Pediatric Conditions Flashcards
What is an Apgar score?
A method of objectively reporting the health of a newborn shortly after it is delivered. Score is determined by rating 5 different criteria:
Appearance (skin color) Pulse Grimace (reflex irritability) Activity (muscle tone) Respiration
Each scored 0, 1, or 2.
Score of 7 or above is considered good
Score below 3 indicates the need for immediate medical attention
When is an Apgar score determined?
Administered to newborn at 1, 5, 10 minutes after birth.
Continues every 5 minutes if infant is having difficulties
Describe the characteristics of an Apgar score of 0.
Appearance (skin color): Blue/Pale
Pulse: Absent
Grimace (reflex irritability): No response to stimulation
Activity (muscle tone): No movement, ‘floppy’
Respiration: Absent
Describe the characteristics of an Apgar score of 1.
Appearance (skin color): Normal body color, except blue hand and feet
Pulse: Below 100 beats per minute
Grimace (reflex irritability): Minimal response to stimulation
Activity (muscle tone): Flexing of the arms and legs
Respiration: slow, irregular
Describe the characteristics of an Apgar score of 2.
Appearance (skin color): Normal color ‘pink’
Pulse: Above 100 beats per minute
Grimace (reflex irritability): Pulls away, sneezes or coughs
Activity (muscle tone): Active movement
Respiration: Vigorous cry
What is meconium aspiration syndrome?
Due to bowel movement in utero (meconium) that mixes with amniotic fluid
Near-term or term infant inhales substance and can develop respiratory distress
What is respiratory distress syndrome?
Respiratory distress due to atelectasis caused by insufficient surfactant in premature lungs
May lead to acute respiratory failure and death
What is bronchopulmonary dysplasia?
Chronic lung disease as a result of damage to lungs from mechanical ventilation, oxygen administration, and chronic RDS
What is periventricular leukomalacia?
Necrosis of white matter adjacent to ventricles of brain due to systemic hypotension or ischemia
May result in cerebral palsy
What is Patent Ductus Arteriosus (PDA)?
Ductus arteriosus (temporary vessel between the aorta and the pulmonary artery) should close soon after birth
Non-oxygenated blood is circulated
What is failure to thrive?
Infant lacks adequate nutritional intake
Infant can present with development delays
What is cerebral palsy?
An umbrella term used to describe movement disorders due to brain damage that are non-progressive and are acquired in utero, during birth or infancy.
Describe the distributions of involvement for CP. (4)
Monoplegia = one extremity Diplegia = Bilateral LE involvement, but UE can be affected Hemiplegia = unilateral involvement of the UE and LE Quadriplegia = involvement of the entire body
List 6 movement types/disorders associated with CP.
- Spastic = increased tone, lesion of motor cortex, or projections from motor cortex
- Athetoid = fluctuating muscle tone, involuntary slow writhing movements, lesion of basal ganglia
- Ataxia = instability of movement, lesion of cerebellum
- Dystonia = involuntary movements with sustained contractions
- Hypotonia = decreased muscle tone
- Mixed = can present with a multiple/mixture of movement disorders
List 7 impairments associated with all classifications of CP.
- Insufficient force generation
- Tone abnormality
- Poor motor control
- Poor regulation of muscle activity
- Decreased ability to learn unique movements.
- Abnormal patterns of movement in total flexion and extension
- Presence of primitive reflexes
List 5 impairments associated with spastic CP.
- Increased muscle tone in antigravity muscles
- Abnormal posture/movements with mass patterns of flexion/extension
- Imbalance of tone may cause contractures
- Visual, auditory, cognitive and oral motor deficits may be present
- Crouched gait = walks with hip flexion, hip internal rotation, and knee flexion. May also toe walk.
List 5 impairments associated with athetoid CP.
- Generalized decreased muscle tone, floppy baby syndrome
- Poor functional stability, especially in proximal joints
- Ataxia and incoordination in upright position, with decreased BOS and muscle tone fluctuations
- Poor visual tracking, speech delay and oral motor problems
- Tonic reflexes (STNA, ATNR and TLR) may be persistent, blocking functional postures and movements.
List 8 impairments associated with ataxic CP.
- Low postural tone with poor balance
- Stance and gait are wide based
- Intention tremor of hands
- Uncoordinated movement
- Ataxia follows intial hypotonia
- Poor visual tracking, nystagmus
- Speech articulation problems
- May occur with spastic or athetoid CP
Describe proper positioning for a patient with CP when utilizing a wheelchair.
- Maintain head in neutral position
- Trunk upright
- Hips, knees and ankles at 90 deg flexion
- W/C seat may be tilted posteriorly to decrease extensor tone and maintain hip flexion
What milestone is a good prognosis for ambulation for children with CP? What age will most children walk by if ambulation is possible?
Good prognosis for ambulation = if a child can sit independently by 2 years of age
If a child is going to walk, most will walk by 8 years of age
List the 5 levels of the Gross Motor Classification for Cerebral Palsy.
Level I = walk without restrictions; limitations in more advance gross motor skills
Level II = walk without assistive devices; limitations walking outdoors and in the community
Level III = walk with assistive mobility devices, limitations walking outdoors and in the community
Level IV = Self mobility with limitations; children are transported or use power mobility outdoors and in the community
Level V = Self mobility is severely limited, even the use of assistive technology
List 6 interventions commonly used to treat symptoms associated with CP.
Selective dorsal rhizotomy Peripheral nerve block Baclofen pump Botox injections Muscle lengthening/transfers Osteotomies
What is myelodysplasia/spina bifida?
Developmental abnormality due to insufficient closure of the neural tube by the 28th day of gestation
What is spina bifida occulta?
An impairment and non-fusion of the spinous processes of a vertebra, however the spinal cord and meninges remain intact. No associated disability.
