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master semester 1 > PPH - PAEDS > Flashcards

PPH - PAEDS Flashcards

1
Q

What is a full term pregnancy?

A

37-42 weeks

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2
Q

What are the 3 trimesters

A

1 - 12 13-27 28+

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3
Q

What is defined as misscarrige

A

loss of pregnancy before 20weeks

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4
Q

What the roll of Gonadotropin hormone on pregnancy

A

doubles every 2 days and creates nausea

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5
Q

What the roll of progesterone on pregnancy

A

Inhibits smooth muscle, increases ligament laxity Fatigue is a side effect of raised progesterone levels

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6
Q

What the roll of estrogen on pregnancy

A

Enables uterus and placenta to improve vascularization Major role in milk duct development

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7
Q

What the roll of Relaxin on pregnancy

A

Hormone produced by ovary and placenta Important effects during early pregnancy and in preparation for birth

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8
Q

What are the physiological changes during pregnancy

A

Plasma increase by 50% Increase cardiac output by 40% increase oxygen demand 15% Increase temperature mm. relaxation in gastro walls

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9
Q

What are the hormonal changes during pregnancy?

A
  • hair loss/ growth - mood change - breast changes - stretch marks
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10
Q

Routine test during pregnancy?

A
  • ultrasound 11 & 20w - BP - Blood test: Rhd, Anemia, SIT, - Urine (sugar - protein) -Diabetes -Streptococcus
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11
Q

What are the Medical emergencies during pregnancy

A
  • preeclampsia - abortion - ectopic pregnancy - premature rupture of membranes - placenta abruption
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12
Q

What are s&s of preeclampsia

A

High blood pressure, protein in urine, sudden swelling in face, hands and feet. Persistent headache, blurred vision

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13
Q

What are s&s of ectopic pregnancy?

A

one-sided abdominal pain, vaginal bleeding, bowel pain, diarrhoea and vomiting, shoulder tip pain

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14
Q

What are s&s of placenta abruption?

A

vaginal bleeding, continuous abdominal pain, continuous lower back pain, painful abdomen, uterine contractions

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15
Q

What are the conditions not to be missed during pregnancy?

A
  • Hyperthermia - Dehydration - vaginal bleeding - Supine hypotensive disorder - placenta previa - Diabetes: increased thrust, urination, tiredness
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16
Q

Common conditions during pregnancy?

A
  • Nausea -Constipation -Oedema -increased Micturition -Carpal tunnel -Pelvic / rib / spinal pain ( especially pubic symphysis and SIJ) Varicose veins -Reflux -Shortness of breath Fatigue
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17
Q

What are the dietary requirements during pregnancy

A

The dietary requirements are equivalent to an additional snack - Folate - Protein

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18
Q

What foods to avoid during pregnancy?

A

deli, cheese, uncooked, listeria, high level mercury.

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19
Q

What are the exercise recommendation for pregnancy

A

fitness helps with mood swings, stamina, strength, flexibility

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20
Q

What are the adverse effects of osteopathic treatment on pregnant women?

A

Minor adverse effects reported. Consider joint laxity as risk factor

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21
Q

What are the osteopathic considerations for pregnancy

A
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22
Q

What are the brace and support garments available

A
  • Serola belt - best (SIJD or pubic symph)
  • belly band belt
  • compression leggins
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23
Q

what are the Australian options locations to have birth?

A

Public maternity hospital

Private obstetrician

Private Midwife

Home Birth

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24
Q

What are the Stages of Labour?

