Special Topics Flashcards
failure to thrive is common in
children living in poverty and foster care
failure to thrive (FTT) definition
malnourished infants who do not meet growth expectations
what are subtypes of FTT?
wasted child: wt for ht deficit usually due to an acute etiology
stunted child: ht AND wt deficit but wt for ht is normal for age. usually chronic dz.
dx criteria for FTT
wt that falls beneath the 3rd percentile or
wt that remains below the 3rd percentile or
wt that falls, crossing two major percentage lines
what must you identify for FTT?
etiology via history and PE esp dietary/feeding hx is critical
important consideration during PE for FTT
- anthropometrics are essential
- signs/sx of systemic illness
- syndromic features
- observe feedings if possible
Lab evaluations for FTT
- avoid shotgun approach (sticking needles)
- consider first line screening : CBC, CMP, FERRITIN, ESR, CRP,UA, TFTS, ttg & serum IgA (celiac dz panel), CXR
management of FTT
- nutritional intervention for “catch-up” growth : 1.5 x protein and high calorie formula and nutrient-dense component , pay attention to Micronutrient
- family management plan
- identify medical cause
how is prognosis in FTT
see wt gain within weeks-months
monitor for developmental delay/learning delay
depends on underlying cause
child abuse
includes physical, emotional and/or sexual abuse and neglect
most common child abuse
neglect
recipe for disaster for physical abuse
special parent + special child+ crisis => abuse/neglect
red flags for child abuse
history inconsistent with injuries delay in seeking tx repeated accidents bruising, burns, fractures head injuries lead to morbidity and mortality
red flags for bruising burns and fractures
fractures of ribs, scapula, vertebrae, METHAPHASIS
burns with a uniform pattern, depth
bruising patterns and over specific areas of the body
facts about sexual abuse
often chronic
perpetrators aften known to child
demonstrated by aggression, anger, depression
dx often made after child confides in an adult friend/family member
what to avoid when seeing child w/ sexual abuse
avoid repetitive interviewing
what to do when suspecting sexual abuse
evaluate for vaginal, anal, other GU injury
minor injuries heal quickly
coordinate care with CPS to ensure thorough evaluation
involve police if suspicious or fear for child’s safety
ADHD definition
chronic neurobehavioral disorder w/difficulties in at least 1/3 main foci:
1. focusing/sustaining attention 2. inhibiting impulsive behavior 3. regulating activity level
two fact about ADHD
1/5th of elementary school children dx
M:F ~3-4:1
ADHD is a/w what disorders
Behavioral (ODD,conduct, mood) disorders
Learning (50%)–MOST COMMON
Dx of ADHD criteria
sx causing impairment prior to 7-8 yo
sx present in 2 or more settings > 6months
Vanderbilt Questionnaire is helpful
r/o other problems
must have at least 6 specific features (1.inattention, 2.hyperactivity&impulsivity)
goals for Tx of ADHD
decrease problematic behavior
improve independence, self esteem, relationships, school performance
how to Tx ADHD
behavior management plan for home and school
accommodation-school
medication -effective but side effects
megavitamins and special diets
autism spectrum disorder definition
group of developmental disorders w/varying severity (autism, asperger’s, PDD, Rett’s, childhood integrative disorder)
