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Peds Exam 2 > Lecture 1 - Pediatric Behavioral Medicine > Flashcards

Lecture 1 - Pediatric Behavioral Medicine Flashcards

1
Q

Colic

A

Affects 10-40% of infants worldwide
M = F
No correlation with type of feeding

Dx. Of exclusion

Self limiting condition - typically resolve by 3-6 months of age

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2
Q

Wessel’s Rule of 3s

A

Regarding colic

Crying for more than 3 hours a day more than 3 days a week for more than 3 weeks

Consistent with colic

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3
Q

How does the crying of colic appear?

A

Paroxysmal
Facial grimacing
Drawing up of legs

Peaks around 6 weeks

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4
Q

When does colic crying peak?

A

6 weeks

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5
Q

What is the treatment for colic?

A

Parental support and reassurance —colic can lead to abuse and shaken baby syndrome so be sure to support the parents

5 S’s —> swaddle, shush, swing, suck, side or stomach position —used to help sooth colic

Sxs usually resolved 3-6 months of age —> benign, self limiting condition

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6
Q

5 S’s of colic

A 
Ways to sooth colic 
Swaddle 
Shush 
Swing
Suck 
Side or stomach position
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7
Q

Temper Tantrums

A

Out of control behavior including screaming, stomping, hitting, head banging, falling down and other violent displays of frustration

Can include breath holding, vomiting, serious aggression, biting

Normal human development stage
18 - 4 years

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8
Q

What is the most commonly reported behavioral problem in 2 and 3 year olds?

A

Temper tantrums

Typical frequency is 1 per week lasting 2 - 3 minutes (duration increases with age)

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9
Q

How often and how long do temper tantrums typically last?

A

Typically 1 per week for 2-3 minutes

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10
Q

Treatment for temper tantrums?

A

Tantrums are a normal part of development
Parents can help by preventing hunger, not letting the child get over tired, spending more one on one time with the child, ease in to big changes
Support the parents
Will probably get worse before it gets better

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11
Q

Breath holding spells

A

Brief involuntary period typically within a tantrum where the child tops breathing
MC 1-3 years of age
Often causes child to lose consciousness

Sometimes anemia can be related to breath holding spells

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12
Q

What is the treatment for breath holding spells?

A

Really just reassure the parents that this is a normal and temporary phase

Get EEG if pt passed out for more than 2-3 minutes

PANOPTO slide 21

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13
Q

Parasomnias

A

Night terrors
1-6% of preschoolers

Nightmares
62% of preschoolers

Sleep walking
10-30% of kids have episodes

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14
Q

What is the difference between nightmare and night terror?

A

Nightmare the child is awaken fully and is aware or what’s going on around them, can vividly recall the dream
More common in the second half of night

Night terror the child has panicky scream but is not fully awakened. They’re disoriented, difficult to calm, then fall right back to sleep. Amnesia of episode.
MC in first 3rd of night

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15
Q

When in the night do nightmares occur compared to night terrors?

A

Nightmares typically in the second half of the night

Night terror in the first third of the night

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16
Q

What is the treatment for nightmares

A

Provide comfort, reassurance

Efforts during the day to feel safe (check closets, under the bed)

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17
Q

What is the treatment for night terrors?

A

Just barely waking the child just prior to the usual time of night terror
Can sometimes help “reset” the sleep cycle

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18
Q

What are the developmental surveillance components?

A

Eliciting and attending to parents concerns
Obtaining developmental history
Skillfully observing childrens devlopment
Sharing opinions with other professionals

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19
Q

What are the AAP guidelines for developmental surveillance and screening?

A

Surveillance at each visit —if concerns then perform screening test

Perform structured screening at 9, 18, and 30 months
(May need to do 24 months instead of 30 based on insurance)

9 months - motor delays
18 months - language delays
30 months - social interaction and regression

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20
Q

What delays are you looking for during the developmental screening tests?

A

9 months - motor delays
18 months - language delays
30 months - social interaction and regression

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21
Q

What are the benefits of parent-report tools for developmental screening?

A

Takes less time
Same or better psychometrics

Can train office staff to administer

Reduces the “oh by the way” concerns

22
Q

What are the domains of developmental milestones?

A 
Language (receptive and expressive) 
Motor (fine and gross) 
Cognitive
Social 
Play
23
Q

What is the most common isolated developmental delay?

A

Speech - language

24
Q

What does global developmental delay mean?

A

Delay in 3 or more areas

25
Q

Atypical developmental delay

A

Asynchronous - “out of order”

Think ASD (autism spectrum disorder)

26
Q

How do pts with ASD differ in regards to playing with toys?

A

ASD pts won’t play with the toy for its function but rather its color or category

27
Q

What are typical parental concerns that should make you think about ASD?

A 
Preferring to play alone
Lives in a world of their own 
Not talking 
Hearing concerns 
Lines up toys 
Upset by changes 
Eat few foods or only certain textures 
Does not play with toys appropriately
28
Q

What should you do and suspect if a parent of a 15 to 18 months old says “it seems like my child can’t hear me, i call his name but he just ignores me”?