A
  1. Regular contractions with 3cm dilation
    • Easly labour: 3cm to 8-12h
    • active labour: 3cm TO 7cm 3-5h
    • Transition: 7cm - 10cm dilation 30min-2h (pushing for longer than 2h trauma to body and pelvis)
  2. Full dilation 10cm to birth
  3. Delivery of placenta (pushing continues - risk of haemorrhage as placenta may rip uterine wall when it detaches)
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25
Q

What are the fetal position at birth

A
  1. Cephalic presentation is Ideal: left occiput anterior with chin tucked - baby facing Lt. side so to turn facing head to spine.
  2. The left side of the maternal pelvis
  3. Fetal occiput anterior: face first - leads to truma and emergency c-section
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26
Q

What are breach and shoulder presentations

A

Breech:

  • Frank
  • Complete
  • Footling
  • Shoulder
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27
Q

Encourage active birth

A
  • Exercise
    • Moving around (walk, stand, leaning
    • Squat
    • Kneeling
    • Wall press-up
  • Gravity helps the baby move
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28
Q

What are pain management none medical techniques during birth?

A
  • Heat - cold
  • Massage
  • Bath
  • Tens machine
  • acupressure
  • Intradermal water injections
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29
Q

What are pain management medical techniques during birth?

A
  • Gas (nitrous oxide)
  • Pethidine (makes baby sleepy)
  • Epidural (helps woman relax)
  • spinal block
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30
Q

What are the risk associated with epidural?

A
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31
Q

How is labour induced?

A
  1. Artificial rupture of membranes
  2. Oxytocin
  3. Prostaglandin
  4. Cervical balloon catheter
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32
Q

What are the two options for assisted delivery?

A
  1. Vacuum
  2. Forceps
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33
Q

What is an Episiotomy?

A

Cut into perineum and posterior vaginal wall

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34
Q

Things t consider after delivery?

A
  1. Post partum bleeding (lochia) stops after 2-4w
  2. C-section recovers 6-8w
  3. Stitches tear:
    • 1st degree: skin deep
    • 2nd degree: mm. and skin
    • 3rd degree: mm., skin, perineum, sphincter
    • 4th degree: Extends to rectum
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35
Q

What is diastasis Recti?

A

Separation of linea Alba

  • Hormonal change
  • wight gain
  • Abb mm. weakness
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36
Q

How to measure abdominal separation?

A
  • Knees of patient bent, place hand above navel pointing towards feet Patient raise heat and shoulders up, feel for gap or dip
  • Normal – 1 finger space or less
  • Diastasis recti – 2 or more finger spaces
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37
Q

What is the treatment for abdominal separation

A
  • Deep abdominal muscle exercises
  • No sit-ups!!
  • Abdominal support belts/shorts
  • Avoid lifting anything heavy
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38
Q

Post-Natal depression S&S

A

Affect 10-15% - refer to GP for blood tests

  • Feeling depressed or miserable
  • Increased crying
  • Reduced interest in things normally enjoyed
  • Not able to sleep or sleeping more than usual
  • Reduced appetite or overeating
  • Preoccupation with morbid thoughts
  • Excessive feelings of guilt and/or failure
  • Feeling disconnected with baby or that they don’t have a bond with the baby
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39
Q

When to treat a baby?

A
  • Any birth complications / interventions
  • Any signs of feeding difficulties Unsettled,
  • reflux
  • Tongue-tie
  • Plagiocephaly (flat head syndrome)
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40
Q

What to ask about a pregnancy Hx?

A

First pregnancy?

Conception?

Illnesses, interventions, mothers overall health.

Any complications?

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41
Q

Hx of the delivery?

A
  1. Gestational age?
  2. Induced?
  3. Vaginal or caesarian delivery?
  4. How long were stages of labour?
  5. Apgar scores? (initial activity after birth)
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42
Q

Apgar scoring system

A

First check of babies health at 1min 5min 10min after birth

  • Appearance,
  • Pulse,
  • Grimace,
  • Activity,
  • Respiration
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43
Q

How is weight measured?

A

Make sure the baby is on the same line of weight or above

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44
Q

Hx of Baby?

