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Peds > SIDS, cephaly, torticollis > Flashcards

SIDS, cephaly, torticollis Flashcards

1
Q
A
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2
Q

Orthopedic conditions related to birth/postnatal positioning (3)

A

-Cranial deformation
-Torticollis
-Brachial plexus injury

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3
Q

SIDS

A

Syndrome marked by sudden and unexplained death of an apparently healthy infant aged 1 month - 1 year, during sleep

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4
Q

Risk factors for SIDS

A

Prone + side sleeping
Soft bedding + inappropriate bed surfaces
Bed sharing
Exposure to tobacco smoke
Prematurity

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5
Q

Protective factors for SIDS

A

Breastfeeding
Pacifier use
Room sharing
Immunizations

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6
Q

Is SIDS considered a diagnosis of exclusion?

A

Yes: all other causes of death must be ruled out

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7
Q

maternal factors increasing vulnerability in infants

A

Limited prenatal care/nutrition
Subsequent birth less than one yr apart
tobacco, alc, drug use during pregnancy

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8
Q

Infant factors increasing vulnerability

A

Low birth weight (5 lb 8 oz)
Gender (more common in males)
Age (highest risk 2-4 mo)
Preterm birth (before 37 weeks)
Exposure to tobacco smoke
Formula vs breastmilk

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9
Q

Prevention of SIDS

A

always place baby on back to sleep regardless if they can roll
Firm crib mattress
Keep soft objects, toys, and loose bedding out of sleep area
Avoid letting the baby overheat

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10
Q

Developmental outcomes of back to sleep

A

Cranial deformation
Decreased time in prone out of fear
decreased upper trunk strength
Decreased eye hand coordination, reaching, fine motor skill development
delays attainment of gross motor developmental milestones, though still in accepted time range

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11
Q

Cranial deformation

A

Distortion of the skull that occurs in response to prenatal and postnatal external compression forces

Sutures of the skull are open and have not prematurely fused

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12
Q

Characteristics of newborn skulls

A

-Highly soft + pliable separated by sutures
-8 sutures + 6 fontanels accomodate increased growth of the skull
-Normal head shape should be assumed within 6 weeks of birth

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13
Q

Types of cranial deformities

A

Plagiocephaly
Brachycephaly
Scaphocephaly

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14
Q

Plagiocephaly

A

UL occipital flattening
Anterior progression of ear on same side as flattened occiput
varying degrees of ipsilateral frontal and contralateral parietal bossing

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15
Q

How to evaluate plagiocephaly

A

Cranial Vault Asymmetry Index (CVAI)

Diagonal measurements are taken of the skull
[a-b]x100 / A or B (which ever is greater)

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16
Q

How is brachycephaly measured

A

Cranial Index (CI)

width/length x 100

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17
Q

Brachycephaly

A

Wide skull with short length
Prominent/bossed forehead
Increased height of cranial vault
Central occipital flattening

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18
Q

Asymmetric brachycephaly

A

combo of plagiocephaly and brachycephaly

Associated w proloned supine positioning + infant head rot

Measured using CI and CVAI

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19
Q

Scaphocephaly

A

Symmetric, BL long + narrow skull

Common in babies with extended time in NICU or positioned in SL

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20
Q

How is scaphocephaly measure

A

Cranial Index (CI)

21
Q

What is a positional deficit babies with scaphocephaly have?

A

Difficult to keep head in midline

22
Q

Treatment of positional skull deformation

A

Often treatable with parent education, positioning, and exercise

23
Q

Examples of tx interventions for positional skull deformation

A

Alternate head pos in supine
Tummy time with supervision and awake
Avoid too much time in car seats + carriers
Hold baby upright
Change direction the baby faces in the crib from week to week

24
Q

Goal of tx of positional skull deformation

A

Shift the baby off the flattened areas to enable the head to assume a symmetrical shape

25
Q

Tortle

A

Beanie used to treat positional head deformities that positions the head to limit pressure on the flattened side. Designed to switch sides

26
Q

Goal of cranial orthoses

A

Encourage symmetrical skull growth

27
Q

Indications for cranial orthosis

A

No response to repositioning therapy
Secondary changes to the skull or frontal facial asymmetries

28
Q

Contraindications to cranial orthosis

A

Craniosynostosis
Unshunted hydrocephalus
Children > 18 mo corrected
Babies under 3 months corrected age

29
Q

Tx factors for cranial orthosis

A

Optimum age for initiating tx is 4-8 mo
Worn 23 hrs per day for 2-6 months
Follow up 1 week initially and then every 2 weeks

30
Q

Dynamic orthotic cranioplasty band

A

DOC band is designed to redirect growth and thus improve craniofacial symmetry in infants 3-18 mo

31
Q

Results of cranial orthosis

A

Significant reduction of plagiocephaly
Showed better improvement despite more severe initial asymmetry
Weak correlation between initial asymmetry and amount of improvement

32
Q

Congenital muscular torticollis

A

Deformational process resulting in UL tight SCM and loss of ROM of the neck

33
Q

What is torticollis often associated with

A

Plagiocephaly and brachycephaly

34
Q

Cause of congenital muscular torticollis

A

Intrauterine position (breech)
Birth trauma (vaccuum, forceps)
Positioning post natally

35
Q

Symptoms of congenital muscular torticollis

A

Head tilts to IPS side, rotates to CL side
Imbalance in muscle strength around neck of unaffected side (unaffected side is weaker_

36
Q

Non muscular causes of torticollis

A

Ocular torticollis
GERD
Vertebral malformation
Hemiparesis

37
Q

Ocular torticollis

A

Involved eye drifts medially + superiorly
Head posture attempts to optimize visual acuity

38
Q

GERD and torticollis

A

Tip head and neck to relieve pressure on esophagus

39
Q

vertebral malformation torticollis

A

disrupt alignment and pull of muscles

40
Q

hemiparesis and torticollis

A

Affected side: LF towards, Rot away

41
Q

Examination for torticollis

A

Observation
Palpable nodule/skin integrity in SCM
Cranial anthropometry
ROM
Muscle strength
Righting + equilibrium reactions
Developmental assessment

42
Q

Cervical rot cheat sheet

A

40 deg: chin to mid clavicle
70 deg: chin between clavicle and shoulder
90 deg: chin over shoulder
100 deg: chin past shoulder

43
Q

Normal LF and rot for 2-10 month

A

LF: 65-75
Rot: 100-120

44
Q

Mild, mod, severe ROM limitations for LF

A

Mild: 25-45
Mod: 10-25
severe: 0-10

45
Q

Mild, mod, severe ROM limitations for rot

A

Mild: 70-85
Mod: 35-70
Severe: 0-35

46
Q

Muscle function test in torticollis

A

Place child in sidelying and observe head righting pos

0: below neutral
1: head at neutral (2 mo)
2: slightly past neutral
3: High over neutral
4: Very high over neutral (10 mo)

47
Q

PT management of torticollis

A

Stretching: affected side
Strengthening: opp side
(finding balance between strengthening + stretching)

Positioning: SL on affected side to strengthen the unaffected side
Parent ed

Cranial orthosis, orthosis/colar, kinesiotapeM

48
Q

Medical management of torticollis

A

Botox, surgery

Peds (11 decks)

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