Peds 2
what is principle 5 of temperament?
"Goodness of fit" refers to the match of the child's temperament to the demands, expectations, and opportunities in the child's environment. A child's adjustment is enhanced through "goodness of fit." When goodness of fit occurs, positive development can be anticipated. On the other hand, when there is mismatch between the child's temperament and the environment, behavior problems can develop. Effective parents adjust the environment in their home to achieve goodness of fit for their children. However, goodness of fit must be evaluated within the context of the family environment. It can be further complicated if the temperament of siblings are widely different. Enhancing goodness of fit entails implementing the 3 Rs of temperament parenting: recognize, reframe, and respond. The first step is to recognize the child's temperament.
what is narcolepsy?
- chronic neuro disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, sleep paralysis, and sleep fragmentation, affecting 1 in 2,000 individuals. Narcolepsy appears to be a lifelong condition but is not progressive. However, the natural history of narcolepsy is poorly defined, and rigorous longitudinal outcome studies are lacking. The first line of therapy for children with narcolepsy is wake-promoting stimulant medication including methylphenidate Other nonpharmacologic strategies such as exercise and scheduled daytime naps may help to reduce daytime sleepiness, and should be included in individualized education plans. Any pharmacologic treatment must be closely monitored for safety and efficacy, and patients should be periodically assessed for changes in Sx
what are Parasomnias, Disorders of Arousal from Non-REM Sleep? what is the management of this condition?
-MC in children than adults bc children spend more time in deep NREM sleep. Usually occur w/in 1-2 h after sleep onset and coincide w/ transition from the first period of slow-wave sleep. Any conditions that lead to sleep fragmentation or deprivation can predispose a child to parasomnias, and may be comorbid w/ other sleep disorders. Correcting sleep debt alone may be a sufficient intervention. Sleepwalking common between 3-13 years, and most episodes resolve after age 10 years. Usually, episodes last from 5 to 15 min. The management of NREM parasomnias involves parental education as to benign nature of these phenomena and importance of adequate sleep. Modifiable triggers such as hot baths and late night exercise should be avoided, and comorbid sleep disorders that fragment sleep such as obstructive sleep apnea should be treated in children who are prone to problem parasomnias. *these are common in pre-school aged children (3-5)
what are language development milestones of a 15 month old? 12-17 month miles stones
15 month old: 10 words, Uses sign language to communicate, Understands more sophisticated commands 12-17 months: Attends to a book or toy for about 2 mins, Follows simple directions accompanied by gestures Answers simple questions nonverbally Points to objects, pictures, and family members Says 2-3 words to label a person or object, Tries to imitate simple words
what are language devleopement milestones of an 18 month old? what about between ages of 18-23 months?
18 months: 20 words, Understands fluid conversation, Can point to body parts 18-23 months: Enjoys being read to Follows simple commands without gestures Points to simple body parts such as "nose" Understands simple verbs such as "eat," "sleep" Says 8-10 words (pronunciation unclear) Asks for common foods by name, Makes animal sounds such as "moo", Starting to combine words such as "more milk", Begins to use pronouns such as "mine"
what language devleoekmetn occurs at age 4? what are the milestone checklist for 4y/o -5 y/o?
200 to 500 words Abstract language. Names four colors, Understands prepositions, Can count to 5 4 - 5 years Understands spatial concepts such as "behind," "next to" Speech is understandable but makes mistakes pronouncing long, difficult words like "hippopotamus" Says about 200 - 300 different words Uses some irregular past tense verbs such as "ran," "fell" Describes how to do things such as painting a picture Defines words Lists items that belong in a category such as animals, vehicles, etc Answers "why" questions 5: Names many colors Can count to 10, Begins to name letters, Understands opposites, Understand adjectives Understands >2,000 words, time sequences (what happened first, second, third) Carries out a series of 3 directions Understands rhyming, Engages in conversation, Sentences can be 8 or >words in length Describes objects Uses imagination to create stories
what language development skills occur at 24 months? at ages 3, 4, and 5 what language development is occurring? what language dveleopemnt skills occur at ages 3?
24 months: 50 to 100 words, 2 to 3 words sentences, Can point to pictures By age 2, most are putting words together in crude sentences such as "more milk." During this period, children rapidly learn that words symbolize or represent objects, actions, and thoughts 3: 100 to 200 hundred words, Names a color, Uses full sentences, Can name body parts 2 - 3 years Knows about 50 words at 24 months Know some spatial concepts such as "in" and "on" Knows pronouns such as "you," "me," "her" Says around 40 words at 24 months Speech is becoming more accurate but may still leave off ending sounds. Strangers may not understand Answers simple questions Speaks in 2 to 3 word phrases Begins to use plurals such as "shoes" or "socks" and regular past tense verbs such as jumped
what are language development milestone for age groups of 6 months to 11 months?
6 - 11 months Understands "no-no" Babbles (says "ba-ba-ba" or "ma-ma-ma") Tries to communicate by actions or gestures Tries to repeat sounds
what is the fatality rate for acute viral bronchiolitis?
< 1% Fatality rate Death may result from: prolonged apneic spells, severe uncompensated respiratory acidosis profound dehydration 2nd to loss of water vapor from tachypnea & inability to drink fluids
how can ASD be diagnosed?
A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): 1. Qualitative impairment in social interaction, as manifested by at least two of the following: a. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction. b. failure to develop peer relationships appropriate to developmental level. c. a lack of spontaneous seeking to share enjoyment, interests or achievements with other people (e.g., by a lack of showing, bringing or pointing out objects of interest. d. lack of social or emotional reciprocity. 2. Qualitative impairments in communication as manifested by at least one of the following: a. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime). b. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others. c. stereotyped and repetitive use of language or idiosyncratic language. d. lack of varied, spontaneous, make-believe play or social imitative play appropriate to developmental level. 3. Restricted, repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following: a. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus. b. apparently inflexible adherence to specific nonfunctional routines or rituals. c. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements). d. persistent preoccupation with parts of objects. B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder. https://www.youtube.com/watch?v=9VoushTH20Q
Some of the medical diagnoses and underlying conditions, which can lead to feeding issues, include, but are not limited to:
Autism Broncho-pulmonary dysplasia (BPD) Cystic Fibrosis Dysphagia Failure To Thrive Food Allergies Gastroiesophageal Motility Disorders GI Pain Gastroesophageal reflux (emesis) Genetic Syndromes Human Immune Deficiency Virus Reactive Airway Disease Metabolic Disorders Oral-Motor Dysfunction Prematurity Short Bowel Syndrome Status Post Organ Transplant
how is acute bronchitis in children managed?
