Lecture One (Peds)- Exam 1 Flashcards

Question

What are mc causes of calls to poision control?

Answer 1

Across all ages 75.5% of poison exposures reported to U.S. poison centers in 2021 were unintentional. * < 6 years= 99% are unintentional (TALK TO PARENTS) * 13-17= 29.1% are unintentional (DO IT ON PURPOSE)

Answer 2

Educate and discuss: Immunizations, Nutrition, Screening, Safety, Anticipated Milestones Provide Resource Information: * Vaccine Information Statements **(required by law)** * Healthy Children.org * Bright Futures

Answer 3

* Ages and Stages Questionnaire (ASQ) * Parents’ Evaluation of Developmental Status (PEDS) * Child Development Inventories (CDI) * Survey of Well-being of Young Children (SWYC) ## Footnote Basically all the same, just depends on where you work

Answer 4

* Modified Checklist for Autism in Toddlers [MCHAT] * Screening Tool for Autism in Toddlers and Young Children (STAT)

Answer 5

a parent-completed, age dependent based, questionnaire that may be used as a general developmental screening tool

Answer 6

* Addresses: Communication, gross motor, fine motor, problem solving, and personal-social * Ages: 21 total age categories starting at 2 mon old up to 60 months old * Currently available: Arabic, Chinese, English, French, Spanish, and Vietnamese languages * Should be completed at each Well visit

Answer 7

* Below cutoff: Need evaluation * Near cutoff: Monitor and may need evaluation * Above cutoff: Does not need further evaluation at this stage

Answer 8

* a parent-completed psychological questionnaire that evaluates risk for autism spectrum disorder in children ages **16–30 months** (NO YOUNGER THAN 16mo) * Most often given at 18 month and 24 month Well Visits

Answer 9

* Scored based on a list of Failed Responses * Each failed answer = 1 point * Score 0-2 = passed * Score 3-7 = requires further questions and may need evaluation * Score 8-20 = considered high-risk for ASD and requires further evaluation

Answer 10

Surveillance should continue at all subsequent health supervision visits regardless of the score

Answer 11

a condition in which a child is **behind schedule** in reaching milestones of early childhood development * Motor Skills * Speech/language * Social * Cognitive/Problem Solving

Answer 12

* Cause often not known * Can also be a symptom of other underlying medical conditions

Answer 13

* Complications at birth- prematurity, low birth weight, hypoxic birth injury * Perinatal exposures- infection, toxins * Post natal exposures- lead (can reverse if caught early) * Poor nutrition & neglect * Recurrent otitis media (muffled hearing) * Chronic illness (in and out of hospital) * Vision Disturbance * Trauma * Adoption (esp other countries)

Answer 14

A group of conditions due to an impairment in physical, learning, language, or behavior areas that begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person’s lifetime (DOES NOT GO AWAY)

Answer 15

* Attention-Deficit/Hyperactivity Disorder * Autism Spectrum Disorder * Cerebral Palsy * Fetal Alcohol Spectrum Disorders * Fragile X Syndrome * Hearing Loss * Intellectual Disability (tri 21) * Kernicterus (why we care about bilirubin) * Language and Speech Disorders * Learning Disorders * Muscular Dystrophy * Tourette Syndrome * Vision Impairment (not just glasses: more serious)

Answer 16

Persistent deficits in **social communication** (the big issue) and interaction (eg, deficits in social reciprocity; nonverbal communicative behaviors; and skills in developing, maintaining, and understanding relationships), and may have restricted, repetitive patterns of behavior, interests, or activities

Answer 17

Classic autism, childhood autism, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified, Asperger disorder

Answer 18

Prevalence = Estimates vary with study methodology and the population that is evaluated * Europe, Asia, US ranges = 2 - 25 /per 1,000 or ~1 in 40 to 1 in 500 Male-to-female ratio = 3-4 times more common in boys than girls

Answer 19

* Rate in siblings= 10-20% incidence if one sibling has ASD * Associated conditions/syndromes: Intellectual disability, ADD, Epilepsy, genetic syndromes

Answer 20

Pathogenesis: not completely understood * Genetic factors * Neurobiologic factors (atypical neural connectivity) * Parental Age (Moms over 30 and dads over 40) * Environmental & Perinatal factors * Maternal Medication use during pregnancy- seizure medications + SSRIs

Answer 21

MMR and/or Thimersol were originally believed by some as cause ## Footnote * Alleged association was first reported in a 1998 study of 12 children * In 2004, 10 of the 13 authors of the study published a statement retracting its interpretation, and the Lancet fully retracted the paper in 2010 * An investigative reporter found that the study was fraudulent after comparing the paper vs patient medical records

Answer 22

Prospective studies indicate that findings of ASD often are present during the first year of life, before the first dose of MMR * 2020 systematic review of two cohort studies (~2 million children) and four case control studies (~9000 children) found no evidence to support a relationship between MMR vaccination and ASD

Answer 23

* In the US Inactivated Flu vaccine may contain (many do not) * MMR, Varicella, inactivated Polio, Pneumococcal vaccines never contained thimerosal * Before 2001, it was used as a preservative in some vaccines Hep B, dTap, Hib and Rh immune globulin * Mercury concerns have also been refuted (2014 systematic review of three cohort studies which included 718,200 children)

Answer 24

* Typically presents in first 2 years of life * Plateau of social skills between 15-24 months * Lack of interest in others, failure in empathy, absent or delayed language & communication, restricted interests