A
  1. Weight increase
  2. Feeding (formula, breast, frequency, amount, vomit, reflux)
  3. Sleeping (routine, position) (cry while supine?)
  4. Pattern of unsettled
  5. Systems screen (bowel movement, consistency, constipation, urination, burping)
  6. Meds & vaccines
  7. Accidents, surgery, illness?
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45
Q

Observation and initial examination of baby

A
  • Observation
  • General obs
    • skin colour,
    • skin spots,
    • location of hair spots,
    • palmar creases,
    • alertness
  • Head shape
    • Any flattening on one occiput,
    • bulging in forehead or eyes,
    • ear levels Mouth, palate, gums, tongue, frenulum
  • Abdominal examination
    • Palpation,
    • listening with a stethoscope if necessary for bowel movements, symmetry, umbilicus
  • Neuro exam
    • Cranial nerves,
    • Romberg’s,
    • Babinski’s
  • Primitive reflexes
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46
Q

What are the primitive reflexes?

A
  1. Palmar grasp
  2. Plantar grasp
  3. Rooting reflex (tongue)
  4. Startle reflex
  5. Asymmetric tonic neck reflex
  6. Trunk bend stimulus
  7. Pacing and stepping reflex
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47
Q

Musculoskeletal Examination of the baby

A

Hips

  • Ortolani and Barlows maneuvers (hip dislocation)
  • Leg length,
  • fat fold symmetry
  • Club foot (inversion and supination of foot )

Shoulders and arms

  • Torticollis
  • Clavicle fracture (birth injury)
  • Brachial plexus injury
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48
Q

What are the baby skull sutures?

A

New born cranium: ​

  • 2 frontal bones,
  • 2 parietal bones,
  • 1 occipital bone

Sutures

  • Metopic suture: form top of head to middle of forehead. 2 frontal bones meet
  • Coronal suture: extends from ear to ear. Frontal bones meet w/ parietal bones Sagittal suture: middle of the top of head. 2 parietal bones meet
  • Lambdoid suture: extends across back of head. Parietal bones meet with the occipital bone
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49
Q

Baby’s fontanelles

A
  • Anterior (soft spot): junction for 2 frontal and 2 parietal bones. Has pulse (Gentle palpation)
  • Posterior: junction of 2 parietal bones and occipital bone
  • Sphenoidal fontanelle
  • Mastoid fontanelle
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50
Q

Appropriate latching on

A

fit most of the areola in the mouth, chin should be under the areola

51
Q

Mom- baby holds for breastfeeding

A
  • Sidelying
  • Football hold
  • Laidback
  • cradle position
  • Cross cradle position

***dont hold baby up let pillows carry the weight

52
Q

What to do if a mother cannot breastfeed

A
  • Express breastmilk
  • Use donor milk
  • Use formula
  • Use a combination of both

**9/10 women breastfeed but only 4 will continue after 4months

53
Q

What is a tongue-tie

A

Structural abnormality of the lingual frenulum it has an adverse effect on feeding and speech

54
Q

Signs of latching difficulty

A
55
Q

What is a frenectomy?

A

the procedure used to treat tongue, lip or buccal tie

they use water laser to snip the membrane

Mandatory stretching every 4h to help with post-surgery to avoid re-attachment

56
Q

Why does a baby feel uncomfortable lying in the back

A

when they have been over-exerting in latching, the baby bounds up through front and tongue so releasing the anterior body and upper thoracics will comfortably let them lie on their back

57
Q

What is silent reflux?

A

reflux without content

reflux can lead to good

ceases after 4 months

58
Q

How to diagnose GORD in babies?

A

type of vomit

if it shows mucous = stomach content

uncomfortable lying on their back

irritable

discomfort while feeding

59
Q

What is the treatment for reflux in babies?

A
  • increase frequency decrease amount of feed
  • Burp more often during feed
  • put crib at an angle
  • Meds under advice from GP
60
Q

When to refer a baby

A
  • Blood
  • fever
  • GORD
  • refuse to feed
  • regurgitate
  • Chronic respiratory infections
61
Q

Conditions in the baby not to be missed?