Abx Tx doesnt appreciably alter course of illness but often employed to "cover" bacteria. Some pediatricians use fever, WBC, color of sputum, age, severity, length of Sx, and parental factors, in order to make decision
what is acute bronchitis ? what is a cute bronchiolitis?
Acute Bronchitis: acute inflammation of tracheobronchial tree, generally self-limited & w/ eventual complete healing & return of function Acute Bronchiolitis: acute viral infection of lower respiratory tract affecting infants & young children & characterized by respiratory distress, expiratory obstruction, wheezing, & crackles
when does autism appear by in childhood?
Always presents before 36 months of age, these children may have some speech developmental and social interactive regression, usually around 18 months of age. The diagnosis of childhood autism must meet the specific DSM IV criteria and will therefore present with poor eye contact, pervasive ignoring, language delay, and other features. Per definition, these children will have severe impairment in speech, communication, or social interaction. Many of them will be completely non-verbal and "in their own world."
what is the management for a child Dx with ASD?
An effective tx program will build on the child's interests, offer a predictable schedule, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, and provide regular reinforcement of behavior. Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Recognizing that parents are the child's earliest teachers, more programs are beginning to train parents to continue the therapy at home. http://www.nimh.nih.gov/health/publications/autism/complete-publication.shtml As soon as a child's disability has been identified, instruction should begin. Effective programs will teach early communication and social interaction skills. In children younger than 3 years, appropriate interventions usually take place in the home or a child care center. These interventions target specific deficits in learning, language, imitation, attention, motivation, compliance, and initiative of interaction. Included are behavioral methods, communication, occupational and physical therapy along with social play interventions.
what can cause biphasic stridor in children?
BIPHASIC Subglottic Stenosis Severe Croup Moderate to Severe Tracheomalacia Moderate to Severe Tracheal Compression Severe Vascular Ring Severe Bacterial Tracheitis Laryngeal Clefts
what are language and communications milestones a baby should have between birth to 5 months?
Birth to 5 months Reacts to loud sounds Turns head toward a sound source Watches your face when you speak Vocalizes pleasure and displeasure sounds (laughs, giggles, cries, or fusses) Makes noise when talked to As speech mechanism (jaw, lips, and tongue) and voice mature, an infant is able to make controlled sound. This begins in first few months of life w/ "cooing," a quiet, pleasant, repetitive vocalization. By 6 months, an infant usually babbles or produces repetitive syllables such as "ba, ba, ba" or "da, da, da." Babbling soon turns into a type of nonsense speech (jargon) that often has tone and cadence of human speech but does not contain real words.
what is bronchiectasis? what is atelectasis?
Bronchiectasis: Focal bronchial dilation, usually accompanied by chronic infection & associated w/ diverse conditions, some congenital or hereditary Atelectasis: shrunken, airless state affecting all or part of a lung
what are gross motor skills of a 9 month old?
Can go from lying to sitting Creeps or crawls Pulls to stand Walks with hands held, often on toes
what are gross motor skills of a 4 year old?
Can hop on one foot Throws ball with good aim Begins to catch a ball Begins tandem gait
what are vaccines for community acquired pneumonia?
Childhood -Pneumococcal Conjugate Vaccine (PCV) heptavalent -Hemophilus influenza (Hib) Adult -Pneumococcal (Strep pneumo) Pneumococcal Polysaccharide Vaccine (PPV) Pneumovax23. Polyvalent: antigens from 23 common strains of Strep p. -Influenza A & B Influenza vaccine (killed virus) q yr Oct.-Nov. FluMist Live attenuated, trivalent intranasal vaccine Tamiflu 75 mg po bid x 5 d (<36 hr after Sx)
what are gross motor skills of a 12 month old?
Goes from lying to standing Stands without support Walks holding onto furniture Takes a few steps
what can chronic partial sleep deprivation in teenagers cause?
Chronic partial sleep deprivation is a serious problem in teenagers, with a prevalence of at least 20%. Only 15% of teenagers report they get recommended amount of sleep regularly. Parents report that >75% of teenagers btwn 13-18 years go to bed at 11:00 PM or later on school nights. Chronic sleep deprivation has significant consequences, including negative mood, reaction time, attention, memory, behavioral control, and motivation. This may result in declines in school/work, use of alertness-promoting agents such as caffeine and stimulant meds, and ^ risk-taking behaviors. School, homework, jobs, and social activities interfere w/ sleep in adolescents, frequently resulting in delayed sleep onset, variable sleep-wake patterns (esp from weekday to weekend), and early waking
what are gross motor skills of a 3 year old?
Climbs stairs alternating feet Rides tricycles Can stand on one foot Throw balls overhand
what are gross motor skills of a 2 year old?
Climbs stairs with both feet on each step Can jump on two feet Runs efficiently Throws ball sideways
how does acute bronchiolitis present in a child? how can this be Dx?
Common cause of hospitalization < 2yo (winter & spring) Typical presentation: Acute onset tachypnea, cough, rhinorrhea, exp. wheezing Major concern Acute effects of bronchiolitis Chronic airway hyperreactivity (asthma) Underlying conditions morbidity & mortality Bronchopulmonary dysplasia, cystic fibrosis, congenital heart Dz S&S (RSV bronchiolitis) 1-2 days of fever, rhinorrhea, & cough, followed by Wheezing, tachypnea, & respiratory distress Breathing pattern is shallow, with rapid respirations Nasal flaring, cyanosis, retractions & rales (crackles) Prolongation of expiration & wheezing May present with apnea & few findings on auscultation, Then develops rales, rhonchi, & exp. Wheezing S&S (acute viral): Extreme distress, Tachypneic infant, Hyperexpanded chest,. Respirations range from 50-80 bpm, Retractions of accessory muscles(Subcostal, intercostal, subglottic/supracostal), bc of persistent distention of lungs by trapped air Obstruction is almost complete Lab: WBC nl or mild lymphocytosis Imaging CXR- Hyperinflation w/ mild interstitial infiltrates, Segmental atelectasis is common
what are complications of acute bronchitis in children
Complications Otitis media (OM) Sinusitis Pneumonia
what are the essentials of Dx of acute bronchitis?
