1- Community Paediatrics Flashcards
ADHD background
People with ADHD are at the extreme ends of hyperactivity and inability to concentrate (attention deficit).
- Affects persons ability to carry out everyday tasks, develop normal skills and perform well in school
ADHD: management
- Detailed assessment by specialist
- Parental and child education essential
- Healthy diet and exercise can offer significant improvement to symptoms
- Medication (only for severe cases)- CENTRAL NERVOUS STIMULANTS (contrary to common belief)
ADHD: Causes/risk factors
Not fully understood
- Genetics (does run in families)
- Premature babies or low birthweight
- Epilepsy
- Brain damage either in womb or later in life
ADHD: 3 core features
Inattention:
- Short attention span for age (difficulty sustaining attention)
- Difficulty listening to others
- Difficulty attending to details
- Easily distracted
- Forgetfulness
- Poor organizational skills for age
- Poor study skills for age
Impulsivity:
- Often interrupts others
- Has difficulty waiting for his or her turn in school and/or social games
- Tends to blurt out answers instead of waiting to be called upon
- Takes frequent risks, and often without thinking before acting
Hyperactivity:
- Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion
- Has difficulty remaining in his/her seat even when it is expected
- Fidgets with hands or squirms when in his or her seat; fidgeting excessively
- Talks excessively
- Has difficulty engaging in quiet activities
- Loses or forgets things repeatedly and often
- Inability to stay on task; shifts from one task to another without bringing any to completion
ADHD: presentation
Features should be consistent across various setting e.g. only displaying features at school and being well behaved at home – environmental problem
* Very short attention span
* Quickly moving from one activity to another
* Quickly losing interest in a task and not being able to persist with challenging tasks
* Constantly moving or fidgeting
* Impulsive behaviour
* Disruptive or rule breaking
ADHD: medication
- Methylphenidate (Ritalin)- first line drug
- Dexamphetamine
- Atomoxetine
MOA
Stimulant medication such as methylphenidate. These medicines have some activity in the frontal lobe thus increasing executive function, attention, and reducing impulsivity.
ASD: background
- A spectrum which causes deficits in social interaction, communication and flexible behaviour
- Autism spectrum replaced the differentiation between Aspergers syndrome and autistic disorder and grouped them into one spectrum disorder
- Big range
- One end patients have normal intelligence and ability to function in everyday life but displaying difficulties when reading emotions and responding to others (Asperger’s)
- On the other end, patients can be severely affected and unable to function in normal environments
ASD: 3 core areas affected
socail interactions
communication
behaviour
ASD: presentation
Usually presents before age of 3 years old and deficits are found in 3 key areas
1) Social Interaction
* Lack of eye contact
* Delay in smiling
* Avoids physical contact
* Unable to read non-verbal cues
* Difficulty establishing friendships
* Not displaying a desire to share attention (i.e. not playing with others)
2) Communication
* Delay, absence or regression in language development
* Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interest
* Difficulty with imaginative or imitative behaviour
* Repetitive use of words or phrases
3) Behaviour
* Greater interest in objects, numbers or patterns than people
* Stereotypical repetitive movements. There may be self-stimulating movements that are used to comfort themselves, such as hand-flapping or rocking.
* Intensive and deep interests that are persistent and rigid
* Repetitive behaviour and fixed routines
* Anxiety and distress with experiences outside their normal routine
* Extremely restricted food preferences
ASD: investigations
- specialist doctor.
- involves taking a detailed history of child devlopment, behaviour and communication
- involves talking to nursery, school
- speech and language review
ASD: management
Management
Cannot be cured. Management also depends on severity of the child condition. MDT and psychosocial approach
* Child psychology and child and adolescent psychiatry (CAMHS)
* Speech and language specialists
* Dietician
* Paediatrician
* Social workers
* Specially trained educators and special school environments
* Charities such as the national autistic society
risk factors of ASD
- Older parents
- Prematurity
- Low birth weight
- Birth injury or trauma
- Birth defects
- Meconium aspiration syndrome—when the baby inhales stool from the fluid in the womb
- Anemia—a low level of healthy red blood cells
- Blood type incompatibility between the mother and baby
- The risk of having a child with ASD is also higher in mothers who took antidepressants during pregnancy.
- Genetic problems, such as Fragile X syndrome, Rett syndrome, Down syndrome, or tuberous sclerosis
- Epilepsy
ADHD risk factors
- Genetics—People who have a parent or sibling with ADHD are more likely to get it themselves. Twins are also more likely to both have ADHD.
- Birth factors—Being born very early or having a very low birth weight
- Factors in the mother during pregnancy, such as:
- Smoking
- Using drugs or drinking alcohol
- Using certain medicines, such as corticosteroids and antidepressants
- Mental health problems
- High blood pressure
- Hyperthyroidism
- Exposure to certain environmental toxins, such as lead
- Toxins—Exposure to toxins like lead raises the risk of ADHD in children.
Eating disorders: background
An unhealthy and distorted obsession with body image and food
ED: risk factors
- Female
- Personality disorder
- OCD
- Anxiety
- Genetic component likely
- low self esteem
- childhood trauma e.g. sexual abuse
Anorexia nervosa presentation
- Patient feels overweight despite evidence of normal or low body weight
- Involves obsessively restricting calorie intake with the intention of losing weight
- Patient may exercise excessively and may use diet pills or laxatives to restrict absorption of food
- Key features
o Excessive weight loss
o Amenorrhoea
o Lanugo hair is fine, soft hair across most of the body
o Hypokalaemia
o Hypotension
o Hypothermia
o Changes in mood, anxiety and depression
o Solitude
complications of AN
- Cardiac complications:
- Arrhythmia
- Atrophy
- Sudden cardiac death
complications of AN
- Cardiac complications:
- Arrhythmia
- Atrophy
- Sudden cardiac death
Bulimia nervosa presentation
- Normal body weight
- Weight fluctuates
- Involves binge earing followed by “purging”
o Inducing vomiting or taking laxatives - Key features
o Alkalosis (vomiting HCL)
o Hypokalaemia
o Erosion of teeth
o Swollen salivary glands
o Mouth ulcers
o GORD
o Russels sign- calluses on knuckles
Binge eating presentation
Binge eating disorder is characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress. This is not a restrictive condition like anorexia or bulimia, and patients are likely to be overweight.
Binges may involve:
* A planned binge involving “binge foods”
* Eating very quickly
* Unrelated to whether they are hungry or not
* Becoming uncomfortably full
* Eating in a “dazed state”
management of ED
Management
- Self help resources
- Counselling
- Cognitive behavioural therapy (CBT)
- Addressing other areas of life, such as relationships and past experiences
- SSRIs (fluoxetine– can be used due to their ability to help people put on weight
Severe cases may require admission for observed refeeding and monitoring for refeeding syndrome.
refeeding syndrome: background
Occurs when people who are severely malnourished begin eating again.
presentation of DS
Dysmorphic Features
- Hypotonia (reduced muscle tone)
- Brachycephaly (small head with a flat back)
- Short neck
- Short stature
- Flattened face and nose
- Prominent epicanthic folds
- Upward sloping palpebral fissures
- Single palmar crease
upper motor neurone vs LMN
CP is UMN
o Good muscle bulk
o Increased tone
o Brisk reflexes
o Slightly reduced power