What are 2 forms of spina bifida cystica?
Meningocele: Herniation of the meninges and CSF into a sac that protrudes through the vertebral defect. Spinal cord remains within the canal.
Myelomeningocele: Herniation of the meninges, CSF, and spinal cord extending through the defect in the vertebrae. Cyst may or may not be covered by skin.
List 8 possible signs and symptoms associated with spina bifida.
- Arnold-Chiari malformation Type II = cerebellum and brainstem are pushed through the foramen magnum
- Hydrocephalus
- Osteoporosis
- Club foot
- Scoliosis
- Tethered cord syndrome
- Sensory loss
- Developmental delays
Spina bifida lesion at L4-L5 results in _____ dysfunction.
Bowel and bladder dysfunction
What is the orthosis and functional prognosis for a child with Thoracic L2 spina bifida?
Orthosis: THKAFO
Prognosis: W/C for all functional mobility, standing and walking for physiological benefits.
What is the orthosis and functional prognosis for a child with L1-L3 spina bifida?
Orthosis: Reciprocating gait orthosis (RGO); HKAFO
Prognosis: W/C for most functional mobility, short household ambulation possible; standing and walking for physiologic benefits
What is the orthosis and functional prognosis for a child with L3-L4 spina bifida?
Orthosis: KAFO
Prognosis: W/C for community mobility; Household ambulation possible
What is the orthosis and functional prognosis for a child with L4-S1 spina bifida?
Orthosis: AFO
Prognosis: Household or community ambulation
What is the orthosis and functional prognosis for a child with S1 spina bifida?
Orthosis: Foot orthosis; Supramalleolar orthosis (SMO)
Prognosis: Community ambulation
What is a brachial plexus injury?
Traction or compression injury to unilateral brachial plexus during birth process or due to cervical rib abnormality.
Results in sensory deficits and paralysis/paresis of the UE.
Describe the 3 types of brachial plexus injuries.
- Erb’s paralysis: Involves C5-C6 and results in upper arm paralysis
- Klumpke’s paralysis: Involved C8-T1 and results in lower arm paralysis
- Total or whole arm paralysis: C5-T1
What is the characteristic position of the UE for Erb’s paralysis?
Adduction, IR, elbow extension, forearm pronation, and wrist flexion
WAITER’S TIP DEFORMITY
What reflexes are not present in a baby with Erb’s paralysis? What remains intact?
Moro, biceps, radial reflexes are absent
Grasp is intact
What is Down Syndrome?
Genetic abnormality consisting of an extra twenty-first chromosome, termed trisomy 21
List 8 signs and symptoms associated with Down Syndrome.
- Hypotonia
- Intellectual disability
- Joint hypermobility
- Congenital heart disease
- Visual and hearing loss
- Flat feet
- Scoliosis
- AA subluxation/dislocation
List 3 distinguishing facial characteristics associated with Down Syndrome.
Flattened nasal bridge
Narrow eyelids with epicanthal folds
Small mouth
What is Duchenne’s Muscular Dystrophy?
X-linked progressive disorder caused by the absence of the gene required to produce the proteins dystrophin and nebulin. Fat and connective tissue eventually replace muscle.
Only male offspring will manifest the disease, but females are carriers.
List 6 signs and symptoms associated with Duchene’s muscular dystrophy.
- Progressive weakness from proximal to distal beginning and at age 3
- Progressive cardiopulmonary limitations
- Pseudohypertrophy of muscle
- Excessive lordosis
- Toe walking
- Gower’s sign: Child must use UEs to ‘walk up’ legs and rise from prone to standing, due to weak quadriceps and gluteal muscles
What is Becker’s muscular dystrophy?
Variant of DMD that emerges in late childhood or adolescence
What is Autism spectrum disorder?
A group of complex brain development disorders, that appear in the first 3 years of life, characterized by difficulties with social interaction, communication and repetitive behavior.
List 10 signs and symptoms associated with autism spectrum disorders.
- Non-purposeful speech or absence of speech
- Diminished facial expressions
- Inability to understand non-verbal cues
- Limited interests or awkwardness in social interactions
- Lack of empathy
- Defensiveness or indifference to sensory stimulation
- Repetitive self-stimulating behaviors
- Perseveration
- Preoccupation with routines/rituals
- Decreased coordination
What is arthrogryposis multiplex congenita?
Congenital deformity of skeleton and soft tissues leading to several non-progressive contractures at birth
List 4 signs and symptoms associated with arthrogryposis multiplex congenita.
- Cylindrical-like extremities with minimal definition
- Significant and multiple contractures
- Dislocation of joints
- Muscle atrophy
What is Prader-Willi Syndrome?
Genetic condition, caused by partial deletion of chromosome 15, that is diagnosed by physical attributes and patterns of behavior
List 5 characteristics associated with Prader-Willi Syndrome.
- Small hands, feet, and sex organs
- Hypotonia
- Almond shaped eyes
- Obesity
- Constant desire for food
What is spinal muscular atrophy (SMA)?
Characterized by the progressive degeneration of the anterior horn cell (autosomal recessive genetic inheritance)
Describe the 3 types of spinal muscular atrophy.
- Acute infantile SMA (Type 1-Werdnig-Hoffmann disease): Occurs between birth and 2 months of age. Motor degeneration progresses quickly and life expectancy is less than 1 year.
- Chronic childhood SMA (Type 2-Chronis Werdnig-Hoffmann disease): Presents after 6 months to 1 year and has slower progression that infantile SMA. Child can survive into adulthood.
- Juvenile SMA (Type 3-Kugelberg-Welander SMA): Occurs later in childhood from 4-17 years of age. Children with juvenile SMA typically survive into adulthood.