Cough progresses from dry to productive Rhonchi on auscultation (low-pitched, sonorous, gurgling quality in larger airways, frequently clears after cough (mucous)) General Considerations: Inflammation of major conducting airways, Usually not an isolated entity in children (commonly associated w/ other dz processes in respiratory tract) Acute tracheobronchitis commonly associated w/ URI: nasopharyngitis -or associated with: Influenza, Pertussis, Measles, Typhoid fever, Diphtheris, Scarlet fever -most commonly in older children & adolescents. usually of Viral origin -Pneumococci, Staphylococci, H. flu, & various hemolytic Strep may be isolated from sputum But presence does not imply a bacterial cause
early onset pneumonia Vs late onset pneumonia
Early-Onset Pneumonia: Pneumonia as part of generalized sepsis that presents at or w/in hours of birth Late-Onset Pneumonia (> 7 days of age): MC in neonatal ICUs in infants who require prolonged endotracheal intubation because of chronic lung dz
what are nighttime fears? what is night mare disorder?
Dark rooms and imaginary creatures are 2 common fears in preschoolers. Usually short-lived and benign, typically disappearing by 5-6 y/o. Almost all children experience, w/ peak btwn 3-6 years, and 2nd peak in school-aged girls, esp those who are highly anxious. Nightmare Disorder- common in childhood, w/ prevalence estimates of 5-30%, and 75% of children report experiencing at least 1 nightmare (frightening dream occurring in REM sleep, usually resulting in awakening.) Content of nightmares differs across age groups. While toddlers worry about separation from parents, preschoolers may incorporate frightening imaginary creatures. Nightmares have following features: occurrence in last 1/2 of night when REM predominates; recollection of dream content; morning recall of the event; no confusion or disorientation;and delayed return to sleep **these are common in pre-school aged children (3-5)
Sleep problems are extremely common during childhood, from infancy to adolescence.... what is the MCC for referring child to sleep lab?
Despite prevalence, childhood sleep disorders often underrecognized and undx, despite being preventable or treatable. Sleep impacts almost all aspects of child's functioning, and ^ recognition and tx will positively affect child's well-being. Children experience the same broad range of sleep disturbances encountered in adults (sleep apnea, insomnia, parasomnia, delayed sleep phase, narcolepsy, and restless legs) but clinical presentation, eval, and management may differ. Although snoring and sleep-disordered breathing (SDB) may be the MC reasons for referring a child to a sleep lab, ~25% of these children may have 2nd sleep disorder that's associated w/ equally important clinical morbidity
what are causes of expiratory stridor in children?
EXPIRATORY Stridor: Consider the following dx Tracheomalacia Tracheal Compression Vascular Ring Bactrial Tracheitis Retropharyngeal Abscess Bronchogenic Cyst Esophageal Foreign Body
what can a CXR of a baby with acute viral bronchiolitis show? what can lab values show?
Hyperinflation of lungs ^ AP diameter on lateral view 30% of pts have scattered areas of consolidation (caused by atelectasis secondary to obstruction or by inflammation of alveoli) Early bacterial pneumonia cannot be excluded on radiographic grounds alone Lab WBC & diff usually wnl Lymphopenia unusual Nasopharyngeal cultures reveal normal flora Virus may be demonstrated in nasopharyngeal secretions by antigen detection (Enzyme immunoassay, PCR, or culture)
what are causes of inspiratory stridor children?
INSPIRATORY (Upper Airway) Above Vocal Cords Laryngomalacia (60% of all stridor) Vocal Cord Paralysis Croup (Laryngotracheobronchitis) REMEMBER: INSPiratory Child I Immobile Vocal Cords N Noid and Tonsillar Enlargement S Soft Cartilage P Pharnygeal and Hypopharyngeal Masses C Croup
when does Inadequate Sleep Hygiene and Insufficient Sleep typically occur ?
Inadequate Sleep Hygiene and Insufficient Sleep - Sleep hygiene denotes the variety of behaviors and conditions that promote the amount and quality of sleep. Children and teens with inadequate sleep may present with excessive daytime sleepiness, fatigue, difficulties with concentration, and complaints of negative mood. The first step in treating inadequate sleep hygiene is parent and child education. **common in school aged children 6-12 y/o
what is fetal alcohol spectrum disorder?
Infants with the full-blown syndrome are typically born to chronically alcoholic women who have a 40-50% risk of having infants severe problems in growth and development The syndrome is characterized by distinctive facial appearance, with short palpebral fissures and long philtrum ; prenatal onset growth deficiency; and an increased frequency of congenital abnormalities of the heart, skeleton, joints and palate. The face which may be characteristic in a young child, tend to normalize with time, making recognition of the adult difficult. Mental deficiencies and learning disabilities do not disappear with time
what peds pulm diseases are in the infection category? in obstruction? in other?
Infections: Acute Bronchitis, Acute Bronchiolitis, Pneumonia, Tuberculosis, Pertussis Obstructive Dz: Bronchiectasis, Cystic Fibrosis Others: FB Aspiration, Bronchogenic Cysts
what are interventions to calm the policy baby?
Interventions to CALM the "COLICKY" baby: theorized that colicky babies, have trouble w/ self-calming (live through same experiences as calm babies, but rather than taking them in stride, overreact dramatically.) Reproducing the sensations of the womb may help them turn on their calming reflex. The Calming Reflex - the 5 S's SWADDLING- Wrapping makes baby feel returned to womb and satisfies longing for the continuous touching and tight fit of the uterus. SIDE/STOMACH- supine is safest position for sleeping; however, side/stomach is best position for calming crying baby. The side position also allows truncal flexion (fetal position), which is a position of calm. Shhhhh- for a new baby, sound of calm and tranquility is the loud shushing sound of the uterine and placental blood flow. The sound inside the uterus is loud (80-90 db), harsh (high pitched whooshing), rhythmic, and constant. SWINGING - rhythmic movements imitate uterine experience. These movements need to be small and vigorous (like a shiver.) Don't restrict the head from jiggling. It should quiver like Jell-O on a plate. Babies who are really wailing need to be jiggled at 120/min for a few secs or mins until begin to calm. No risk of "Shaken Baby Syndrome" when movements are tiny (excursions of only 1-2 in) and head stays in line w/ the body. However, movement should not be done when a parent is angry SUCKING- requires baby's cooperation and introduced when she calms down. Allows baby to bring to play her own self-calming ability. Sucking (on a breast, bottle, or pacifier) comforts baby and allows her to recover from intensely upsetting experience of screaming.
what are symptoms of feeding disorders?