A
  • Pyloric stenosis:
    • enlarged muscles around pyloris
    • surgical repair
    • lots of vomit
  • Intussusception
    • Abdominal emergency
    • Bowel telescope up on itself
    • Intense abdominal pain
    • knees to chest
  • Hip Dysplasia
    • ​femur separated from the acetabulum
    • Bridged position at birth
    • Girls 4>1 Boys
62
Q

How to diagnose hip dysplasia

A

Symmetric but and legs folds

even hip abduction

Knee height difference

After 8 weeks - Barlow: Hip adduction + compression “clunk”

After 8 weeks - Ortolani: abduction and traction and feel

63
Q

Vaccination policy for oteopaths?

A
64
Q

What are the developmental milestones?

A

The motor skills children are expected to develop at a certain age

65
Q

What are the 3 month milestones

A

Gross Motor skills

  • 3/12- lying supine head midline
  • 3/12-no head lag when pulled from supine to sitting
  • 3/12- lift head when on tummy

Fine Motor skills

  • 3/12- plays with hands, hands in mouth
  • 3/12- will hold things but unaware they are holding it
66
Q

5-8 months milestones

A

Gross motor skills

  • 5/12- rolling
  • 7-8/12- sitting by themselves

Fine Motor skills

  • 6/12 – reaching and grasping objects and putting into mouth
  • 6/12 – transferring objects from one hand to another
  • 6-12 months poking and pointing with index finger
67
Q

12-18 months milestones

A

Gross motor skills

  • 10-12/12- crawling
  • 1 year- cruising on furniture
  • 19/12- walking
68
Q

Visual Milestones 0-3months

A

seeing near and far.

Birth- can see, pupils react to light, will follow face 1⁄4 circle

3/12- very alert, follow face 1⁄2 circles

69
Q

Hearing Milestones 0-3 months

A

hear information, listen and interpret

Birth- startled by a sudden noise
3/12- may be distressed by a sudden noise

70
Q

Speech milestones 0-12

A

understand and learn a language

6/52- starting to make ‘coo’ noises

3/12- quite vocal

9-10/12- using words

71
Q

Social Behaviour 0-3

A

eating, communication, relationships

6/52- smile

3/12- loves to be talked to and played with

72
Q

When to refer if a milestone is delayed

A
  1. Baby not responding to sounds
  2. Appears baby cannot see things of has white or cloudy eyes Squints a lot after 3/12, eyes not focusing
  3. If baby is not interested in what is going on around them Cannot hold head up on tummy by 3-4/12
  4. Persistent and excessive crying after 3-4/12
  5. No babbling by 6/12
  6. If baby doesn’t use or move both arms and both legs
  7. Baby not sitting by themselves by 10/12
  8. Not weight bearing by 1 year
73
Q

Common problems related with maintaining primitive reflexes beyond normal

A

4 Months

  1. Moro (startle): over sensitive and reactive to sensory stimulus
  2. Rooting (suckling): difficulty with solid foods, poor articulation
  3. Palmer: difficulty with fine motor skills, messy hand writing

6 Months

  1. Asymetrical tonic reflex: poor hand-eye coordination, poor visual tracking while learning to read and write
  2. Spinal Galant reflex: may affect posture, coordination, attention, ability to sit still, wet the bed
74
Q

Treatment for retained primitive reflexes?

A

fatigue reflex – generally do something that over stimulates reflex until it starts to go away

Frequency of exercises is more important than intensity

75
Q

What is Plagiocephaly ?

A

Misshapen baby head after 6/12

most common on supine sleeping

76
Q

How to prevent and manage Plagiocephaly?

A
  • tummy time
  • move cot around
  • use toys to get rotation
  • helmet 23h/24 a day - before 1yr.

Osteo

treatment for Cx, Tx, upper ribs, cervical musculature, jaw

77
Q

Why to encourage tummy time?