A

Get audiologic evaluation but if it is normal be thinking this is a joint attention problem

29
Q

Joint Attention

A

4 components

  • oriented and attending to a social partner
  • coordinating attention between people and objects
  • sharing affect and emotional states with people
  • being able to draw others attention to objects or events to indicate need or to share experiences

This is something ASD don’t really have

I believe this happens over time between 12 to 18 months of age

30
Q

In regards to joint attention, what milestones should pts have reached by 14 months?

A 
2 months - reciprocal smiling 
6 months - joyous smiling, known caregiver 
8 months - gaze monitoring 
10 months - follows a point 
12 months - proto - imperative pointing 
14 months - proto-declarative pointing
31
Q

When do you see affective reciprocity?

A

3 - 6 months

32
Q

When do you see joint attention?

A

12 - 18 months

33
Q

When do you see theory of mind?

A

30 months

34
Q

What component is most delayed in ASD kids?

A

Social

35
Q

How is ASD broken down?

A

Level 1 - requiring support

Level 2 - requiring substantial support

Level 3 - requiring very substantial support

36
Q

What is the DSM - 5 definition of ASD?

A

Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays
Must meet all 3 of the following:
-problems in social -emotional reciprocity
-deficits in non-verbal communicative behavior used for social interaction
-deficits in developing and maintaining relationships (beyond those caregivers), appropriate to developmental level

Presence of restricted, repetitive, stereotyped behavior, interests and activities (at least 2 of the following):

  • stereotyped speech
  • excessive adherence to routines, ritualized patterns or behavior, resistance to change
  • highly restricted, fixated interests that are abnormal in intensity or focus
  • hyper- or hypo- reactivity to sensory input or unusual interest in sensory aspects of environment
37
Q

What are risk factors for ASD?

A

Child’s sibling has ASD, parental concern, other caregiver concern, provider concern

Score 0-4
Score >/= 2 refer to audiology, early intervention/childhood services, ASD dx eval
Score 1 for <18 month old - ASD screening tool

38
Q

When do children get screening for ASD?

A

If they get a risk score >/= 2

Meaning that either their sibling has ASD, then parent, caregiver, or provider is concerned

Also AAP is pushing for screening at 18 and 24 months

39
Q

M-CHAT

A

Modified checklist for autism in toddlers

40
Q

What is the management of ASD?

A 
Refer 
Medical tx: 
-manage co-morbidities
      Behavioral 
      Sleep problems 
      Feeding/GI problems 
ABA - applied behavioral analysis 
Pt and caregiver education 
Management of the environment
41
Q

What are the typical language milestones?

A

Intelligibility
50% by age 2
75% by age 3
100% by age 4

42
Q

What are typical variations in language milesones?

A

Echolalia - 18 months
- when you ask the pt a question they can’t answer but they can repeat what you said

Dysfluency, stuttering in preschoolers

Articulation errors ~ 4-5 years
-not knowing how to say Rs or switching letters

43
Q

What is the most influential language development?

A

Language exposure

44
Q

What are infancy clinical findings that a child might have hearing loss?

A

Doesn’t startle with loud or sudden noises
Does not respond to voice (but does if caregiver in visual field)
Doesnt turn head toward sound by 6 months
Delayed expressive and receptive language milestones

45
Q

What are child and adolescent clinical findings suggestive of hearing loss?

A

Delayed receptive & expressive milestones
Ask for verbalizations of others to be repeated
Turns up TV or radio too loud
Does not attend to verbal instruction
Articulation impairments in speech

46
Q

ADHD - inattention DSM Criteria

A

6 or more of the following:

  • inattention to details/makes careless mistakes
  • difficulty sustaining attention
  • seems not to listen
  • fails to finish tasks
  • difficult organizing
  • avoids tasks requiring sustained attention
  • loses things
  • easily distracted
  • forgetful
47
Q

ADHD hyperactivity/impulsivity subtype DSM 5 criteria?

A

6 or more of the following
Hyperactivity
- fidgets
- unable to stay seated
- inappropriate running/climbing (restlessness)
- difficulty in engaging in leisure activities quietly
- “on the go”

Impulsivity

  • blurts out answers before question is finished
  • difficult awaiting turn
  • interrupts or intrudes on others
48
Q

What are the subtypes of ADHD and what is the most common type?

A 
Inattentive type (20%) 
-more females 
Hyper/impulsive type (15%)
Combined type (65%)
49
Q

What is the most common co-morbidity seen with ADHD pts?

A

Learning disorders (40-50%)

Oppositional defiant disorders (30-40%)

50
Q

When do you use behavioral therapy for ADHD?

A

Preschool aged kids

51
Q

IEP vs section 504

A

In regards to ADHD

IEP - individualized education plan - needs a medical dx — focused on interference with school

504 - focuses on interference with life (modifications - sits at special desk, have additional time for tests)

52
Q

What medications are FDA approved for ADHD?

A

Stimulant medications
- methylphenidate, dexmethylphenidate

Non-stimulant medications

  • atomoxetine
  • long acting alpha agonists - guanfacine, clonidine

Peds Exam 2 (11 decks)

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