Issues related to growth and failure to thrive or failure to consume adequate nutrition to meet required caloric intake to promote growth. Commonly, children who experience reflux often fall into this category. -Abnormal suck-swallow-breathe synchrony, prolonged feedings ( >30 mins), ^ oral loss during breast or bottle feeding which may indicate oral motor dysfunction. -Episodes of gagging, coughing, or choking during mealtimes may be indicative of swallowing dysfunction. Additional concerns include upper airway congestion, noisy or "wet" respirations, presence of food nasally during or following swallow, a previous dx of aspiration. -Difficulty transitioning from breastfeeding to bottle/cup feeding, baby food consistencies (stage I, II, III, table foods), and NG/G-tube to oral feeds. Food refusal with any consistency. Maladaptive or disruptive behaviors at mealtime (temper tantrums, crying, food refusal, food throwing, etc.)
what are gross motor skills of a 1 month old?
Lifts chin off bed above plane of body Head lags Mostly fencing posture Poor trunchal tone
what are gross motor skills of a 6 month old?
Lifts head and body to umbilicus while supine Rolls over Sits with straight back for few minutes Gets up onto knees
what are gross motor skills of a 1 week old?
Lifts head from side to side while prone Lifts Chin Head lags on pull to sitting Doll's eye movement Infant Reflexes present
what are gross motor skills of a 2 month old?
Lifts shoulder off bed in prone position Better trunchal tone Extends legs, arms, fingers more Begins hands in mouth
what are Tx options for ADHD?
Meds of choice are in stimulant class and include METHYLPHENIDATE, DEXTROAMPHETAMINE, and combinations of DEXTROAMPHETAMINE and LEVOAMPTHETAMINE SALTS. These meds improve attention and concetration and decrease distractability and impulsivity. Side effects of these meds include appetite suppression, weight loss, as well as sleep disturbances. Some pts experience increased anxiety with higher doses of stimulant medications; stimulants may exacerbate psychotic symptoms Behavioral management is more useful with secondary sx such as oppositionality and poor social skills.
what is acute viral bronchiolitis most commonly confused with?
Most commonly confused with asthma Asthma associated with: + Family Hx of asthma, Repeated episodes in same infant, Sudden onset w/o preceding infection, Eosinophilia, Aerosolized albuterol gives immediate good response
how can fetal alcohol spectrum disorder be DX?
Most significant areas to be assessed are: Growth deficiency, Facial features, Brain Dysfunction, Documentation of Prenatal Alcohol Exposure The majority of children with alcohol-related syndromes present with ADHD symptoms, with or without developmental delays Difficult to Diagnose Outside of Early Childhood
what motor skills should develop between 10-12 months?
Motor skills gain speed. Most babies this age can sit without help and pull themselves to a standing position. Baby may use various forward movements to explore new territory. Creeping and crawling will give way to cruising along the furniture and eventually walking. By 12 months, baby often takes his or her first steps Hand-eye coordination improves. Most babies this age can feed themselves finger foods, grasping items between the thumb and forefinger. Baby may delight in banging blocks together and stacking objects or nesting them inside one another.
what is principle 1 of temperament?
PRINCIPLE 1: Children are born with a unique temperament Our inborn temperament influences the way we act and react in any given situation. Temperament involves the intrinsic and stylistic parts of ourselves that contribute toward making us the unique individuals that we are. Parents often become believers when they have a second child. Strategies that worked for the first child may be counterproductive with the second child. Whereas the first baby may have laughed when jostled, the sibling may be over stimulated by such activity and would rather be held quietly and securely.
what is principle 2 of temperament?
PRINCIPLE 2: Temperament influences behavior & emotional reactions Temperament is more than behavior. It also involves our internal reactions to situations. Temperament influences how individuals perceive other people and events. It has major implications for how we remember and interpret experiences. People often differ in their description of the same situation, and temperament contributes to their diverse perceptions.
what is principle 4 of temperament?
PRINCIPLE 4: Temperament does not change easily Attempting to change a child's temperament is futile. Because temperament is inborn and partly hereditary, it is highly resistant to change. Efforts to change a child's temperament are frustrating for both the parent and child and are likely to be counterproductive. Such strategies undermine the child's self-esteem.
summary of sleep disorders in children?
Pediatric nonrespiratory sleep problems are common, underdiagnosed, and treatable. Because of the impact of sleep on children's physical, psychological, academic, and overall functioning,the impact of an increased recognition, evaluation, and management of pediatric sleep disorders will likely have a significant impact on the general health and well-being of children. Since children referred for sleep medicine evaluation frequently have other comorbid medical, psychiatric, or behavioral comorbidities, a multidisciplinary approach to clinical assessment and coordination of care at a specialty level (eg, ear-nose-throat, behavioral psychology, neurology, and psychiatry) and close collaboration with pediatric specialists, when available, will optimize the quality of sleep medicine services for children.
what is a colicy baby? How does it present?
Persistent crying, diminished soothability, and restlessness in an otherwise healthy, well-fed infant characterize infant colic. The classic definition of infant colic, is paroxysms of irritability lasting for a total of >3 hrs/day and occurring on >3 days/week for 3 wks in an otherwise healthy infant. Colic occurs in ~20% of all infants, unrelated to sex, race, or socioeconomic status. Caring for a colicky infant is very stressful for parents, and in high-risk families, colic may have a lasting effect on the parent-infant relationship. The onset of colic is frequently the first 3 weeks of life. Infants usually recover by 3-4 months of age
what is the prevalence of developmental and behavioral delay?
