjugated Pneumococcal (Synflorix)

ECG intervals by age

Tessa Davis

Age	HR(bpm)	QRS axis (degrees)	PR interval (sec)	QRS interval (sec)	R in V1	S in V1	R in V6	S in V6
1st week	90-160	60-180	0.08-0.15	0.03-0.08	5-26mm	0-23mm	0-12mm	0-10mm
1-3 week	100-180	45-160	0.08-0.15	0.03-0.08	3-21mm	0-16mm	2-16mm	0-10mm
1-2 mo	120-180	30-135	0.08-0.15	0.03-0.08	3-18mm	0-15mm	5-21mm	0-10mm
3-5 mo	105-185	0-135	0.08-0.15	0.03-0.08	3-20mm	0-15mm	6-22mm	0-10mm
6-11 mo	110-170	0-135	0.07-0.16	0.03-0.08	2-20mm	0.5-20mm	6-23mm	0-7mm
1-2 yr	90-165	0-110	0.08-0.16	0.03-0.08	2-18mm	0.5-21mm	6-23mm	0-7mm
3-4 yr	70-140	0-110	0.09-0.17	0.04-0.08	1-18mm	0.5-21mm	4-24mm	0-5mm
5-7 yr	65-140	0-110	0.09-0.17	0.04-0.08	0.5-14mm	0.5-24mm	4-26mm	0-4mm
8-11 yr	60-130	neg 15-110	0.09-0.17	0.04-0.09	0-14mm	0.5-25mm	4-25mm	0-4mm
12-15 yr	65-130	neg 15-110	0.09-0.18	0.04-0.09	0-14mm	0.5-21mm	4-25mm	0-4mm
16 yr and over	50-120	neg 15-110	0.12-0.20	0.05-0.10	0-14mm	0.5-23mm	4-21mm	0-4mm

Normal vital sign values

Tessa Davis

Age	Heart Rate	Respiratory Rate	Blood Pressure (systolic)
14 years	60-100	16-20	92-130
12 years	60-110	16-20	90-126
10 years	70-110	16-20	90-121
8 years	70-110	18-22	86-118
6 years	75-115	18-24	82-115
4 years	80-120	20-26	78-112
2 years	80-140	20-28	74-110
1 year	80-160	20-30	72-110
6 months	110-180	25-35	72-110
3 months	110-180	30-45	70-104
1 month	110-180	30-50	70-104
Newborn	90-180	40-60	60-90

These parameters are based on APLS values.

Blood pressure centiles

Tessa Davis

If you’re wondering if your patient’s BP is over the 95th centile….here’s the table you need.

This data is extrapolated from the National Heart, Lung and Blood Institute

View Systolic BP Centile Charts

Age (years)	BP Centile	Height - 5th	Height - 10th	Height - 25th	Height - 50th	Height - 75th	Height - 90th	Height - 95th
	99th	122	123	125	127	128	130	130
	95th	115	116	117	119	121	122	123
	90th	111	112	114	115	117	119	119
10	50th	97	98	100	102	103	105	106
	99th	120	121	123	125	127	128	129
	95th	113	114	116	118	119	121	121
	90th	109	110	112	114	115	117	118
9	50th	95	96	98	100	102	103	104
	99th	119	120	122	123	125	127	127
	95th	111	112	114	116	118	119	120
	90th	107	109	110	112	114	115	116
8	50th	95	95	97	99	100	102	102
	99th	117	118	120	122	124	125	126
	95th	110	111	113	115	117	118	119
	90th	106	107	109	111	113	114	115
7	50th	92	94	95	97	99	100	101
	99th	116	117	119	121	123	124	125
	95th	109	110	112	114	115	117	117
	90th	105	106	108	110	111	113	113
6	50th	91	92	94	96	98	99	100
	99th	115	116	118	120	121	123	123
	95th	108	109	110	112	114	115	116
	90th	104	105	106	108	110	111	112
5	50th	90	91	93	95	96	98	98
	99th	113	114	116	118	120	121	122
	95th	106	107	109	111	112	114	115
	90th	102	103	105	107	109	110	111
4	50th	88	89	91	93	95	96	97
	99th	111	112	114	116	118	119	120
	95th	104	105	104	109	110	112	113
	90th	100	101	103	105	107	108	109
3	50th	86	87	89	91	93	94	95
	99th	109	110	111	113	115	117	117
	95th	101	102	104	106	108	109	110
	90th	97	99	100	102	104	105	106
2	50th	84	85	87	88	90	92	92
	99th	105	106	108	110	112	113	114
	95th	98	99	101	103	104	106	106
	90th	94	95	97	99	100	102	103
1	50th	80	81	83	85	87	88	89
		5th	10th	25th	50th	75th	90th	95th
Age (years)	BP Centile				Height Centile

