8-year old well-child Flashcards
BMI
weight (kg)/height (m2)
- reflects amount of body fat
- used for children over 2 to account for height
Weight age
age at which patient’s weight would be at 50th percentile
Height age
age at which patient’s height would be at 50th percentile
ADHD symptoms
inattention
hyperactivity
impulsivity
Prevalence= 8-10%
Diagnosis of ADHD
- Symptoms must be present for 6 months and be inappropriate for patient’s age
- Symptoms must be present before age 12
- 2 or more settings
- Interfere with social, school, or work
- Not due to mental disorder
Possible causes of school failure
- Sensory impairment - hearing or vision impairment
- Sleep disorder - inadequate sleep can cause trouble in school
- Mood disorder - increases with age and can cause trouble
- Learning disability - impair performace –> behavioral and attention problems
- Conduct disorder - hostile, defiant, deviant behavior
Red Flags of learning disability
- history of maternal illness during pregnancy
- complications at time of delivery
- history of meningitis or serious illness
- history of serious head trauma
- parental history of learning disability or school trouble
Response to ADHD medication
Methylphenidate - 80% of kids with ADHD will respond to the medication
Adverse effects of ADHD meds (stimulants)
Appetite suppression
Tic disorders
Insomnia - dose-related
Decreased growth velocity
Addressing obesity with kids
inquire whether they think weight is a concern
- talk about immediate effects and long-term effects
Epidemiology of obesity
- Prevalence has double last 20 years
- 15% has of adolescents are obese
- 80% presist into adulthood
- mulifactorial
Risk Factors for obesity
- high birth weight and maternal diabetes
- Having an obese parent
- Low SES
- Genetic syndromes
Complications of obesity
- Sleep apnea
- Dyslipidemia
- Type II diabetes
- SCIFE
- HTN
- Steatohepatitis
Type II diabetes in kids
Increasing incidence (19% of all newly diagnosed type II were children)
Diagnostic criteria for diabetes
- Random glucose >200
- Fasting glucose >126
- Post-glucose load at 2 hr >200
- HgA1C >6.5%
Screening guidelines for diabetes
- Overweight with family history or signs of insulin resistance
- > 10 years old
- Screen every 3 years
Causes of falsely elevated BP
“white coat HTN”, pain, arm below heart level
Secondary HTN in kids
- Umbilical artery or venous access in neonates predisposes to kidney problems
- UTIs - renal scarring
- Pheochromocytoma
- Family history
- Coarctation of the aorta
Acanthosis Nigricans
associated with obesity and a indicator of insulin resistance
- lesions improve with weight loss
- hyperpigmentation and hyperkeratosis
Weight gain vs endocrine disorders
Endocrine disorders that cause weight gain usually lead to height growth impairment –> short stature
- these disorders should be referred to an endocrinologist
- too much weight gain and normal height is obesity
Evaluating HTN
- regular BP checks outside the office and keep a BP log
2. Try to cut back on salt and incorporate more fruits, veggies, and water
Initial treatment for ADHD
Write down name of medication, starting dose, frequency, when to take it
- monitor for efficacy
Weight management plan for family
Start with diet –> limit screen time –> increase physical activity
Motivational Interviewing
counseling technique based on identifying patient’s motivation for changing behavior
- get them to state their reasons for change
- set a goal (realistic)
- use external motivators
- be cautious
Steps in change
Precontemplation Contemplation Determination Action Maintenance Relapse