Prevalence of developmental (DD) and behavioral disabilities among US children is 15-18% •Only 20-30% of children with or at risk of DD are identified prior to starting school •Clinical impressions alone detect <30% of children with DD •Standardized developmental screening tools have specificity of 70-90% 95% of young children see a child healthcare clinician in the first 3 years of life but only 57% of children (10-15 months old) ever received a formalized developmental screening
how can acute bronchiolitis be prevented? how is this condition managed?
Prevention of RSV Bronchiolitis -High-risk infants (FDA recommends prophylaxis) Prematurity, Bronchopulmonary dysplasia, Congenital heart Dz ---> Synagis (palivizumab) injectable [monoclonal RSV ab to RSV F glycoprotein, 15mg/kg IM q month in RSV season, 55% reduction in hospitalization of high-risk peds pts] Tx RSV-IVIG (intravenous immune globulin): CI in pts w/ cyanotic congenital heart Dz Ribavirin (no benefit) Hospitalization: < 2 months, Hypoxemia on RA, Hx of apnea, Moderate tachypnea w/ feeding difficulties, Marked respiratory distress w/ retractions, Underlying chronic cardiopulmonary disorders SEVERE CASES: O2 SAT < 95%, PO2 < 65%, PCO2 > 40, RR > 70 CXR: Diffuse atelectasis Management: Oxygen! Humidified air (Abx not useful) Oximetry provides early warning of resp. failure 7% require mechanical ventilation Higher rates w/ CF & pulmonary dysplasia IV fluid hydration Avoid fluid overload & pulmonary edema +/- Bronchodilators, corticosteroids Prognosis: Good in healthy children, High mortality in pts w/ cardiopulmonary Dz, 50% recurrent wheezing episodes, many develop asthma Sedatives should be avoided whenever possible because of potential depression of respiration Sit at a 30 - 40 degree angle or with the head & chest slightly, so neck is somewhat extended Supplement oral intake with IV fluids to offset the dehydrating effect of tachypnea Electrolyte balance & pH should be adjusted by suitable IV solutions Ribavirin (Vibrazole), an antiviral agent administered by aerosol, may be considered for infants with congenital heart Dz or bronchopulmonary dysplasia there is no convincing evidence of ribavirin's impact on the duration of hospitalization, requirement for supportive Tx such as oxygen or mechanical ventilation, or mortality. some high-risk infants not Tx with ribavirin have good Px Antibiotics have no Tx value unless there is 2nd bacterial pneumonia Corticosteroids are not beneficial & may be harmful under certain conditions Bronchodilating aerosolized drugs (albuterol) are frequently used empirically studies divided between those that demonstrate benefit & those that demonstrate no benefit or even harm If improvement is documented after a trial of inhaled albuterol, it should be continued Epinephrine or other adrenergic agents have a theoretical basis for use in that they might be expected to decrease venous engorgement & mucosal swelling by causing vasoconstriction In 2 studies, aerosolized epinephrine provided some benefit to infants with bronchiolitis
what are causes of acute bronchiolitis? what is the pathophysiology of this condition?
Proliferation & necrosis of bronchiolar epithelium produces obstruction from cell sloughing & ^ mucus secretions viral infection of lower respiratory tract affecting infant/young children, characterized by respiratory distress, expiratory obstruction, wheezing, and crackles. often occurs in epidemics: Mostly in children < 18 mo Peak incidence in infants < 6 mo Predilection for RSV & Parainfluenza 5 day incubation Inoculation through nose or eyes 50% Respiratory Syncytial Virus (MC pathogen) 25% Parainfluenza 20% other viruses: Influenza, adenovirus 5% Mycoplasma, Chlamydia, Ureaplasma, Pneumocystis No firm evidence bacteria causes bronchiolitis Bacterial bronchopneumonia may be confused w bronchiolitis. Diminished lung function may play a role in determining which infants w/ viral infection acquire bronchiolitis. Infants whose mother smokes cigarettes more likely to acquire bronchiolitis than infants of nonsmoking mothers
what are findings on physical exam of a pt with acute viral bronchiolitis?
Severe cyanosis may occur Nasal flaring Depression of liver & spleen by overinflated lungs may make them palpable below costal margin Widespread fine crackles may be heard at end of inspiration & in early expiration Expiratory phase of breathing prolonged, & wheezes are usually audible BSs are barely audible, in most severe cases
what are gross motor skills of a 4 month old?
Raises chest off bed when prone Sits with truncal support No head lag Pushes with feet when held erect Makes effort to rollover, back to front
what are signs and Sx of acute bronchitis?
Secondary bacterial infection may occur with: Strep pneumo, M. cat, H. flu 3-4 d after rhinitis, gradual onset of frequent, dry, hacking, nonproductive cough. Sometime post-jussive emesis Substernal discomfort/ soreness often present, may be aggravated by coughing Whistling sounds during respiration (probably rhonchi-Not rales) SOB, occasionally -3 d: Cough becomes productive & sputum goes from clear-> purulent -5-10 d: Mucus thins, & cough gradually disappears Malaise may cont. 1 wk after acute Sx subside Initially: Afebrile or low-grade fever, Nasopharyngitis, conjunctival infection, & rhinitis Later: Auscultation reveals "rough" BS, Coarse Rhonchi usually (fine rhonchi, moist rales, or high-pitched wheezing all possible) Complications are few, in otherwise healthy children CXR not helpful for dx used to eliminate other dx
what are the gross motor skills of a 5 year old?
Skips Hops alternating feet Heel to toe walking
what things may predispose children to acute bronchitis?
Some children far more susceptible to acute tracheobronchitis than others -reasons are unknown, but contributing factors: Allergy, Climate, Air pollution, Chronic URI (Sinusitis) No specific Tx, Most recover uneventfully w/o any Tx In small infants, pulmonary drainage facilitated by frequent shifts in position, suction and humid air Older children more comfortable in high humidity, but no evidence this shortens duration of illness; expectorant to keep mucous thin is most help Uncomplicated viral URI- Supportive Tx(Expectorant & antitussive, Avoid irritants (smoke)) Bacterial- Abx Others: Tx primary underlying problem
what are some proposed causes of colic?
