Typical Childhood Behaviour and Concerns Flashcards
Differential Diagnosis for emergent inconsolable crying and irritability:
sepsis, otitis media, GERD, intussusception, fracture/bone condition, anal fissure/severe diaper rash, pyloric stenosis, non-accidental trauma, colic, hair tourniquet
ROME IV criteria for Colic:
No evidence of ___ to __, __ or ___
Caregiver reports infant has cried for >___ hours per day during >___ days in 7 days
Total 24 hour crying plus fussing is confirmed to be >3 hours measured by a 24 hour ___ ___.
Prevalence rate in asian population is considerably ___ .Colic occurs equally in both male and female infants.
No evidence of failure to thrive, fever or illness
Caregiver reports infant has cried for >3 hours per day during >3 days in 7 days
Total 24 hour crying plus fussing is confirmed to be >3 hours measured by a 24 hour behaviour diary.
Prevalence rate in asian population is considerably lower .Colic occurs equally in both male and female infants.
causes of colic
behavioural factors, GI causes (food hypersensitivity, allergy, gut dysmotility, gut immaturity)
risk factors of colic
Risk factors of colic: food sensitivities, exposure to cigarette smoke, lack of breastfeeding, increased parental age, high level of parental intelligence and education.
Red flags of colic: it might not be “just colic” if → impaired growth/development, blood in stool, fever, lethargy, true irritability, projectile vomiting.
red flags of collic
Risk factors of colic: food sensitivities, exposure to cigarette smoke, lack of breastfeeding, increased parental age, high level of parental intelligence and education.
Red flags of colic: it might not be “just colic” if → impaired growth/development, blood in stool, fever, lethargy, true irritability, projectile vomiting.
treatment of colic
Overfeeding or underfeeding the infant should be avoided
Feeding the infant in a semi-upright position is recommended to prevent aerophagia, and the infant should be adequately burped.
Parents may pick up or carry their infant as much as they wish.
Increased sensory stimulation in the form of body massage, car-ride stimulation, and rocking or crib vibration has been found no more effective than placebo. However sensory deprivation can worsen symptoms.
Ovol-Simethicone: decreasing the accumulation of gas bubbles. Large multi-center trial found no improvement in symptoms compared to placebo.
Dietary interventions: hypoallergenic/hydrolyzed formula, maternal hypoallergenic diet, no soy formula, consider probiotics.
Alternative interventions: chiropractic manipulation (controversial), herbal supplements (fennel and chamomile), glucose and sucrose.
T/f temper tantrums can be assocaited with loss of consciousness
- Can be associated with breath holding spells
- Child will hold breath and briefly lose consciousness. Can be associated with a brief seizure
differential diagnosis for temper tantrums
Differential Diagnosis for temper tantrums
Recurrent URTI, otitis media
Resp or GI allergies
Eczema
Sleep disturbances (obstructive sleep apnea)
Endocrine disorders (andorgen excess)
hospitalization/invasive medical procedures
Medications
Dental carries
Temper tantrum (normal variation because they are sleepy, grumpy, hungry, hyperactivity etc).
etiologies of temper tantrums
normal development, inability to regulate feelings of frustration, drive for autonomy vs parental goals, may be unintentionally reinforced by parents, medical problems.
redflags of temper tantrums
Parents see in their child as only negative things, or see child as antagonistic and controlling
Tantrums at school
Severe self injurious behaviour.
Concern of developmental delay.
management of temper tantrums
clarify diagnosis, address contributing factors, educate parents.
ABC approach to behaviour observation
Excessive media use treatment
Treatment of Excessive Media Use:
Reduce screen time to no more than 2 hours per day. Lower levels are associated with additional health benefits
Limit sedentary transport, extended sitting time, and time spent indoors throughout the day
- Children and youth should accumulate at least 60 minutes of moderate to vigorous PE daily.
- Vigorous intensity activities at least 3 days a week.
- Activities that strengthen muscle and bone at least 3 days a week.
Restore sleep: implement a relaxing bedtime routine, children should always fall asleep in their bed alone. Use the bed for sleeping only→ avoid doing homework or using a tablet in bed.
No screens before bed.