A
  • Improve development of neck, back, shoulder mm.
  • 0-3m = couple minutes several times
  • 3+ more than 1h tummy time
78
Q

Milestones for children 1-8yr

A
79
Q

Case Hx questions for toodlers

A

Duration of Symptoms Trauma

Preceding illness (a simple viral infection can preced transient synovitis or reactive arthritis)

Fever or systemic symptoms

Pain levels and measures taken to reduce pain

Daily pattern – worse in Am/PM only with activity?

Previous injuries

80
Q

Musculoskeletal examination on children

A
81
Q

Musculoskeletal examination on children - ortho test

A
  • Always do scoliosis
  • AROM - All joints – knee pain can come from hip, thigh pain from the spine
  • Internal rotn hip loss: Legg-Perthes disease, slipped capital femoral epiphysis Trendelenburg
  • Galeazzi (knee heights)
  • Faber
  • Pelvic compression
  • Psoas sign
82
Q

Causes of limping in children

A

In most children limping is caused by a mild, self-limiting event like a sprain, strain or contusion

change inactivity

Always investigate can be life-threatening (osteomyelitis??)

Woodling not normal after 3

83
Q

DDx for limping in children

A
  • Trauma (eg fracture, sprain etc)
  • Overuse syndromes
  • Infections (osteomyelitis, septic arthritis) Malignancy
  • Rheumatological disorders and reactive arthritis Intra-abdominal pathology (appendicitis) Inguinoscrotal disorders (eg testicular torsion) Transient synovitis of the hip
  • Non-accidental or inflicted injury (abuse) ??
84
Q

When to refer a child limp for investigation? what test are done

A

If in doubt refer

Imaging:
Xrays – Perthes, tumours, dysplasia of hips
Ultrasound – septic hip
Bone scan – osteomyelitis, Perthes, occult fracture CT/MRI usually only done after orthopedic consultation

85
Q

Red flags for children

A
  • Fever, systemic upset (malaise, weight loss, night sweats)
  • Lymphadenopathy, hepatosplenomegaly Bone pain
  • Pain described as deep, not localised and not associated with trauma
  • Persistent night waking
  • Incongruence between history and presentation/pattern of physical findings
  • Regression - ALERT - can’t do the same as before sign of underline pathology
86
Q

Common malignancies in children

A

Cancer

  • Osteosarcoma
  • Ewings sarcoma
  • Acute lymphoblastic leukemia
  • Rhabdomyosarcoma

Infection

  • Osteomyelitis
  • Septic Arthritis
87
Q

Clinical features of Osteosarcoma

A
  • Forms from osteoblasts. Usually at the ends of long bones
  • Most common in 10-25 years old
  • Pain and swelling over bone or joint, most commonly affects the knee
  • Bone that breaks for no reason
88
Q

Clinical features Ewings Sarcoma

A
  • Forms in bone marrow, tends to be extensive in the bone shaft
  • Peak incidence between 10 and 25 years old
  • Pain or swelling, pain worse at night
  • Lump that feels soft and warm in legs, arms, chest or hips
  • Fever, tiredness, weight loss
89
Q

Clinical features of Acute lymphoblastic leukemia (ALL)

A
  • Overproduction of immature white blood cells
  • Most common type of childhood leukemia and most common childhood cancer More common in children aged 0-14
  • Slow healing, infections, unexplained bleeding or bruising
  • Anaemia: tired, dizzy, pale, shortness of breath
90
Q

Clinical features Rhabdomyosarcoma

A
  • Can occur anywhere, but head and neck, trunk, extremities and genitourinary system most common
  • Lump or swelling that keeps getting bigger Bulging eye, headache
  • Difficulty urinating or with bowel motions
91
Q

Clinical features osteomyelitis

A
  • subacute onset of limp
  • refusal to use limb
  • localized pain on movement
  • renderness
  • soft tissue redness and swelling
  • fever +/-
92
Q

