common issues in older child Flashcards
4 ways to define enuresis
primary - always
secondary - 6 months of no spills
diurnal - when awake
nocturnal - when sleeping
2 times enursis is worrying
- diurnal in school-agers
2. any secondary
4 gen. causes of diurnal enureisi
- fear
- constipation
- motivation
- disease
2 causes of secondary
- if nocturnal, usually a variant of primary
2. if nociturnal only, rarely disease
what is primary epi
common
- 1% keep til age 15
main cause of promary
sleep too deep
- can’t wake them
- more REM sleep
treatment of primary
just accept and don’t make them feel bad
- no behavioral
- no imipramine
one drug for primary enur
desmopressin (DDAVP)
- only for short term like before sleep-over
- risk of hyponatremic seizures
use for sleep alarms?
bad, wakes everyone else up
- maybe for teens
3 times to treat
- co-bedding
- sleepovers
- failure of non-medical mgmt
epi of ADHD
~5%
- more boys
- children under 12
common ADHD impairments
- school
- social
- family
- driving
- criminal
- job changes
common ADHD comorbidities
ODD, CD, mood, anxiety, BN
associated factors
- low SES
- low birth weight
- maternal smoking
- dysfunctional families
what is heritibility of ADHD
pretty strong - 0.8
- runs in families
env effects on ADHD
perinatal - smoking - alc - LBW port-natal - head injuries - infection - autoimmune
2 main cog. deficits
- exectuve control
2. higher order processing
what is effect of methyphenidate
increased DOPA at synapse
brain structural diffs (2)
- reduced size
2. slower growth, esp prefrontal cotrex
DSM def. of ADHD
either A or B
A - innattention
B - hyperactivity/impulsivity
3 types
- primarily inattentive
- hyperactive
- combined
what is hallmark
inattention
what is very common issue with ADHD
learning diability
10 Ds of ADHD
Distracted Delayed Dyslexic Depressed Dozy Defiant Delinquant Drugged Diseased Disconnected
what is best Tx for ADHD with behav. probs
meds and behavior therapy
best for core AHDH
meds
best for pre-schoolers (4-6yo)
behavior therapy
4+1? SEs of ADHD drugs
- apptetie supression -common
- insomnia - uncommon
- emotional after school
- anxiety
- growth supression - probably not
what is cardiac risk of drugs
no major risk
best way to give ADHD drugs
long acting
