Behave And Develop Lec. 6 Flashcards
When is crying most frequent and normal
Late in the afternoon
What is normal premies crying pattern
Premature infants cry less before 40 wks gestational age but cry more than term infants at 6 wks corrected age
Wessels rule of threes
Wessel’s rule of threes (starts at about 3wks of age ): Crying >3 hrs/day Crying at least 3 days/wk Crying longer than 3 wks Typically resolves around 3mo of age
This defines colic
If crying last longer than 20 minutes
What is the complication to the mother
Higher risk for post partum
When are tantrums normal
Age 1-4 years old
When are tantrums abNML
Past age 4
Wanting to injure themselves
Lasting longer than 15 min
Persist negative mood between tantrums
W/u for tantrums
Sleep hx
Feeding
Hearing? Language delay?
Iron deficiency? Lead screening?
Parent education starting at 12 months
What is the workup for breath holding spells?
Check for iron deficiency and treat if present
Otherwise: Ignore! Without reinforcement, the episodes usually will stop
What is the best approach to special needs mgmt
Medical home model
Provides level of autonomy to family by having direct communication with team and more “control” over care
Define intellectual disability
Definition: used for children over age 5**
Significantly subnormal general intellectual functioning for a child’s developmental stage
Based on an administered test with scores >2 SD below the mean
IQ tests avg is 100, SD is 15, therefore IQ test <70
Define Global developmental delay
DSM-5: Global Developmental delay (GDD) children under age 5 Significant delay (>2 SD) in multiple developmental milestones
What is the difference between
Mild ID (IQ 50-70)
- Higher association with environmental influences
- Highest risk among low socioeconomic status
Severe ID (IQ <50) -More frequently linked to biological and genetic causes
Intellectual Disability investigation
Labs/Tests to consider
Urinalysis
-Screen for amino/organic acids
Inborn errors of metabolism screens
-Verify newborn screen performed and reviewed
TSH, free T4
Chromosomal analysis
EEG
Cerebral palsy
Group of non-progressive, but often changing, motor impairment syndromes
Secondary to anomalies or lesions of the brain arising before or after birth
What are the major causes of Cerebral Palsy
80% antenatal factors causing abnormal brain development
- Preterm, low birth weight, congenital malformations, kernicterus
- Less than 10% with intrapartum asphyxia
Intrauterine exposure to maternal infection
A pt that is stiff or floppy at 3 months, with head lag, no rolling at 6 months, or only uses one hand
Lopsided crawling, or knee, butt scooting
Think
Cerebral palsy
Conduct :
Vision and hearing eval
Urine screen for amino/organic acidurias
Genetic screening
Refer to Neurology
Define ASD
Autism spectrum D/o
Persistent deficits in social communication and social interaction
Restricted, repetitive patterns of behavior, interests, or activities
(Lining up toys, echolalia)
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
Hyper- or hyporeactivity to sensory input
When must S/s be present for ASD
Symptoms must be present in the early developmental period
When is MCHAT-R used for ASD
18 and 24 months
ADHD in pts under 16
at least 6 symptoms of inattention OR 6 symptoms of hyperactivity-impulsivity
ADHD in children older than 17
at least 5 symptoms of inattention OR at least 5 symptoms of hyperactivity-impulsivity
When must S/s present for ADHD
Symptoms present prior to age 12
For at least 6 months
In 2 or more environments
Clinically significant impairment in social, academic or work settings
What is the checklist to eval ADHD
Conners or vanderbilts
What is the tx approach to ADHD
Behavior MGMT
Structure and routine
Stimulants 1st line:
Methylphenidate
Amphetamine
2nd line: Norepinephrine-reuptake inhibitor -Atomoxetine (Strattera) Alpha agonists—helpful adjuncts for tics, sleep problems, agression -Clonidine -Guanfacine
ADE of ADHD meds
Appetite suppression
-Evaluate with growth chart—weight loss
Sleep disturbance
Heart palpitations
Hypertension
Tremors/tics
Nausea*
Headache*
Asses every 3-6 months
(1-3 when 1st starting meds)
Define opp. Defiant disorder
Frequent & persistent pattern of:
Angry/irritable mood
Argumentative/defiant behavior
Vindictiveness
Define conduct disorder
Aggression to people & animals
Destruction of property
Deceitfulness or theft
Serious violations of rules
major age-appropriate societal norms or rules are violated
Can progress to antisocial personality disorder
