Common Pediatric Complaints Flashcards
Additional etiologies to consider for constipation in a child
- Hirschprung’s disease
- Voluntary holding
- Diet
- Anatomical features
- Neurologic disease
Voluntary holding
- Voluntary!!! (at least at first, may turn involuntary)
- Mostly due to pain or embarassment associated with passing stool. Intellectual disability is an important risk factor.
- Will present as overflow incontinence and encopresis (stooling in bed).
- Diagnosis: Clinical
- Treatment: Bowel regimen (stool softeners, motility agents) and behavioral counseling. If impacted, disempact under anesthesia.
Expressive vs language disorders
- Expressive disorders are problems with articulation
- Language disorders are problems with neurologic expression and reception of language
Leading cause of mortality through 4 months of life
Sudden infant death syndrome
Leading cause of childhood mortality after 4 months of life
Trauma, especially motor vehicle accidents
Second most frequent cause of childhood mortality
Drowning
Risk for choking and poisoning is highest for children from age range ___ to ___.
Risk for choking and poisoning is highest for children from age range 9 months to 3 years.
Basically, the toddler period
When teeth appear
A full set of primary teeth should erupt between 25 to 33 months of age
Fluorosis
Excessive fluoride intake leads to staining of tooth enamel permanently
Clinical definition of failure to thrive
- Note: It is a physical sign, not a final diagnosis
- Suspected when weight is below the fifth percentile. Usually seen in children under 5 years whose physical growth is significantly less than their peers
- Divided into organic and non-organic:
- Organic: Poor growth due to underlying medical condition, such as IBD, renal disease, or congenital heart defect.
- Non-organic: Poor growth without medical etiology, often related to poverty or child-caregiver interaction
Next step for failure to thrive with suspected non-organic etiology
- Two weeks of food, stool, and urine diary, with associated symptoms, then follow-up appointment
- Directly examine feeding session if young infant
Children with failure to thrive will require ___ as part of intervention
Children with failure to thrive will require catch-up calories as part of intervention
You can’t expect them to catch up just by giving them the same amount, they are already behind! They will require ~50-100% excess calories to get where they need to be.
The “picky eater” phenomenon
- Between ages 18 months and 30 months, children often become picky eaters
- Some will be so picky that they may actually fall off of their weight curve, which can be distressing for families
- However, this is completely normal and is just a phase. They child has no underlying condition and is not at risk of developmental issues due to this.
- Counsel parents to avoid force feeding and avoid providing snacks
- Schedule follow-up
___ is a common, but often missed, etiology of failure to thrive. Treat with ___.
Renal tubular acidosis is a common, but often missed, etiology of failure to thrive. Treat with bicarbonate.
An adolescent with new-onset truant behavior, depression, or declining grades is most commonly associated with ___
An adolescent with new-onset truant behavior, depression, or declining grades is most commonly associated with drug abuse
It is possible that there could be a brain tumor or psychiatric disorder, but these are nowhere near as common as drugs
A history of exposure to insecticides, working on a farm, or symptoms of lacrimation and salivation should make you think. . .
. . . organophosphate toxicity
Testing for organophosphate toxicity
- Decreased serum pseudocholinesterase
- Decreased erythrocyte cholinesterase levels
Treatment of organophosphate poisoning
- Decontamination (ie, CHANGE CLOTHES, clothes are contaminated if via spraying)
- Atropine or pralidoxime
- Supportive care
Various types of mercury poisoning
-
Acute inorganic mercury poisoning
- Takes a large quantity – a mercury thermometer would not be enough
- GI complaints
- Fever, headache, vision changes if vaporous
-
Chronic inorganic mercury poisoning
- Gingivostomatitis, tremor, and neuropsychiatric disturbance
-
Methylmercury poisoning
- From contaminated fish
- Ataxia, dysarthria, paresthesias
Symptoms of acute arsenic ingestion
-
GI symptoms
- N/V, hemorrhagic diarrhea, abdominal pain
- QT prolongation and Torsades
- Congestive heart failure
-
Cerebral edema and downstream consequences
- Seizure, encephalopathy, coma
Most chronic sexual abuse has findings of __ on physical exam
Trick question
None. Most have no findings at all.
Still, NAAT on a urine sample should be performed for C. trachomatis and N. gonorrheae
Signs of penetrating anal trauma
- Loss of stellate pattern of anus
- Loss of anal sphincter tone (which may present with encopresis/loss of continence)
- Deep anal fissures
Single most common movement disorder in childhood
Cerebral palsy
Common comorbidities of cerebral palsy
- 33% have seizures
- 60% have mental developmental delay
- Thus, anyone diagnosed with CP should have an EEG and cognitive testing
Diagnosis of cerebral palsy in a neonate
. . . is impossible
The CNS is too immature at this point to tease these things out.
Diagnosis of cerebral palsy
- Head imaging by ultrasound or MRI
- May reveal periventricular leukomalacia, atrophy, or focal infarcts
- Beyond infancy, CP should be suspected whenever a child fails to meet an anticipated developmental milestone
- ex, retention of primitive reflexes:
- Moro reflex persisting beyond 6 months
- Fencer reflex beyond 6 months
- ex, retention of primitive reflexes:
Hemiplegia and Diplegia in cerebral palsy
- Hemiplegia: Unilateral, arms more effected
-
Diplegia: Bilateral, legs more effected
- Note: Remember your neuroanatomy! This makes sense. The apical-most region of the brain controls the legs, hence palsy involving legs is more likely to be bilateral. Arms are more lateral and thus topographically farther apart.
Motor quotient in cerebral palsy
Used to categorize CP by severity
Calculated as motor age / chronologic age
Where “motor age” is age at which their motor functionality would be developmentally appropriate
Duschene Muscular Dystrophy
- Characterized by progressive loss of balance, frequent falling, difficulty climbing stairs, waddling gate, and proximal muscle weakness. Typically appears before age 5.
- Pseudohypertrophy due to muscle inflammation is classical on exam
- Gower’s sign when going from sitting to standing, shown below
- The most common hereitable neuromuscular degenerative disease
- Complications:
- Cardiomyopathy
- Nonprogressive intellectual disability
- Often wheelchair bound by age 10-12
- Cause of death is usually respiratory failure
- Diagnosis: DNA blood analysis usually works. When it is negative of equivocal, muscle biopsy and staining for dystrophin makes the diagnosis.
- Treatment consists primarily of orthopedic intervention and physical therapy. There is no cure. Early cardiomyopathy may be responsive to digoxin.
Seborrheic dermatitis
- Common in infancy and in adolescence
- Chronic, symmetrical eruption characterized by overproduction of sebum
- Affects the scalp, forehead, auditory meatus, cheeks, eyebrows, nasolabial folds
- Treat by softening scales with mineral oil (avoiding scrubbing), and daily shampooing with a mild shampoo. Low to medium potency topical corticosteroids or ketoconazole shampoo are also helpful.