Some proposed causes of the "colicky" baby: -Cow's Milk/Soy Protein Allergy or Intolerance- breastfed infants were as likely to be colicky as bottle-fed infants. Intolerance to either cow's milk or soy protein are temporary and result in intact protein being absorbed as result of ^ mucosal permeability in infant's GI tract. A change in diet will result in immediate improvement in 10-35% of colicky infants -The word "colic" originates from Greek word "kolikos," meaning "of the colon," suggesting thought persistent infant crying resulted from GI pain. Proposed GI causes categorized into 4 main groups -- excessive gas, bowel distention and spasm, abnormal intestinal motility, and gastroesophageal reflux (GER). -GER significant causative factor in ~5% of infants w/ colic, particularly those w/ vomiting and food refusal. The acid reflux would have to lead to esophagitis to cause pain resulting in colic.[6] Immature CNS - Irritable infants found to be more disorganized at birth, causing them to be easily stimulated. Crying during first 3 months may be byproduct of major reorganization of human brain that take place during this period. The CNS gradually matures over first 3-4 months of life. Likely that neurologically mediated individual differences in reactivity to stimulation are at least part of the reason for variations in crying behavior Difficult Infant Temperament - amount of concern generated by crying infants often depends on experience, anxiety level, and general personalities of caregivers. The aversive crying of colicky infant is hard to soothe effectively and occurs for no apparent reason. In face of their inability to control or explain such behavior in their infants, parents feel helpless and inadequate and may become anxious and even depressed over time
what are language development at 12 months?
Specific words 3 simple words Understands simple commands like "No" and "Don't touch By end of their 1st year, most children have mastered the ability to say a few simple words. Children are most likely unaware of the meaning of their first words, but soon learn the power of those words as others respond to them
what are temper tantrums? When do they occur?
TTs occur when strong feelings of frustration or anger exceed the child's cognitive abilities to manage them. They generally occur in young toddlers who have limited language for communication and . limited behavioral strategies for dealing with these frustrations. Through maturation and experience, a child develops improved communication and a wider variety of strategies for dealing with these frustrations. Parents must also teach the child better self control with proper management techniques The incidence of TTs decreases as children mature to school age Studies suggests that 80% of toddlers have a tantrum at least once a week. Management begins with setting limits ... giving in reinforces the tantrum. Ignoring or not speaking to the child should replace attempts to reason with a child who has lost control. The tantrum may initially escalate, but while keeping the child and others safe, ignoring the behavior is effective over time. Provide positive reinforcement for the desired behavior. Do not hold a grudge after the tantrum is over.
what is principle 3 of temperament?
Temperament is easy to see in situations that involve change & stress Temperament is a powerful predictor of children's reaction to change. Children differ on which circumstances they find stressful. Change can be stressful even when it involves a positive event like going on a vacation or anticipation of a holiday like Christmas. Every day, multiple situations occur that are likely to elicit reactions that differ depending on the child's temperament.
what is delayed Sleep Phase Syndrome?
The MC sleep disorder in adolescence (~ prevalence, 10%), is a circadian rhythm disorder characterized by habitual sleep-wake times that are delayed, usually more than 2 h, relative to conventional clock times. A typical teenager has difficulty initialing sleep and prefers late wake-up times, but once sleep begins, sleep Treatment focuses on aligning the teenager's natural sleep rhythm with a sleep-wake schedule that promotes school attendance and family functioning. The management of DSPS begins with regularizingthe teenager's sleep-wake schedule, limiting daytime napping, minimizing night-to-night and weekday-to-weekend variability, eliminating caffeinated beverages, minimizing the use of bedroom electronics (eg, television, computers with Internet access, and text messaging), and increasing morning sunlight. is reported to be normal.
when should a baby start: Cries for basic needs Coos Specific vowel sounds Consonant Sounds Responds to name
The beginning signs of communication occur during the first few days of life when an infant learns that a cry will bring food, comfort, and companionship. Cries for basic needs- 1 month Coos- 2 months Specific vowel sounds- 6 months Consonant Sounds- 9 months Responds to name- 9 months
what is insomnia?
The features associated w/ adolescent insomnia include changes in mood, daytime fatigue, poor school performance, cognitive impairment, excessive caffeine use, and hypnotic use. Insomnia likely results from a combination of predisposing factors (eg, genetic vulnerability, underlying medical or psychiatric conditions, or sleep disorders), precipitating factors (eg, acute stress), and perpetuating factors (eg, poor sleep habits, caffeine use, and unhelpful cognitions). Insomnia can also be part of learned sleep-preventing associations and heightened physiologic arousal.
when is the most intensive part of speech and language development occur?
The most intensive period of speech and language development for humans is during the first 3 years of life, period when brain is developing and maturing. increasing evidence suggesting that there are "critical periods" for speech and language development in infants and young children. The sound of a parent or voice can be one important sound. As grow, infants begin to sort out speech sounds (phonemes) or building blocks that compose the words of their language. Research shown that by 6 months of age, most children recognize the basic sounds of their native language.
What is Asperger's Syndrome?
These are kids w/ a form of autism that affects language less, yet there are difficulties with appropriate speech and communicative development. Mostly, however, these children have social interaction difficulties and impairments related to a restricted, repetitive, stereotype behavior. These kids may have very high IQ's, may do very well academically, have a superior memory for "unimportant" details, such as the birth dates of all baseball players, some historical or geographical trivia, yet they lack the skills to care for themselves and live independently.
what is Childhood Disintegrative Disorder?
These are kids who develop normally for the first 3 years of life. Later they seem to regress and develop some autistic features associated with a severe functional impairment. These children must be thoroughly evaluated for the possibility of the development of seizures, affecting the speech areas of the brain, or Landau Kleffner syndrome (acquired epileptiform aphrasia), where seizure activity "robs" the brain from previously acquired speech. type od ASD
what is rett's disease?
This affects only girls. These are girls who develop normally until 6 months of age and regress. Their regression is associated with microcephaly (small head). The head size seems to stop growing from 6 months and on, from the time of the observed regression. Recently a specific chromosomal marker (MEC-P-2) has been associated with this disorder and is now commercially available in some laboratories. type of ASD
what congitive skills should develop in a child between 10-12 months?
