Pediatrics Flashcards
Age-Related Terminology
gestational age: the time between the first day of the last menstrual period and the day of birth
chronological age: the time between birth and the present
- “actual age”
Adjusted/corrected age: chronological age minus the number of weeks born before 40 weeks
APGAR
appearance
pulse
grimace
activity
respiration
each section 0-2 points
total:
- 7-10 is good
- less than 3 is an immediate medical emergency
- less than 5 at birth: neurological
Outcome Measures
AIMS: infant motor scale (0-18 months)
BOT: fine manual control, manual and body coordination, balance, strength, agility (4-21 years old)
GMFM: gross motor functional skills like rolling, lying, sitting, standing, walking, running, jumping, stairs (all ages)
Peabody: fine and gross motor (0-6 years)
PEDI: self-care, mobility, social function (6 months to 7.5 years old)
SFA: school function, kindergarten to 6th grade
Cerebral Palsy
non-progressive movement disorders that result from brain damage
most common cause of permanent disability in children
may present with high tone, low tone, or athetoid movement
monoplegia, hemiplegia, quadriplegia
spastic: UMN
athetoid: basal ganglia
GMFCS Levels
1: can ambulate indoors and outdoors, ambulate stairs without hand assistance; can run and jump
- decreased speed, balance, and coordination
2: can ambulate indoors and outdoors, ambulate stairs with handrail support; minimally run and jump
- difficulty with inclines, uneven surfaces, and crowds
3: walks with AD indoors and outdoors on level surfaces only; may be able to climb stairs with handrail, may be able to use manual WC
- may need assistance with manual WC for longer distances
4: walking ability is severely limited even with AD, uses a WC most of the time, may participate in standing transfers
5: physical impairments that restrict voluntary movement control and the ability to maintain head and neck position against gravity
- impairment in all motor function
- can’t sit or stand independently, even with AD
- can’t independently walk, though may be able to use power mobility
Down Syndrome
“trisomy 21”; extra chromosome (21)
disability, hypotonia, atlantoaxial instability, joint laxity
flattened nasal bridge, narrow eyelids with epicanthal folds, small mouth, feeding issues
flat feet, scoliosis, congenital heart disease, visual and hearing loss
focus on exercise and fitness, stability, and managing resp. function, monitor for cardiac abnormalities
Spina Bifida
developmental abnormality due to insufficient closure of neural tube by 28th day of gestation
occulta: no neural protrusion
cystica:
- meningocele: meninges protrude
- myelomeningocele: meninges and spinal cord protrude
myelomeningocele impairments:
motor and sensory. loss below vertebral defect, hydrocephalus, Arnold-Chiari type II malformation, clubfoot, scoliosis, bowel and bladder dysfunction, learning disabilities
* the higher the lesion, the worse the prognosis for survival
*shunt placement to alleviate hydrocephalus
Shunt Malfunction Symptoms
from blockage, infection, fracture, size
headaches, n/v, irritability, loss of sleep, fatigue, loss of motor function, seizures, behavior changes, visual problems
Duchenne Muscular Dystrophy
manifests symptoms once fat and connective tissue begin to replace muscle that has been destroyed by the disease process
fat and connective tissue eventually replace muscle, and death usually occurs from CVP failure prior to age 25 (usually in teenage years)
- dx usually occurs between 2 and 5 years old
- waddling gait, proximal muscle weakness, clumsiness, toe walking, excessive lordosis, pseudohypertrophy of calves, difficulty climbing stairs
- Gower’s sign
*impairment with ADLs and mobility begins around 5
*inability to ambulate by 10-12 years old
Spinal Muscular Atrophy
characterized by progressive degeneration of the AHC
1. acute: birth to 2 months, life expectancy is < 1 year
2. chronic childhood: 6 months-1 year, slower progression
- survival into adulthood
3. juvenile: 4-17 years old, typically survives into adulthood
all have progressive muscle weakness and atrophy, diminished or absent DTRs, normal intelligence, intact sensation, and end-stage respiratory compromise
Prader-Willi Syndrome
partial deletion of chromosome 15
small hands, feet, and sex organs, hypotonia, almond-shaped eyes, obesity, constant desire for food
coordination impairments and intellectual disability
postural control, gross and fine motor training, exercise, and fitness
Juvenile Rheumatoid Arthritis (JRA)
most common chronic rheumatic disease in children and presents with inflammation of the joints and connective tissues
systemic: (least common) acute onset, high fevers, rash, enlarged spleen and liver, inflammation of lungs and heart
polyarticular: (high female incidence) significant RA in >4 joints with symmetrical involvement
oligoarticular: (most common) less than 5 joints with asymmetrical joint involvement
NSAIDs, antirheumatics, corticosteroids, and immunosuppressants
Torticollis
shortened/tight SCM
ipsilateral sidebending and contralateral rotation
postural: preference, no SCM tightness
muscular: SCM tightness, ROM restrictions
sternomastoid tumor: palpable in SCM
Legg-Calve-Perthes
degeneration of femoral head due to a disturbance in blood supply
-self limiting: condensation, fragmentation, re-ossification, remodeling
pain, decreased ROM, positive Trendelenburg sign
Slipped Capital Femoral Epiphysis (SCFE)
a hip condition that occurs when the growth plate in the thigh bone breaks and the head of the femur slips out of place
- common developmental condition that usually affects pre-teens and teens
pain in the hip, groin, thigh, or knee, pain that worsens with activity and improves with rest, limping, walking with the leg turned outward, clicking sensation in the hip
requires surgery
