PED Behavioral concerns

Question 1

Herald-sound-kids are inventive, but generally a very attention-getting high pitched/piercing cry

Answer 1

Cyanotic spell. After the cry kid does forced expiration

Question 2

Clonic jerks, eyes roll back (opisthotonos) and bradycardia

Answer 2

See if kid LOC in a cyanotic spell

Question 3

Peak age is 2 years, but seen as early 6 months and can last to age 5 years or so

Answer 3

Cyanotic spell

Question 4

How can the parents manage the cyanotic spell by the kid

Answer 4

Do not acknowledge the episode (act naturally)

Question 5

what is initiated by painful episode (falling, hitting head, etc)

Answer 5

Pallid spells

-similar to cyanotic spells, but Pain -> apnea ->may have tonic seizure -> bradycardia +/- asystole of 2 secs or more

Question 6

how can pallid spells be reproduced

Answer 6

Ocular compression -> afferent to trigeminal -> efferent to vagal nerve and bradycardia

Question 7

Pallid can be treated like cyanotic spells, but if medication is required then what is it

Answer 7

atropine sulfate

Question 8

when do you begin use of training pants/pull-ups

Answer 8

when kid has increased periods of daytime dryness

Question 9

Asks to use the potty seat or uses it in self directed manner —–»»> leads to what

Answer 9

encourage use in post-prandial time (gastrocolic reflex) or at times of ‘normal’ BM

Question 10

when do GIRLS get potty trained. When do boys get trained

Answer 10

Girls: ~2 y/o
Boys: ~2.5 y/o

Question 11

how long does the potty training take

Answer 11

If ready, relatively quick process (2 wks to 2 months)

Question 12

when does conditioned reflex sphincter control occur

Answer 12

around 9 months

Question 13

Stool holding

Answer 13

Encopresis

-passage of feces into inappropriate places after the age of 4 years

Question 14

repeated underwear soiling, abd pain (worse after meals, exercise), painful rock hard stools, could be bloody, disordered urine production (night time especially)

Answer 14

Encopresis

Question 15

Getting a stool history. Timing of stools (night time incontinence is most consistent w/ what)

Answer 15

constipation

Question 16

what may be a sign of tethered cord/spina bifid a occulta

Answer 16

sacral dimple

Question 17

passage of explosive stool w/ completion of digital exam can be a sign of

Answer 17

aganglionic megacolon

Question 18

Kid says, “my belly hurts when I eat”

Answer 18

encopresis

Question 19

what is necessary for tx to work in encopresis

Answer 19

Disimpaction

Question 20

Enuresis and Encopresis.. boy or girl. which is more common

Answer 20

boy

Question 21

Enuresis or Encopresis. which is usually associated w/ other delays or performance (motor/language)

Answer 21

Enuresis

Question 22

with enuresis. who gets it more in twins. Monozygotic or dizygotic

Answer 22

Monozygotic:dizygotic 2:1

-mono get it more

Question 23

Causes of this can be maturation delay, genetics, small bladder capacity, nocturnal poluria and ADH, detrusor instability, sleep disorders, psychological

Answer 23

enuresis

Question 24

enuresis differential: other causes of nocturnal enuresis. Which is the number 1 differential

Answer 24

Endocrine are number 1 (DM, thyroid, DI)

Question 25

signs of excoriation or irritation local or perianal area…think of what

Answer 25

pin worms

Question 26

If kid has a history of UTI and has enuresis. what lab should we order

Answer 26

renal U/S

Question 27

Tx: calendar: 5 of 7 nights dry -> reward: 3 of 4 in month -> family activity of choice

Answer 27

Tx for enuresis

Question 28

how should we tx enuresis when it comes to fluid managment

Answer 28

Restrict evening fluids (and caffeine avoidance)

Question 29

best if used w/ other therapies (behavioral)

Answer 29

DDAVP (desmopressin acetate)

-check electrolytes at 3-6 wks of therapy

Question 30

what tx drug for enuresis has side effects: CNS (stim), cardiac (arrhythmias)

Answer 30

imipramine

Question 31

are kids that are colic considered healthy

Answer 31

yes they are healthy

Question 32

what are the rule of 3’s for colic

Answer 32

• crying lasting three hours or more
• more than three days per week
• more than three weeks

Question 33

what meds should be avoided when trying to tx a colic kid bc they sedate the child and have been releated to apnea, seizures, coma, and DEATH

Answer 33

antispasmodic or anticholinergics

Question 34

what is the real treatment for colic kids

Answer 34

the real treatment is reassure the parents and assure yourself that the child is healthy