Understanding dawns. Baby's memory matures, will be able to easily find hidden objects. Often point to correct picture when you say what it is. Baby will realize that parents still exist even when they leave the room — which may lead to crying spells when they are out of sight. Imitation also reigns supreme. May find baby brushing his or her hair, pushing buttons on the remote control, or "talking" on the phone Language evolves. Most babies this age respond to simple verbal requests and understand words for familiar people and events. Baby may become skilled at various gestures, such as shaking head "no," pointing at something out of reach, or waving bye-bye. Baby's babbling may take on new inflection. May begin to hear new words and exclamations such as "uh-oh!"
what can cause acute bronchitis?
Viral infection MC: Adenovirus can produce more severe sx Bacteria: Mycoplasma pneumoniae, Bordetella pertussis (Whooping cough), Mycobacterium tuberculosis (TB), Corynebacterium diphtheriae (Diphtheria) Other causes: Asthma, Sinus infection, Cystic fibrosis, FB aspiration Repeated attacks of acute bronchitis may indicate possibility of respiratory tract anomalies: Ciliary disorders, FBs, Bronchiectasis, Immune deficiency, TB, Allergy, Sinusitis, Tonsillitis, Adenoiditis, Cystic fibrosis?
what are gross motor skills of a 15 month old?
Walks alone, Can walk backwards Crawls up stairs Climbs low obstacles Stoops and recovers
what are gross motor skills of an 18 month old?
Walks downstairs assisted Runs stiffly Sits on small chair Explores efficiently, Climbs furniture Kicks ball
when should you consider referral for a child between 7-9 months for further evaluation ?
When to consider referral for further evaluation Inability to bear weight on his or her legs No interest in reaching for objects or putting objects in his or her mouth Lack of response to sounds or visual cues Resistance to making eye contact No babbling, cooing or imitation of common sounds
when dhousl you consider for a referral in a baby between 10-12 months old?
When to consider referral for further evaluation No interest in crawling, or consistently dragging one side of the body while crawling Inability to sit or stand, even with help No use of gestures, such as waving or shaking the head No spoken words, such as "mama" or "dada" Lack of interest in his or her surroundings Resistance to making eye contact
what is a breath holding spell?
are one of the more frightening experiences parents encounter in their young children. Episodes involve the sudden cessation of breathing in response to a strong emotional stimulus A prolonged episode can lead to unconsciousness Parents can be reassured that there have been no reported adverse outcomes associated with breath-holding TWO TYPES OF BREATH-HOLDING SPELLS v Cyanotic Episodes - As child is expressing displeasure, there is involuntuary holding of the breath during expiration ... if it persists, may lose consciousness v Pale and Limp - In response to a sudden fright or painful experience, child gasps, turns pales and limp ... thought to be due to an overresponsive vagal nerve that results in bradycardia KEY POINTS TO RECALL: The spells are self-limited They will resolve without any intervention The child will spontaneously begin breathing again without intervention The child will not die The brain will not suffer damage
Chronic or frequently recurring productive cough should be evaluated for:
chronic bronchitis, No accepted standard for children Chronic or frequently recurring productive cough should be evaluated for: Asthma Immune deficiencies Cigarette smoke exposure Anatomic abnormalities Environmental Dz Upper airway infection with postnasal d/c Cystic fibrosis Ciliary dyskinesis Bronchiectasis
what is a pediatric feeding disorder?
condition in which an infant or child fails to consume enough nutrients to promote growth. Can also be characterized by loss of a significant amount of weight over 1 month. Feeding disorder is similar to failure to thrive, except that no medical or physiological condition can explain the low food intake or lack of growth. -25% of all children experience some feeding difficulties. Can be a fairly common problem in infants and toddlers; however, is MC in children w/ developmental disabilities -Feeding/swallowing problems are most associated w/ complex medical dx (such as prematurity, Reflux, complications secondary to tube feeding for extended periods of time, and disorders of digestive system), anatomical or structural abnormalities (such as congenital diaphragmatic hernia or tracheo-esophagael fistula), allergies, or oral-motor dysfunction. -A feeding disorder can include problems such as food refusal, selectivity, inability to consume adequate calories, or an inability to consume an age appropriate diet
what is behavioral insomnia of childhood?
difficulty falling and/or staying asleep w/ an identified behavioral etiology. type of "learned insomnia." The sleep-onset-association type is characterized by child's dependency on stimulation, objects, or environments for initiating or returning to sleep. Behavioral insomnia of childhood may be preventable with early intervention and parent education about appropriate sleep habits (ie, regular bedtimes and sleep routines, and putting the child to bed awake so she or he learns to fall asleep independently). **common in infants and toddlers
what is the evaluation and management of a child with suspected feeding disorder?
evaluation process for children w/ feeding problems = interdisciplinary approach w/ a medical, nutritional, occupational therapy, speech pathology, psychology, GI and behavioral evaluation. The MC feeding problems encountered during eval include food refusal, inadequate intake, overselectivity, and texture related problems. In children w/ medical conditions (prematurity, gastroesophogeal reflux, CF), feeding problems represent a major tx challenge. Oral-motor assessment may lead to conclusion that feeding problem is not based in motor deficits but behavioral in nature The behavioral tx of feeding problems in children involves 2 major components: appetite manipulation and contingency management. Success of any intervention relies on the child's motivation to change his or her current eating patterns The potential medical risk to child and whether child has sufficient feeding skills to be able to ^ oral intake on his or her own when motivation has been ^ must be considered. It is difficult for parents to place their child temporarily in a distressed state, even if outcome is positive. The most basic form of appetite manipulation for children feeding by mouth is simply to restrict all calories between meals, while continuing to offer water or another zero-calorie fluid.
what is Sleep-Related Rhythmic Movement Disorder?
rhythmic movements that occur on falling asleep or during any stage of sleep and can involve any part of body characterized by repetitive and stereotyped body motions, and includes a spectrum of behaviors (head banging, head rolling, and body rocking). Movements occur in a high proportion of otherwise healthy children as self-limiting phenomenon starting and remitting w/in early childhood. However, some forms occur against a background of developmental, psychiatric, or neuro disorders (mental retardation, autistic, ADHD, OCD, s/p head trauma or encephalitis), persist beyond childhood, or have their onset in adulthood. CAN BE NORMAL **common in infants and toddlers
when in childhood does Restless Leg Syndrome and Periodic Limb Movement Disorder typically present? what is this condition?
