School-Age Health

Question 1

What is the definition of school age?

Answer 1

6 through 12 years

Question 2

What is the average height and weight of a 10 year old?

Answer 2

rapid physical growth/development tends to level off

avg height for 10 yr old is 52-56 inches and avg weight is 70 lbs

Question 3

How much height and weight do school age children gain per year?

Answer 3

5-7 lbs per year

2-3 inches per year

Question 4

When do girls reach peak height velocity?

Answer 4

11 to 12 years old prior to menarche

Question 5

When does scoliosis screening begin?

Answer 5

age 9

Question 6

BMI between 85th-95th percentile?

BMI above 95th percentile?

Answer 6

at risk for becoming overweight

>95% indicates obesity

Question 7

What are developmental warning signs in younger school-age children?

Answer 7

poor adjustment to school
not working to ability
frequent illnesses and need to stay home from school
lack of social interaction and peer problems
bullying??

Question 8

Developmental warning signs in older-school age children?

Answer 8

personality change
revert to dependent, shy, passive roles
using illness to avoid responsibilities
cannot make or keep friends
poor school performance
disinterest in academic activity 
destructive behavior to express self
gang activity?

Question 9

What is the most common type of child abuse?

Answer 9

neglect

Question 10

Who is most commonly the abusers in child abuse?

Answer 10

80% are parents

Question 11

When should a skeletal survey be ordered for children with suspected abuse?

Answer 11

for any child with soft tissue findings who are nonverbal or unable to give a clear history or for infants suspected of failure to thrive

Question 12

What are the 3 subtypes of ADHD?

Answer 12

predominantly inattentive type
predominantly hyperactive-impulsive type
combined type (most diagnosed with this)

Question 13

What criteria must be present to make the diagnosis of ADHD?

Answer 13

symptoms must be present before age 7
symptoms must persist for 6 months
symptoms must be more frequent and more severe than those observed in other children at the same developmental level
symptoms must interfere with functioning in at least 2 settings: home, school, and play

Question 14

What population does ADHD most commonly affect?

Answer 14

boy at a rate of 6 times higher than girls

Question 15

What are the predisposing factors of ADHD?

Answer 15

biologic influences: genetics, prenatal smoking, perinatal (prematurity, fetal distress, long labor, perinatal asphyxia) and postnatal factors (cerebral palsy, epilepsy, CNS trauma)

environmental: lead, dietary
psychosocial: chaotic environments, child abuse, family history of substance abuse, developmental learning disorders

Question 16

To diagnose ADHD there must be ___symptoms of ____OR _____ symptoms of ______.

Answer 16

6 symptoms of inattention

6 symptoms of hyperactivity/impulsivity

Question 17

What medications are used to treat ADHD?

Answer 17

CNS stimulants:
Methylphenidates- ritalin, concerta, focalin
Amphetamines- adderall, vyvanse

Question 18

How do stimulants help with ADHD?

Answer 18

stimulants increase availability of neurotransmitters to increase focus and attention

Question 19

What is the main prescribing principle of ADHD medications?

Answer 19

start low and go slow–titrate up at weekly intervals based on feedback from parents and teachers

**if a child does not respond well to higher doses of 1 stimulants, or if side effects are unacceptable, switch to another stimulant before considering other medications

Question 20

What is the starting doses typically of ADHD medications?

Answer 20

usual dose is 0.3 to 0.7 mg/kg starting with 5 to 10 mg in the morning
If not effective, increase dose increments of 2.5 to 5 mg per week until effect level is reached

Question 21

How soon do the ADHD medications show changes and how long do both short/long acting preparations last?

Answer 21

Behavior changes can be identified within 30-90 minutes of injection

Short acting prep- last 4 hours and often need reducing
Long acting prep- last 10-12 hours

*avoid evening dosage changes to prevent insomnia

Question 22

What are contraindications of ADHD medications?

Answer 22

symptomatic cardiovascular disease
hypertension
anxiety
glaucoma
history of drug abuse
depression
suicide risk

Question 23

What are the side effects of ADHD medications?

Answer 23

insomnia
anorexia
weight loss
tachycardia 
temporary decrease in rate of growth and development 
tics
headaches
stomachaches 
tolerance to medication