Case 4 Flashcards
What is on the differential diagnosis for a child with school failure?
Sensory impairment, Sleep disorder, Mood disorder, Learning disability, Conduct disorder
What is the epidemiology of obesity in children?
Prevalence of childhood overweight and obesity in US has doubled in past 20 yrs. Currently, 15 percent of 19 yo are greater than 95th percentile for BMI based on reference data from the 1970s; higher rates in minority and economically disadvantaged children.
What is the probability of childhood obesity persisting into adulthood?
20 percent at 4 yrs. Approximately 80 percent in adolescence. Comorbidities will likely persist into adulthood.
What are genetic risk factors for obesity?
Prader-Willi syndrome
Bardet-Biedl syndrome
Cohen syndrome
What are birth history risk factors for obesity?
High birth weight
Maternal diabetes
What are family history risk factors for obesity?
For young children, if one parent is obese, odds ratio is about 3 that child will be obese in adulthood. If both parents are obese odds ratio is greater than 10. Before age 3 yr, parental obesity is a stronger predictor of obesity in adulthood than child’s own weight status.
What are the critical periods of excessive weight gain?
Infancy: Extent and duration of breastfeeding inversely associated with risk of obesity in later childhood (possibly due to physiologic factors in human milk, feeding/parenting patterns)
Adolescence: Normal tendency during early puberty for insulin resistance; early menarche; risk of obesity persisting into adulthood higher among obese adolescents than among younger children.
What are environmental risk factors for obesity?
Family/parental dynamics, Lack of safe places for physical activity, Inconsistent access to healthful food choices, low cognitive stimulation in home, low socioeconomic status.
What CV sequelae can obesity cause?
Hypertension. Found to occur up to nine times more frequently in overweight children. Approximately 1/3 of children with a BMI greater than 95th percentile are hypertensive.
What sleep sequelae can obesity cause?
Obstructive sleep apnea
What syndrome sequelae can obesity cause?
Pickwickian syndrome - obesity hypoventilation syndrome
What are pulmonary sequelae of obesity?
Morbid obesity may directly cause restrictive lung disease, but is not causally linked with reactive airway disease (RAD). (Conversely, poorly controlled RAD, which in turn impairs exercise tolerance, may contribute to obesity.)
What are the endocrine sequelae of obesity?
Insulin resistance (may correlate with acanthosis nigricans on exam), Hyperinsulinism, Type 2 DM, Obesity typically advances bone age and leads to early puberty.
What are the gastrointestinal sequelae of obesity?
Nonalcoholic steatohepatitis, Gallbladder disease
What are the orthopedic sequelae of obesity?
Blount disease, Slipped capital femoral epiphysis (SCFE): Involves displacement of the femoral head from femoral neck through physeal plate. Most commonly occurs at the onset of puberty in obese patients with delayed sexual maturation. Typical sx include an antalgic gait due to pain referred to the hip, thigh, and/or knee, with limited range of motion (esp. internal rotation) on examination of the hip. SCFE can be diagnosed on plain X-rays of the pelvis which shows widening of the physis.
How do you diagnose ADHD in children?
No laboratory test. Diagnosis based on a set of characteristic clinical findings. Core symptoms include inattention, hyperactivity and impulsivity.
What is the epidemiology of ADHD?
Est. prevalence in the US is about 8-10 percent, making ADHD the most common neurobehavioral disorder of childhood and among the most common chronic health conditions in schooled children. Not all children with ADHD have obvious behavioral problems, esp. those with predominantly inattentive not hyperactive type.
What is notable about girls with ADHD?
Girls who more often get the inattentive type, may be significantly impaired socially and academically, yet go unrecognized.
What is the etiology of diabetes in children?
Type 1 DM is characterized by insulin deficiency, typically due to autoimmune destruction of pancreatic beta cells. Type 2 CM is more heterogenous, but typically involves insulin resistance.
How does DM present in children?
Patients with Type 2 DM typically have a more indolent presentation than patients with Type 1 DM. In Type 2 DM, weight loss is less common, and DKA is rare, although 25 percent of pts. with Type 2 DM will have ketonuria at dx. “Accidental” diagnosis by routine laboratory screening, especially urinalysis, occurs in up to one third of patients with Type 2 DM; this presentation is rare in Type 1 DM.
What is the epidemiology of DM?
Type 1 DM is more likely to present in early childhood. Age is not generally helpful in differentiating between Type 1 and Type 2 DM in adolescence. The CDC reports that type 2 DM (previously “non-insulin dependent” or “adult-onset” DM) represented 19 percent of all DM cases in children between 2002 and 2005. Though most of these patients are adolescents, rare cases have been reported in children as young as 5 yo. The trend is clearly rising.
How do you diagnose DM in children?
Sx of DM (polyuria, polydipsia, polyphagia or weight loss), plus random blood glucose level greater than 200 mg/dL (greater than 11.1 mmol/L). OR Fasting serum glucose greater than 126 mg/dL (greater than 7.0 mmol/L) Or, 2-hour serum glucose greater than 200 mg/dL (greater than 11.1 mmol/L) during oral glucose tolerance test.
What is the criteria for ADA Guidelines for testing for Type 2 DM in children and adolescents?
Overweight. BMI greater than 85th percentile. Weight:height greater than 85th percentile. Weight greater than 120 percent ideal for height plus any two of the following risk factors: (1) family hx of type 2 DM in 1st or 2nd deg relatives (2) Race/ethnicity (AI, AA, Hispanic, Asian/Pacific islander), signs of insulin resistance (acanthosis nigricans, polycystic ovary syndrome, HTN, dyslipidemia)
What is the timing for ADA Guidelines for testing for Type 2 DM in children and adolescents?
Start screening at age 10 years or at onset of puberty, whichever is earlier.
What is the frequency for ADA Guidelines for testing for Type 2 DM in children and adolescents?
Every 2 years.
What is the preferred test for ADA Guidelines for testing for Type 2 DM in children and adolescents?
Fasting serum glucose.
How should you screen for HTN in children?
Measure bp yearly starting at age 3 yrs as part of routine health maintenance visits.
What is the normal bp for a child?
Less than 90th percentile for age, gender, height and weight.