Peds: School Age Health & Issues

Question 1

School Age Health: Well Child Checks (WCC)

Answer 1

• *subjective (elimination, school activities, relationships with friends/family, drug use, caffeine use, behavior);
• *objective (physical exam, BMI, tanner staging-precocious puberty, scoliosis);
• *lab- PPD before school entry (age 4-6) and annually if indicated (low socioeconomic status, possible TB exposure, immigrant status), HCT @ 8 yrs of age and PRN, cholesterol is high risk (premature CV disease, dyslipidemia, & family hx MI before age 55);
• *Management- immunizations, (2nd MMR), meds, anticipatory guidance for health promotion, dental assessment q 6 mos;
• *use visual aids (diagrams), acknowledge modesty and fears

Question 2

School Age Health: Physical Exam Elements

Answer 2

• *period of rapid growth then levels off (latency);
• *average 10 yr old = 70 lbs and 52 to 56 in ht;
• *average growth = 5-7 lbs/yr and 2-3 in/yr;
• *peak ht velocity (PHV) = age 11/12 (prior to menarche);
• *ht, wt, BMI = BMI (starts at age 2) between 85th and 95th percentile (risk of overweight), above 95th percentile (indicates obesity);
• *vitals (p, r, bp) each visit;
• *visual acuity 20/20;
• *permanent teeth eruption;
• *breast development in girls’
• *scoliosis screening beginning at age 9 (early screeing = early intervention = 85% correction)

Question 3

School Age Health: Physical Development (Motor Skills)

Answer 3

• *motor skills well developed;
• *muscle strength increased;
• *hand dominance emerges

Question 4

School Age Health: Cognitive Development (Language Skills/Reasoning)

Answer 4

• *Erik Erikson = industry vs inferiority (active, energetic, & curious);
• *Piaget’s concrete operational thinking stage:
• –cognitive tasks are varied; acquiring new knowledge, sense of self;
• –fluid & descriptive language, expands thought, grasps concepts of conversations, space, time, money; —-masters cause and effect; deductive reasoning,

Question 5

School Age Health: Psychosocial Development

Answer 5

• *expansion of outside world;
• *develops self-esteem;
• *learns decision-making, competent in abilities, believes worthy of love,
• *plays with others, organized sports, behaves in peer environment;
• *late school age- peers very important;
• *proactive in meeting needs, fullfills household responsibilities, seeks money making opportunities ex. babysitting

Question 6

School Age Health: Anticipatory Guidance

Answer 6

• *discipline- consistency is crucial, adults are role models, emphasize consequences, assign regular chores, listen to child, reinforce honest, limit electronic devices, expect lying & confront child in positive way;
• **refer to My Plate for food guidelines; limit junk foods, appears to increase wt as linear growth stabilizes;
• *brush after meals/before bed, dental assessments q 6 mos, sealants to protect teeth, teach flossing;
• *injury prevention- drugs, smoking, alcohol, helmets;
• *sleeps 8-10 hours/night, nightmares decrease

Question 7

School Age Health: Development Warning Signs

Answer 7

• *younger school age- poor school adjustment, not performing to ability, frequent illness, lack of social interaction;
• *older school age- shy, passive roles, cannot keep/make friends, poor school performance, disinterest in activities, destructive behavior

Question 8

School Age Health: Common Disorders-

Obesity

Answer 8

• *obesity- mild, moderate, or morbid;
• *etiology- genetic, environmental, physiological; high fat diet, inactivity, health conditions which decrease energy expenditure, poor eating habits;
• *differential dxs- endocrine disease, genetic conditions (Prader-Willi syndrome); medication-induced obesity (antipsychotic);
• *dx sutdies- as indicated per physical cause, physiological sequelae, obesity (BMI 95th percentile based on age/gender);
• *management- prevention through anticipatory guidance, treat underlying condition, nutrition planning, increase activity;
• *referral- counseling per psychosocial issues

Question 9

School Age Health: Common Disorders-

Child Abuse/Neglect

Answer 9

• *acts of commission/omission (physical, sexual, or emotional acts) that endanger the health and development of the child;
• *know state reporting standards;
• *etiology- former victims of abuse, neglect is common abuse, African-Americans and Native Americans have high incidence reported, 80% are parents;
• *s/s- vague hx incompatible to injury, delay in seeking care, unmet needs, obvious evidence of injury, developmental delay, unusual child/parent interaction;
• *diff dxs- accidents, coagulopathies, homeopathic/cultural practices;
• *dx studies- thorough physical exam, as indicated rule out underlying conditions such as coagulopathies or osteogenesis imperfecta, home assessment;
• *dx assessment- labs- coags (platelet, bleeding time, prothrombin time, partial thromboplastin time) with hx of easy brusising, serium Ca, Phos, Alk Phos - may indicate bone disease; radiographic studies- as indicated with limited ROM & bony tenderness; skeletal survey- nonverbal child with soft tissue findings (over 4-5 yrs of age) or suspected FTT; CT/MRI scans based on findings, U/S if visceral injury is suspected;
• *management- education, prevention, identify high risk, anticipatory guidance, report to state

Question 10

School Age Health: Common Disorders-

Attention Deficit Hyperactivity Disorder (ADHD)

Answer 10

**commonly dx behavioral problem in childhood (considered a chronic illness);
**essential impairment- deficit behavioral inhibition which disrupts developmental process of learning;
**Diagnostic & Statistical Manual of Mental Disorders (DSM-IV) noted 3 dx subtypes of ADHD-
—inattentive, hyperactive-impulsive, and combined;
**s/s must present before age 7; persist for at least 6 mos, be more frequent and severe than observed in children of same level of development, interfere with function in 2 settings (home, school, or play);
s Rating Scales, Achenbach Child Behavior Checklist, Vanderbilt Assessment Tool), direct observation in multiple settings;
**management- structured environment, routine, organization, simple instructions, operant conditioning, mental health referral, pharmacological agents ex. CNS stimulants

Question 11

School Age Health: Age

Answer 11

6 - 12 yrs of age

Question 12

School Age Health: Common Disorders- Pharmacologic Management of
Attention Deficit Hyperactivity Disorder (ADHD)

Answer 12

• *CNS stimulants (highly effective 70-90% cases)- increase availability of neurotransmitters to increase focus and attention;
• *caution bi-polar (worsens with stimulants);
• *methylphenidates (ex Ritalin, Concerta, Metadate, Focalin);
• *amphetamines (Adderall, Adderall XR, Dexedrine, Vyvanse);
• *prescribing principles- “start low and go slow”, titrate up at weekly intervals, get parent/teacher feedback**
• *use 0.3-0.7 mg/kg (start with 5-10 mg in am);
• *if not effective- increase dose in increments of 2.5-5.0 mg/week until effect level is reached;
• *behavior change can be noted 30 and 90 min of ingestion;
• *short-acting preps last 4 hrs (no chewing) and often require re-dosing;
• *long-acting preps last 10-12 hours;
• *avoid evening dosage changes to minimize insomnia;
• *if no response to higher dose of 1 stimulate or unacceptable side effects noted–switch to another stimulant before considering other medication;
• *caution/contraindications- symptomatic CV disease, moderate HTN, marked anxiety, depression, suicide risk, hx of drug abuse;
• *side effects- insomnia, anorexia, tics, HA, stomach aches, tolerated to med, tachycardia, temporary decrease in growth/development;
• *non-pharm management- cogitive, social skills, or parenting therapy; “no drug holidays’ = practice guidelines