Clinical features of septic arthritis

A
  • Refusal to use limb
  • acute onset limp
  • pain on movement or rest
  • limited ROM
  • soft tissue tenderness and redness
  • fever
93
Q

clinical features transient synovitis

A

diagnosis of exclusion

  • Most common reason for a limp in children aged 3-8
  • “irritable hip”, involves inflammation of the synovium of the hip joint
  • Recent history of viral URTI
  • Usually able to walk but with pain.
  • Pain usually felt in the groin, sometimes in the front of the thigh or knee
  • Child otherwise afebrile and well
  • Decreased ROM in hip especially internal rotation
94
Q

Clinical features of Perthes disease

A
  • Avascular necrosis of bone, breaks more easily and heals poorly
  • Usually occurs in children aged 4-10 years old and more common in boys
  • Insidious onset, but may occur after injury to hip
  • Usually unilateral
  • Symptoms:
    • gradual onset of pain in the hip and sometimes the knee.
    • Limping, slow joint movements, sometimes wasting of thigh mms
95
Q

Clinical features Slipped Capital Femoral Epiphysis

A
  • Epiphyseal plate on femur slips down and backwards
  • Can happen spontaneously and not associated with injury
  • More common in boys, and obesity is a significant risk factor
  • Symptoms develop slowly,
    • may seem like a pulled muscle in groin, hip, thigh or knee
  • On examination show shortening of one leg
  • Usually a progressive condition, most children need operation to resolve
96
Q

Clinical features of juvenile arthritis

A
  • Umbrella term used to describe the many autoimmune and inflammatory conditions that can develop in children under 16
  • No known cause, possible genetic predisposition
  • No cure, early diagnosis and treatment are essential. Remission is possible
  • Common symptoms are joint pain and swelling, but some types affect the musculoskeletal system while others involve eyes, skin, muscles and gastrointestinal tract
97
Q

clinical features of growing pains

A

Cause is unknown, no evidence that growth is painful. Doesn’t happen only when growth is occurring

_Cramping, aching or throbbing pain_s of the thigh, shin and calf; typically at evening or night

Moving the legs does not make the pain better or worse

Pain does not cause a limp
May awaken child at night, disappears by morning

No pain with activity

98
Q

Conditions that affect children during groth spurs

A
99
Q

Iselins syndrome

A
  • Traction apophysitis of the tuberosity of the fifth met, due to peroneus brevis tendon
  • Most seen between 8 – 13 year old

History:

  • Pain in lateral aspect of foot
  • Worse with activity, better with rest
  • Not always history of trauma to the foot

Phys exam:

  • Tenderness over base of 5th met
  • Pain with resisted eversion and extreme plantar flexion

Treatment:

  • REST
  • Analgesics
  • Ice pack after activity
  • Slow, guided return to sports / aggravating activities
  • Manual therapy to help improve flexibility and function of leg
  • Very severe symptoms may require case immobilization or controlled ankle motion walker (CAM boot)
  • If conservative management fails and results in nonunion of the bone, surgical excision
100
Q

Severs disease

A

Traction apophysitis at calcaneus

Active children aged 9 – 13, especially those who do running or jumping

History:

  • Pain over posterior heel
  • Pain worse with activity or impact

Phys exam:

  • squeeze test - positive
  • Hypertonic Achilles tendon Positive squeeze test
  • Pain over calcaneal apophysis

Treatment:

  • REST
  • Analgestics
  • Ice to the area after activity
  • Slow, guided return to sports/ aggravating activities
  • Stretching or massaging Achilles tendon, gastrocs, plantar fascia etc
  • Use a heel cup or heel pad Taping
  • Immobilization if pain is severe, ongoing or persistent
101
Q

Osgood schlatters disease

A

OSD traction apophysitis at tibial tubercle. Bilateral 20-30% of the time

More common in boys. Boys 12-15, girls 8-12y. More common in jumpers or sprinters

History:

  • Pain on anterior aspect of knee
  • Aggravated with running, jumping, squatting, kneeling

Phys exam
Enlarged tibal tuberosity Tenderness over tibial tubercle Pain on resisted knee extension

Treatment:

