Increased risks for children with disabilities
Increased risk for child abuse
Increased risk of harm (safety concerns)
Intellectual disabilities
Many potential causes, genetics, environment, substances, unknown, etc.
Many medical comorbidities
Psychiatric comorbidities
The rate is increasing for unknown reasons
Downs Syndrome
Trisomy 21 = 95% of Down Syndrome cases
Incidence is higher in boys and the Caucasian population
Maternal age is the biggest risk factor
Most are mild to moderately intellectually impaired
Many comorbidities such as cardiac defects, vision, and hearing impairments, leukemia, umbilical hernia, TEF & imperforate anus, premature aging + Alzheimer's
Fragile X
Common inherited cause of cognitive impairment
Known genetic cause of autism
Physical characteristics such as large prominent ears and narrow face
The mother carries the gene
Boys are more typically affected than girls
Fetal Alcohol Syndrome
There is no cure, prevention is key
No amount of alcohol is ok during pregnancy
Causes physical and mental stunting
Symptoms range from mild to severe
Autism – 3 Questions
Ranges from mild to severe
Symptoms usually noticed by 3, and can be gradual or sudden
Many potential causes, no cure
Lack of attachment or socialization
Tx. Focuses on symptoms and behavior management
Failure to Thrive – 2 Questions
Children whose weight or weight gain is significantly below normal
Organic: Causes within the child (chromosome abnormalities, heart/lung defects, toxins)
Inorganic: Familial issues (socioeconomic issues, parental relationship, parental emotional state)
ADHD – 1 Question
More common in boys than girls
Drug Abuse – 2 Questions
Opiate usage is trending upwards
Pharmaceutical parties (Risky, random drug parties consisting of raided pills)
Vaping is a big concern
Marijuana and Alcohol usage 35% of 12th graders, very concerning and damaging to development of adolescents
General Growth & Development – 7 Questions
Infant-Specific Milestones/Behaviors/Concerns – 13 Questions
Fontanelles: A: 18 Months P: 2 Months
Growth:
2 Months: Move head, Verbal noises babbling, Smiles, Holds head up on stomach
4 Months: Babbles, reaches for toys, remembers faces, rolls over, likes to play
6 Months: Sits up without support, recognizes name, stranger anxiety, early vowels babbling
5-7 Months: Hand to hand
8-9 Months: Crawling, Stands up holding onto objects, Pincer Grasp, object permanence
10-12 Months: Begin walking, Simple commands, Putting objects in containers / smacking things, simple words, Separation anxiety
Toddler-Specific Milestones/Behaviors/Concerns – 12 Questions
1-3 years
Skills: Running, Throwing, Drawing, 3 word sentences,
2-3 4x body weight
T: Tantrums, Erikson Autonomy,
O(OTM): Safety concerns, carseat rear facing if under 2 years 20lbs,
D(Diaper): 18-24yo potty training, most trained by 4-5 yo, 3yo night time
Development: Egocentric, parallel play, symbolic play, Push-pull toys, pretend
Preschool Specific Milestones/Behaviors/Concerns – 2 Question
Initiative vs. Guilt
Magical thinking
Separation anxiety
Open choices for preschoolers
School Age Specific Milestones/Behaviors/Concerns – 2 Questions
Puberty becomes a topic of concern, with girls developing sooner than boys and sexual maturation in boys being less apparent.
Children should increase their ability to think and consider the intention of rules rather than the punishments/rewards involved in them.
Conformity and social pressures increase.
Adolescent Specific Milestones/Behaviors/Concerns – 8 Questions
Animism, centration, egocentrism, irreversibility, & magical thought – 5 Questions
Animism: Child believes that nonliving things are alive or have living qualities (Teddy bear)
Centration: The child can only think about one aspect of an object, like it’s color but not it’s volume
Egocentrism: The child can only think about themselves and their needs
Irreversibility: Difficulties in a child reversing the order of events in their minds
Magical Thought: I think something bad will happen and it happens, must have something to do with my thoughts
• Erikson – 2
• Piaget – 2 Questions
• Kholberg – 1 Question
Infectious Diseases:
What is diphtheria? S/S? Assessment and management?
S/S: Sore throat, fever, difficulty swallowing, airway obstruction
Administer abx, immunization status, closely observe respiratory status, droplet precautions for a child, no longer infectious 9 days following parotid swelling
What is pertussis? S/S? Assessment and management?
“Whooping cough” paroxysmal coughing spells (difficulty breathing)
Lack of immunization is a big risk factor
Humidity, suctioning of the nose, fluids, antibiotics, droplet precautions
Often misdiagnosed as RSV
What is tetanus? S/S? Assessment and management?
S/S: lockjaw, trouble swallowing, muscle spasms, change to bp and hr, PE, pneumonia
Lack of immunization (go figure)
Wound care, TIG (human tetanus immune globulin), tetanus vaccine, drugs for muscle spasms, antibiotics, ventilation possible
What is Haemophilus influenzae Type B? (Hib) S/S? Assessment and management?
S/S: Fever, confusion, headache/stiff nech, light sensitivity, nausea, poor reflexes (meningitis),
Mostly affects children less than 5
Can cause meningitis, pneumonia, swelling of the throat, infection to joints, bones, and heart, sepsis, otis media, conjunctivitis
Antibiotics, respiratory support, meds to treat symptoms, droplet precautions
What is measles? S/S? Assessment and management?
Highly contagious,
S/S: Fever, cough, coryza(cold symptoms), conjunctivitis, rash, koplik spots
Treated with bedrest, fluids, antipyretics, cool mist
Airborne precautions
What is Mumps? S/S? Assessment and management?
Fever, swelling of parotid (cheeks), orchitis in boys (can result in sterility in boys), meningitis/encephalitis,
Supportive tx, airway, icepack for testicles if orchitis present
Droplet precautions
Rubella (German measles)
Can be transmitted mother to fetus
Spread up to a week before rash appears
Facial rash that spreads to other areas of the body
Supportive tx.
Maternal rubella can result in miscarriage, fetal demise, or congenital malformations
Screen for pt contact with pregnant women and notify them of possible exposure
Vaccines :/
Chicken Pox
Highly contagious, airborne + Contact precautions
Approx 90% not immune will become infected with close contact
Supportive tx, vaccine!!!
Symptoms can take 10-21 days to develop. It can spread 1-2 days before appearance.
Poliomyelitis
Vaccines!!!
There is no cure for polio
Flu like symptoms and possible paralysis / permanent disability
Manage respiratory, contact precautions
Limit contact with saliva and feces, VERY GOOD HAND HYGIENE
Flu-like symptoms, paralysis
Parasite Diseases: Pinworms (helminthic)
Fecal oral route of transmission
Anal itching
Dx tape worms and microscope
Vermox med
Keep fingernails short and hand washing!This helps prevent the spread of infection and reduces irritation.