sleep disturbance associated w/ this disorder can manifest as difficulty falling asleep, bedtime resistance, or night wakings, and symptoms similar to those of ADHD. The RLS diagnostic criteria for adolescents (ie, 13 years of age) are the same as those used in adults, as follows: (1) an urge to move the legs; (2) the urge to move begins or worsens with sitting or lying down; (3) the urge to move is partially or totally relieved by movement; and (4) the urge to move is worse in the evening or night than during the day, or it occurs exclusively in the evening or nighttime hours. Definite RLS in a child < 13 years of age meets all of the four basic adult criteria and includes the child's description of the leg discomfort in his or her own words **common in school aged children 6-12 y/o
What is autism spectrum disorder?
term used to denote conditions that are referred to in literature as either Pervasive Developmental Disorders or Autistic Spectrum Disorders. Pervasive Developmental Disorders characterised by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests and activities. Includes the conditions known as Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder and Pervasive Developmental Disorder Not Otherwise Specified
what is adhd?
the most researched and written about disorder of all behavioral disorders in pediatrics or adult medicine -principle features are persistent pattern of hyperactivity and impulsivity and problems w/ inattention inappropriate for a child's developmental level -Medical eval includes hearing and cognitive testing in addition to tests focused on any sx possibly related to developmental and behavioral problems. Although genetics are unclear, a + fhx seen in ~50% of cases Some studies suggest that nearly half of ADHD children also have an accompanying learning disability. There is no single lab test or physical finding diagnostic of ADHD
what is Sleep-Related Bruxism ?
the repetitive, audible grinding and clenching of teeth during sleep, behavior is problematic in ~5% of pop. The risk factors orconditions that exacerbate bruxism include anxiety, stress, malocclusion, allergies, cerebral palsy/mental retardation, alcohol and stimulant medications use, tx with serotonin reuptake inhibitors, and primary sleep disturbances. Although bruxism is usually self-limiting, treatment for more chronic symptoms may include dental appliances for children with dental damage, pain relief, and stress management **common in school aged children 6-12 y/o
what are the AAP guidelines for developmental screening?
· 9-month visit: Motor, vision, hearing, emerging communication, social development · 18-month visit: Communication and language, motor, autism · 30-month visit (or 24-month): Motor, language, cognitive Other screening: · Maternal depression (@ 6 weeks postpartum) · Social emotional development · School readiness (@ 4 years) ·Screening should be conducted anytime parents raise concerns, Referral should be made anytime professionals have concerns. Close f/u should be scheduled anytime decision is made to not refer but questions remain
what motor and communication skills occur during months 7-9 ?
· Motor skills advance. By this age, most babies can roll over in both directions — even in their sleep. Some babies sit on their own.. Baby may begin to scoot, rock back and forth, or even crawl across the room. Some babies this age can pull themselves to a standing position. Baby may cruise along the edge of the couch or coffee table. · Hand-eye coordination improves. Most babies this age transfer objects from one hand to another or directly to their mouths. Baby develops more refined movements, such as picking up objects with just the thumb and forefinger ("Pincer Grasp"). Improving dexterity will helps baby handle a spoon and soft finger foods. · Communication evolves. Baby communicates through sounds, gestures and facial expressions. Lots of laughing and squealing emerge. Respond to his or her own name. Babies this age can distinguish emotions by tone of voice. They may repeat sounds they hear . Baby's babbling is likely to include chains of sounds maybe even an occasional "mama" or "dada."
what motor skills occur during birth-3 months? what hearing skills occur during this time?
· Motor skills. newborn's head wobbly at first. But within first few months, most babies can face straight ahead while lying on their backs and lift their heads while lying prone. Baby's stretching and kicking is likely to get more vigorous. If offered a toy, baby may grasp it and hold on tight for a few moments. · Hearing. W/in a few weeks, baby may respond to loud noises by blinking, startling, frowning or waking from light sleep. Even everyday household sounds — footsteps on the floor, water running— may elicit subtle responses (increased limb movement or slowed sucking rhythm). Baby responds to the sound of familiar voices.
Childhood Development proceeds in what direction?
· Proceeds in cephalocaudad direction · Proceeds in a medio-lateral direction · Parallels neuronal myelination · Sequence is similar between children · Rate varies among children · Milestone attainment may not be parallel
what other developments occur during months 7-9?
· Stranger anxiety appears. Many babies this age become wary of strangers. Baby may resist staying w/ anyone other than parents, shunning even grandparents or familiar baby sitters. ·Teething begins. If no teeth yet, you can expect the first tooth — likely one of the middle teeth in the lower jaw (a lower central incisor) — to break through anytime. May notice baby drooling more than usual and chewing on just about anything. Suggest a cool, wet washcloth or teething ring. Baby's teeth and gums should be cleaned at least once a day. Use plain water and a soft cloth or baby toothbrush. · SUGGEST AN EXPLORATION SAFE ENVIRONMENT & BEGIN DAILY READING TIME!
infant-toddler development can be broken down into what areas?
· The normal growth of children can be broken down into the following areas: · Gross motor - controlling the head, sitting and walking · Fine motor - holding a spoon, picking up a piece of cereal between thumb and finger · Sensory - seeing, hearing, tasting, touching and smelling · Language - being able to talk and be understood, and understanding what parents and other children say · Social - the ability to play with family members and other children
what changes occur to a babies vision and voice occur during months 4-6 ?
· Vision becomes clear. Baby's vision may be fully developed by age 6 months. He or she will begin to distinguish between strange and familiar faces. Baby begins concentrating on a toy, studying fingers and toes, or staring at his or her reflection. Most babies this age turn their heads toward bright colors and lights. If a ball is rolled across the floor, baby turns his or her head to follow the action. · Babbling begins. Babies this age often begin to babble, squeal, gurgle and laugh. Baby may respond to and imitate facial expressions and sounds. He or she may babble and then pause, waiting for you to respond. As baby's memory and attention span increase, he or she will begin to pick out the components of your speech and hear the way words form sentences. Baby may recognize his or her name. There may be changes in inflection or tone as baby babbles and coos.
when you consider sending for referral for a baby between 4-6 months?
· When to consider referral for further evaluation · Stiffness or tight muscles · Extreme floppiness · