Community & Development Flashcards
Low risk BRUE criteria
Age > 60 days
If premature, gestational age >/= 32 weeks and CGA >/= 45 wks
First episode of BRUE
Duration < 1 min
No CPR required by trained medical provider
No concerning features on history or physical
Breath holding spell management
Reassurance
Self limited episodes
Outgrown within a few years
Screen for anemia with CBC recommended
- Spells can be worse with iron deficiency anemia
Screen for arrhythmia with ECG recommended
- Rarely presenting sign of long QT syndrome
Meds (rarely used, only if anoxic seizures that are recurrent, prolonged and not responding to other measures)
Atropine
Antiseizure meds
CPR training if severe spells s
Head shape cranio vs plagio
ears anterior = A-ok = plagio
ears posterior = bad = cranio
Tics criteria
Typically preceded by a premonitory urge
Suggestible
Suppressible - can be suppressed for varying periods of time – e.g. when deeply focused, during sleep
Distractible
Tourette disorder dx
Both multiple motor AND one or more vocal tics have been present at some time during the illness, although not necessarily concurrently
Tics may wax or wane in frequency, but have persisted for > 1 year since first tic onset
Onset before age 18 years
Persistent/provisional tic disorder
Persistent (>1yr)
Single or multiple motor or vocal tics have been present during the illness, but not both motor + vocal
May wax + wane in frequency but have persisted for > 1 year since first tic
Onset before 18 years
Provisional (<1 yr)
Single or multiple motor and/or vocal tics
Persistent for < 1 year
Onset before age 18
Tourette comorbidities
ADHD
OCD
Tic treatment meds
alpha agonist (clonidine, guanfacine)
antipsychotics
use if tics are painful or injurious or cause functional impairment or impair quality of life
treat ADHD or OCD first
CPS physical activity in toddlers recommendations
Toddlers age 1-4
- > 180 mins of any intensity per day
-
Bacteria causing dental caries
strep mutans
Cannabis withdrawal syndrome
at least two of five psychological symptoms:
Irritability
Anxiety
Depressed mood
Sleep disturbance
Appetite change
And at least one of six physical symptoms:
Abdominal pain
Shaking
Fever
Chills
Headache
Diaphoresis
craniosynostosis types
Sagittal > metopic > unilateral coronal
Sagittal: long head, bulging forehead
Lamboid willl have flat occiput similar to :(
Vaccines after HD steroids
–> inacctivated 2 weeks after stopping
–> live 4 weeks after stopping
Influenza vaccines
everyone 6 mo up should get it including pregmany women
Car seat safety
rear facing: until 2-4 yr old
Forward facing with 5 pt harness: at least 2 yo and have outgrown larg rear facing seat
Booster seat: once 18kg (40lb) and can sit straight and tall without moving
Seat belt only: must be at least 145 cm ( 4’9) - usually age 9-12
Colic
-normal crying
-colic criteria
normal crying
2 weeks 1-2 hr
peak 2-3 hr at 6-8 weeks
less than 1 hr by 12 weeks
Rome criteria for colic:
- Infant < 4 months of age
- Paroxysms of fussiness/crying that starts/stops without obvious cause
- >3h/day, >3day/week, for >1 week
- Otherwise well
red flags
- apneic
- cyanosis
- resp distress
- vomiting
- bloody stools
- fever
Enuresis
- decide if they have lower urinary tracts symptoms or not to determine overactive bladder vs. dysfunctional voiding vs. lower tract obstruction
alarm therapy if 2x a week but don’t use if nightly
DDAVP - used for nocturnal polyuria with normal daytime bladder capacity
- anticholinergics for bladder overactivity, need to refer to urology
- don’t use tricyclics
- mirabegron refer to urology to use; used to treat overactive bladder
Screening for STIs
annual G/C if sexually active < age 25 yo
- First catch urine for chlamydia and gonorrhea (small volume)
- Pharyngeal swab if oral sex
- anal swab if anal receptive intercourse
Annual serology for HIV and syphilis if >15 yo or high risk
Hepatitis B/A/C serology if sexually active with unclear immunization hx or high risk bevahiour or partner
Rome III Criteria for functional constipation
Rome III Criteria 2 or more of:
2 or less BM per week
1+ episode of incontinence per week (2dary)
Hx of excessive stool retention (volitional, posturing)
Hx of painful or hard bowel movements
Large fecal mass in the rectum
Hx of large-diameter stools that may obstruct the toilet
If <4 year developmental age:
2+ above for 1 month+
If >4 year developmental age:
Cannot also fulfill IBS criteria
2+ above for 2 months+
constipation red flags
History: 🚩
Onset <1mo age
Delayed meconium >48h
Ribbon stool
Blood in stool without fissure
Resp problems (CF)
Bilious emesis
Family history: celiac, thyroid, MEN2b
Exam: 🚩
Poor growth
Lumbosacral anomalies: tuft, dimple, deviated cleft
Abnormal lower extremity tone/gait/reflexes
Absent anal or cremasteric reflex
Abnormal anus position
Abnormal thyroid gland
Severe abdo distension
Perianal fissure
Anal scars
Extreme fear during anal examination (sex assault)
Constipation management
Disimpaction
PEG PO 1 to 1.5 g/kg/day for 3- 6 days
If PEG not available, an enema daily for 3-6 days
Maintenance
PEG 0.4g/kg/day to start, titrate to 1 soft BM daily
(lactulose if PEG not available)
2nd line or adjuncts: milk of magnesia,mineral oil, stimulant laxatives.
Duration:
At least 2 months (Old CPS statement said at least 6 mos)
At least 1 mos after all symptoms gone
Decrease gradually
Do not stop until toilet training is achieved in younger kids
Non Pharm:
Normal Fiber
Normal Fluid
Normal Activity
RSV immunophrophylaxis
antibody for passive protection (not a vaccine)
Should be offered:
- Premature: born <30wGA and <6mo at onset of RSV season
- <24 months with CLD who require ongoing oxygen therapy within the six months preceding or during the RSV season ( ie. CLD with O2 gets it until theyre 2yo)
- Hemodynamically significant CHD <12mo (ie. heart until 1 yr)
- Preterm born <36 wGA and <6mos old living in remote northern Inuit communities who would require air transport for hospitalization
Should NOT be offered:
- Otherwise healthy >= 33 wGA
- Multiples*
- To prevent recurrent wheeze or asthma
- Not routinely for (*- who don’t otherwise qualify)
(CF, Downs, health infants from northern communities unless hospitalization rates high)
- To prevent hospital-associated RSV infection in eligible children who remain in hospital (because purpose is to prevent hospitalization?)
ADHD DSM Criteria
Inattention 6+ symptoms
Hyperactive 6+ symptoms
6+ months
symptoms severe, persistent (present before 12 yr and continue for > 6mo)
2+ social settings
If preschooler, parents should have parent training
CBC for Trisomy 21
screen by day 3 then annual
Red flags for sacral dimple
🚩Red flags for which investigating would be indicated:
midline tuft of hair
sacral dimple or sinus tract above the gluteal cleft
Hemangioma
dermal appendage and/or a subcutaneous lump
Acrodernmatitis enteropathica
autosomal dominant
can’t absorb zinc
Features:
- bad perioral rash
- often when switches from breastmilk to formula
Newborn Development
Moro, primitive reflexes
Hand grasp reflex
Root, suck reflexes
Orients to sound
Cries when tired, hungry, pain
Able to see ~10’’
Prefers faces
Cries when another infant cries
2 mo Development
Head 45° when prone
Holds placed rattle
Turns to voice
Coos
Follows horizontal arc
Eye contact
Awake more during day
Social smile
4 mo Development
Sits with support
Rolls front to back
Weight bears in standing position
Palmar grasp
Hands together in midline
Reaches and grasps rattle
Squeal
Anticipates routines
Explores eyes, hands, mouth
Calms when spoken to
Facial expressions
Self-soothes to sleep
6 mo development
Most primitive reflexes fade/absent
Sits tripod
Rolls both ways
Raking grasp
Transfers hand to hand
Looks at person talking
Babbles (“bababa”; “mamama”)
Bangs objects together
Looks for dropped object
Shares enjoyment
Prefers familiar people
9 mo Development
Sits without support
Pulls to stand
Cruises
Crawls
Hand to hand transfer
Inferior pincer grasp
Pokes at objects
“Mama” “Dada”
Gestures bye bye, up
Object permanence
Searches for hidden toy
“Peek-a-boo”
Attachment starts to develop—stranger anxiety
Feeds self
12 mo Development
Stands
Walks
Fine pincer grasp
Voluntary release
Throws objects
1 word besides mama, dada
Inhibits to “no”
Respond to own name
1 step command w/gesture
“Cause and effect” toys
Imitates gestures and sounds
Rolls toy car
Points at wanted items
Narrative memory begins
18 mo Development
Walks up steps (one step at a time)
Runs
Carries toys while walking
2-4 cube tower
Scribbles, fisted pencil grasp
10-25 words
Single step commands
Points to 3 body parts
Labels familiar objects
Imitates housework
Symbolic play with doll (give doll drink)
Increased independence
Parallel play
2 years development
Jumps on two feet
Throws ball
Upstairs alternating w/ railing
6 cube tower
Uses fork
Handedness established
Copies vertical stroke
2 word sentences
50+ words, 50% understandable
I, me, you, plurals
Searches for hidden object after multiple displacements
Testing limits, tantrums
Negativism (NO!)
Mine!
3 yr development
Tricycle
Upstairs alternating feet w/o railing
Copies a circle, cross
Undresses
Turns pages of book
3 word sentences
75% understandable
W questions
Simple time concepts
Shapes
Compares 2 items
Counts to 3
Group play
Knows name, age, gender
Role play “pretending”
4 yr development
Hops on 1 foot
Down stairs alternating feed
Draws x, square
Cuts shape with scissors
Buttons
Sentences, 100% intelligible
Tells a story
Past tense
Counts to 4
Opposites
Identifies 4 colors
Tells stories
Interactive play
Has preferred friend
Developmental dysfluency vs. stuttering
Stuttering: may have vocal tension, pauses in words, facial twitching and may cause frustration
DD: normal tempo with pauses in fluency, often resolves by school age. more occassional. treat with reassurance
if tension or tics or twitching, refer to SLP
indications for refer to SLP for stutter
Parent or child concern
Frequent episodes of dysfluency (b-b-but; th-th-the; you, you, you) 3+ dysfluencies per 100 syllables
Speech is completely blocked
Discomfort or anxiety while speaking
Presence of secondary behaviors (eye blinking, jaw jerks, head or other involuntary movements)
Impaired function (social) or mental health (anxiety) associated with it
most likely test to reveal abn in GDD
microarray and fragile x testing are both first line
autism workup
chromosomal microarray in everyone
fragile x only if boys or girls with fam hx or clinical feature
fragile x
X-Linked Dominant
clinical features
- delayed motor and verbal
- facial features: prominent jaw and forehead, large ears
- hyperactive
- macro-orchidism
associated with:
- autism
- anxiety, depression, ADHD
- mitral prolapse
- premature ovarian failure if female
x linked triple repeat diagnosed on PCR
management
- audiology for AOM
- echo
- SLP, behaviooural
diencephalic syndrome
FTT
emaciated
hyperactive, restless
learning disability diagnosis
difficulties in at least one of the following areas for 6+ months despite targeted help:
- reading
- understanding what they read
- spelling
- writing
- numbers or calculations
mathematical reasoning
adult seat belt size
145 cm (4’9”), lap belt fits low and snug
autism DSM criteria
Impairment in social interaction and communication (all 3 of):
i. Social and emotional reciprocity
ii. Impairment of nonverbal behaviors
iii. Failure to develop/maintain relationships
Abnormal and restricted, repetitive behaviors, interest, and activities ( 2 of 4):
i. Stereotyped speech and behaviors
ii. Insistence on sameness/resistance to change
iii. Restricted, fixated interests
iv. hyper/hyposensitivity to sensory input
early warning signs of autism
by 12 mo: limited smiling, eye contact, facial expressions, or gestures
12-18 mo: no gestures, no words, limited joint attention, no pointing, usual play
which stimulant to use for patients with substance use problems
vyvanse (can’t be crushed)
dont use ritalin - higher potential for abuse, shorter acting and crushable
first line adhd med
extended release stimulant (methylphenidate or amphatemine)
developmental coordination disorder diagnostic criteria
- difficulties with acquisition and execution of motor coordination skills on standard motor assessment
- motor skills deficit impairs ADLs /sports/school
- onset of symptoms in early development
- not better explained (ie. r/o CP, muscular dystrophy)
soft neuro signs seen in DCD
incoordination on exam ex. might not be able to do finger to nose but is not truly dysmetric, normal romberg
mild hypotonia