View Diastolic BP Centile Charts

Age (years)	BP centile	Height - 5th	Height - 10th	Height - 25th	Height - 50th	Height - 75th	Height - 90th	Height - 95th
	99th	85	86	86	88	89	90
	95th	77	78	79	80	81	81	82
	90th	73	73	74	75	76	77	78
10	50th	58	59	60	61	61	62	63
	99th	84	85	86	87	88	88	89
	95th	76	77	78	79	80	81	81
	90th	72	73	74	75	76	76	77
9	50th	57	58	59	60	61	61	62
	99th	83	84	85	86	87	87	88
	95th	75	76	77	78	79	80
	90th	71	72	72	73	74	75	76
8	50th	56	57	58	59	60	60	61
	99th	82	82	83	84	85	86	86
	95th	74	74	75	76	77	78	78
	90th	70	70	71	72	73	74	74
7	50th	55	55	56	57	58	59	59
	99th	80	80	81	82	83	84	84
	95th	72	72	73	74	75	76	76
	90th	68	68	69	70	71	72	72
6	50th	53	53	54	55	56	57	57
	99th	77	78	79	80	81	81	82
	95th	69	70	71	72	73	74	74
	90th	65	66	67	68	69	69	70
5	50th	50	51	52	53	54	55	55
	99th	74	75	76	77	78	78	79
	95th	66	67	68	69	70	71	71
	90th	62	63	64	65	66	66	67
4	50th	47	48	49	50	51	51	52
	99th	71	71	72	73	74	75	75
	95th	63	63	64	65	66	67	67
	90th	59	59	60	61	62	63	63
3	50th	44	44	45	46	47	48	48
	99th	66	67	68	69	70	71	71
	95th	59	59	60	61	62	63	63
	90th	54	55	56	57	58	58	59
2	50th	39	40	41	42	43	44	44
	99th	61	62	63	64	65	66	66
	95th	54	54	55	56	57	58	58
	90th	49	50	51	52	53	53	54
1	50th	34	35	36	37	38	39	39
		5th	10th	25th	50th	75th	90th	95th
Age (years)	BP Centile				Height Centile

References

Baylor College of Medicine, Age-based centile charts

British Hypertension Society Guidelines

Levels of radiation from imaging

Tessa Davis

	Typical Effective Dose (mSv)	Number of chest X-rays (PA film) for Equivalent Effective Dose	Time Period for Equivalent Effective Dose from Natural Background Radiation
Abdo CT	8	400	2.7 years
Chest CT	5	250	1.7 years
Head CT	2	100	243 days
Barium enema	8	400	2.7 years
Upper GI	6	300	2 years
IVU	3	150	1 year
Lumbar spine	1.5	75	182 days
Skull x-ray	0.1	5	12 days
Chest x-ray (PA film)	0.02	1	2.4 days
Airline flight	0.02	1	2.4 days

Average effective dose in millisieverts (mSv) as compiled by Fred A. Mettler, Jr., et al., “Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog,” Radiology Vol. 248, No. 1, pp. 254-263, July 2008.
Based on the assumption of an average “effective dose” from chest x ray (PA film) of 0.02 mSv.
Based on the assumption of an average “effective dose” from natural background radiation of 3 mSv per year.

References

Radiation Emitting Products, US Food and Drug Administration, accessed online

X-ray Risk, accessed online

Cardiac anomalies and associations

Tessa Davis

Disorder	Cardiac Anomaly
Williams	Supravalvular AS, PA stenosis
VATER/VACTERL	VSD
Turner	CoA, bicuspid aortic valve, AS, hypertension, aortic dissection
Tuberous sclerosis	Rhabdomyoma
TAR (thrombocytopenia absent radius)	ToF, ASD, dextrocardia
Rubella	PDA, PA stenosis
Patau	VSD, PDA, dextrocardia
Noonan	PS, hypertrophic cardiomyopathy
Marfan	Aortic aneurysm, aortic or mitral regurgitation
Kartagener	Dextrocardia
Infant of diabetic mother	TGA, VSD, CoA, cardiomyopathy, PPHN
Homocystinuria	Medial degeneration of aorta and carotids, atrial or venous thrombosis
Holt-Oram	ASD, VSD
Goldenhar	VSD, ToF
Friedrich's ataxia	Hypertrophic cardiomyopathy
Fetal warfarin syndrome	ToF, VSD
Fetal trimethadione syndrome	TGA, VSD, ToF
Fetal alcohol syndrome	VSD, PDA, ASD, ToF
Ehler's Danlos	ASD, aortic/carotid aneurysm
Edwards	VSD, PDA, PS
Down	AVSD, VSD, ASD
Di George	Interrupted aortic arch, truncus arteriosus, VSD, PDA, ToF
Crouzon	PDA, CoA (occasional)
Cornelia de Lange	VSD
CHARGE	ToF, truncus arteriosus, aortic arch anomalies
Alagille	Peripheral PA stenosis