Answer 25

* Behavior disturbances- overfocus on preferred topics, difficulty with organization, disruptive behaviors * Stereotyped and repetitive motor mannerisms - hand flapping, toe walking, rocking * Insistence on sameness/resistance to change- only eats same foods, same routine

Answer 26

* Sensory Issues -Preoccupation with edges, spinning objects, texture issues with food, Preoccupation with sniffing or licking nonfood objects, resistance to being touched, hypersensitivity to certain types of sound * Macrocephaly – ¼ have >97% HC * Special Skills (card skills, rubic cubes, etc)

Answer 27

* Well Visit Developmental Screening tools: ASQ, MCHAT * Clinical Judgement * Parental Concerns * Correlation with Associated Conditions (more on alert)

Answer 28

## Footnote Learning difficulty often arises in those with normal IQ by 3rd or 4th grade

Answer 29

* Refer to Specialist for comprehensive multidisciplinary evaluation * developmental-behavioral pediatrician, child psychiatrist, child neurologist, (neuro)psychologist * Refer to local Developmental/Behavioral services (Ex. Early Steps, FDLRS) * Refer to Speech, OT, PT (when appropriate) * Refer to Dentist who works with Developmental Disabilities

Answer 30

* Educate parents on importance of maintaining routine well visits & appropriate f/u * Continue with age-appropriate screening (hearing, vision, lead) * Discuss with parents' school-based programs (Individualized Education Program: IEP) * Advise parents about support groups & counseling

Answer 31

* A condition marked by impaired muscle coordination (spastic paralysis) and/or other disabilities, typically caused by damage to the brain before or at birth. * A group of disorders that affect a person’s ability to move and maintain balance and posture.

Answer 32

* Prematurity * Intrauterine growth restriction * Intrauterine infection * Antepartum hemorrhage * Severe placental pathology * Multiple pregnancy (twin, triplets) * Perinatal hypoxic-ischemic injury * Intracranial hemorrhage ## Footnote MCC

Answer 33

Post-Natal Causes (~10-18% of all cases) * Stroke- heart disease, prothrombotic disorder, sickle cell disease, vasculopathy, metabolic disorder * Trauma * Severe Hypoxic Event- near-drowning * Sepsis * Meningitis * Kernicterus * Other causes of encephalopathy- Inborn errors of metabolism

Answer 34

* Clinical Features depend on subtype of CP * Many have overlapping features making classification difficult

Answer 35

Spastic subtypes: * Spastic diplegia =13-25% * Spastic hemiplegia =21-40% * Spastic quadriplegia =20-43% Dyskinetic subtypes (Choreoathetotic, Dystonic) =12-14% Ataxic CP =4-13%

Answer 36

* Inability to use both hands in midline or to reach out with the affected limb * Poor head control * Scissoring of the legs

Answer 37

* Persistence of primitive reflexes (last too long) * Motor milestones and language skills delayed * Growth failure (because cannot consume food)

Answer 38

* Increased tone * Brisk deep-tendon reflexes * Clonus * Contractures of affected muscles

Answer 39

* Lower limbs can be more affected than the upper limbs * Reduced limb length and muscle bulk in lower extremities * Flexion, adduction, and internal rotation of the hips * Sensory deficits

Answer 40

* Involuntary movements (Chorea, Athetosis, Dystonia) * Ataxic movements * Feeding difficulties, chronic respiratory insufficiency, & seizure disorder in severe forms

Answer 41

Refer to Specialist for comprehensive multidisciplinary evaluation * Ortho, Psychiatrist, Neurologist, Psychologist, Optho, GI, Pulm, ENT, Pain Management Centers Refer to local Developmental/Behavioral services (Ex. Early Steps, FDLRS) Refer to Speech, OT, PT (spasticity treatments, orthotics)

Answer 42

* Educate parents on importance of maintaining routine well visits & appropriate f/u * Continue with age appropriate screening (hearing & vision) * Discuss with parents school-based programs (Individualized Education Program: IEP) * Provide families information about support groups & counseling

Answer 43

* Trisomy 21 * Klinefelter Syndrome * Turner Syndrome * Fragile X Syndrome * Fetal Alcohol Syndrome * Prader-Willi Syndrome * Angelmann Syndrome

Answer 44

* Maintain relationship with families * Continue with Routine Health Visits * Refer to appropriate Specialists & Therapy Services

Answer 45

* Provide families with appropriate resources & support * Educate families on being the child’s advocate * Educate families on Education/Learning Services

Answer 46

* Get different things cover that might not have been covered previously without the CDC disability * Insure Kids Now

Answer 47

* Early 1970s, U.S. public schools accommodated only 1 out of 5 children with disabilities * More than 1 million children had no access to public school * Many of them living at state institutions where they received limited or no educational & rehabilitation services

Answer 48

* 1975-Originally known as Education for All Handicapped Children Act (EHA) : schools were required to evaluate handicapped children and create an educational plan with parent input * 1990 IDEA replaced EHA * September 6, 2011, the US Department of Education updated the IDEA to include specific interventions for children <2yrs who have disabilities

Answer 49

* Passed into law Dec 15, 2011 * Replaced No Child Left Behind Act (NCLB) 2001 * Set new mandates on expectations and requirements for students with disabilities * State driven education plans * Requires states to provide the appropriate accommodations for students with disabilities