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25 Cards in this Set
- Front
- Back
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What are first variety 'cyanotic' spells? what is peak age?
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Herald-sound-kids are inventive, but generally a very attention-getting high pitched/piercing cry.
– Followed by forced expiration – Then ‘apnea’ and associated color change LOC often observed maybe similar to seizure... peaks at AGE 2 |
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First variety 'cyanotic' spells? Tx?
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Be a Rock... unless child is really bad
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What are pallid spells?
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Initiated by painful episode.... (after falling, hitting head)
- will have bradycardia and maybe asystole of 2 seconds or more |
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How does a baby repeat pallid spells
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Ocular compression --> afferent to trigeminal --> efferent to vagal nerve and bradycardia.
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Average age of toilet training
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18-24 months or when child can perform a mutistep behavior
Girls ~ 2 yrs Boys ~ 2.5 yrs |
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What is encopresis?
What is common complaint when they come in? |
Passage of feces into inappropriate places after the age of 4 yrs
types- (with constipation and overflow), (w/o constipation), - often COMPLAINS OF ABDOMINAL PAIN WORSE AFTER MEALS |
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With encopresis what do you look for in butt check?
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• Check sphincter wink (cotton swab or light touch) and tone
• Look for sacral dimple (may be a sign of tethered cord/spina bifida occulta). • Passage of explosive stool with completion of digital exam can be a sign of aganglionic megacolon |
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What labs would you examine in suspsected encopresis?
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mostly urine analysis for Specific gravity for dehydration
- abdominal films - possible thyroid and electrolyte studies |
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Meds for encopresis?
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First disimpaction (rectal lub or softener) then maintenance (stool softeners)
Initially laxative/oral or rectal, stool softener, fluids |
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What is enuresis?
At age 5 what percent have this condition? |
nightime bed wetting
- 1/8 or 15% at age 5 have this - 1-2% of population still have it at age 15 |
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Causes of enuresis?
Medical causes of enuresis? What is key focus on hx of nocturnal enuresis |
variation of many different causes
- endocrine (#1), UTI, renal, pinworms, psychogenic polydipsia - address how many times/week this occurs and what has been attempted |
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Most successful treatment of enuresis?
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Behavioral modification/motivation- with reward system
Others - stretching bladder out - restrict evening fluids (avoid caffeine) - Alarms |
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Medication for Enuresis?
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DDAVP (desmopressin acetate) (synthetic ADH)- expensive best if used with behavioral modification
- TCA's (imipramine) |
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What is the Wessel criteria rule of 3's
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– Crying lasting three hours or more
– More than three days per week – More than three weeks |
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7 important questions to ask for Colic suffering?
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1. When does baby cry
2. • What do you do when it happens? 3. • What does the cry sound like? 4. How and what does the baby eat? 5. How do you feel when the baby cries? 6. How has the ‘colic’ affected your family”? 7. What is your theory of why the baby cries? • (Plus one: What do you expect from this office visit?) |
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Key to tx of colic?
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Parental reassurance is a key- show child is healthy, growth rate is good, development is normal, continue to seek possible cause/ resolution
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What is the new term for MR?
What if under the age of 5? |
Intellectual disability (ID)
<5 yo called Global and developmental Delay w or w/o significant cognitive deficits (this doesnt mean they will become ID) |
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For someone under 5 yo to be labeled Global developmental delay...?
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2 of the 5
Motor development Speech and language Cognition Personal-social Daily living skills |
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What are some genetic causes of ID?
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Trisomy-21
Fragile X Syndrome Rett Syndrome Many others |
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What are perinatal cause of ID?
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1. Prematurity
2. Hypoxia 3. Infections 4. Trauma (instrument and delivery) 5. Intracranial hemorrhage 6. surgical delivery |
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Postnatal causes of ID?
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Accidental or non-accidental trauma
CNS hemorrhage (parents who dont get Vit K after birth) Hypoxia (i.e. near-drowning) Environmental toxins (i.e. lead) Psychosocial deprivation Malnutrition CNS mass (malignancy) Intracranial infection |
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Rx factor for ID development?
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1. Male
2. low birth weight 3. Blacks, hispanic, and asian > Whites for severe ID 4. Blacks> whites and hispanics > asian for mild ID 5. older mom or younger mom 6. multiparous, later children, dumb mothers |
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Clinical signs of ID? Most predictive indicator of future intelligence?
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1. language delay (most herald sign and most predictive of future intelligence)
2. immature behavior 3. immature self-help skills 4. difficulty learning if recognized < 2 yo = most severe |
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Associated mental disorders and pts with ID?
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up to 70%
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Screening and surveillance for ID?
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1. Printed info to parents about what child "should be" at
2. PEDS (parents eval of develop status)- birth to 8 years 3. ASQ (age and stage quest)- takes 15-20 min 4. Brigance0 0-90 months 5. Denver Develope screen |