*

102
Q

Aphophisitis of pelvis or hip

A

Eccentric contraction of a muscle causes avulsion

Most often in ages 14-17, more in males. Occurs mostly in sports involving kicking

History
‘pop’ feeling in pelvic
Pain and weakness on affected side

Phys exam

  • Antalgic gain
  • Anterior hip/pelvis pain
  • Pain at mm origin with active resisted

Treatment:

  • Bed rest
  • Ice after activity Activity modification
  • Rehab aimed to increase flexibility and improve range of motion
103
Q

Osteochondritis dissecans

A

Splitting of osteochodrosis, small area of avascular subchondral bone

Most often on convex articular joint surface (knee, elbow, ankle, hip, talus)

History

  • Pain that is vague and poorly localized Ongoing swelling in joint

Phys exam

  • Localised tenderness Stiffness and swelling
  • Wilsons test for knee – pain w/ int rotn and extn of knee, rel of pain w/ external rotn

Treatment:

  • Stable lesions:
    • Restricted weight wearing/load bearing of joint
    • Bracing
  • Instability, expanding lesions, conservative management failure
    • Arthroscope
    • Fixation
    • Chondral resurfacing
104
Q

What are non-accidental injuries in children

A
105
Q

When is reporting mandatory for children

A
106
Q

Scoliosis

A

F>M

Idiopathic

  • Infintile: 2
  • JuvenileL 2-10
  • Adolescent: 12+ most common

Congenital

Neuromuscular

Paralytic

107
Q

What is the clinical presentation of scoliosis

A
108
Q

What is Adams test for scoliosis

A
109
Q

What are the red flags for scoliosis

A

Left thoracic curves – convex left / concave right

  • Spinal cord tumors Neuromuscular disorders
  • Arnold-Chiari malformations or occult syrinx
  • Severe pain
  • Neurological
  • Neurological deficits
  • Midline hairy patches Café au lait spots
110
Q

What is the best scan for scoliosis

A

EOS

111
Q

What is the treatment for scoliosis

A

*

112
Q

Sheuermans disease

A

M>F

113
Q

Treatment for Scheuermanns

A

Less than 60 degrees kyphosis

  • Stretching, lifestyle modification, physical therapy
  • No significant long term sequelae

Kyphosis 60 – 80 degrees and/or symptomaticBracing for 12-24 months

  • Most effective in skeletally immature patients
  • Does not improve curve, but impedes progression

Kyphosis more than 75degrees with unacceptable deformity, pain and/or neurological deficit

  • Surgery
114
Q

Why children and teens get HA

A

Headache is one of the main reasons children are taken to emergency departments

Most are benign and have common triggers – missed meals, dehydration, tiredness etc

Discerning between primary and secondary HA is essential, to ensure any serious conditions are not missed

115
Q

Red flags for HA

A

Changing quality of headache from usual

  • HA that occurs in awakening or awakens child from sleep Declining school performance
  • Functional changes (vision, gait, coordination, behavior)
116
Q

Examination for HA in children

A

Initial questions:
Onset, duration, temporal pattern, frequency, location, quality, severity

Back ground factors:

Medication use, systemic illness, fever, vomiting, visual symptoms, seizures, trauma, family history

117
Q

WHen to refer for imaging in children HA

A
118
Q

HA management in children

A
  • Lifestyle factors – regular meals and hydration, avoiding trigger foods Regular sleeping routine
  • Balance between school, sports, TV, computer games
  • Relaxation and meditation
  • Headache diary – record times, places, events, foods, sleep etc every day to try determine any patterns or triggers
  • Consider referral to dentist for assessment of TMJ, teeth, grinding etc Musculoskeletal treatment as per HA type
  • Also need to consider co-occurring psychological problems and psychosocial factors
119
Q

Concussion in children

A
120
Q

Concussion plan for children to return to sport

A
121
Q

What are the red flags for concussion

A
122
Q

Management for concussion

A
123
Q
A

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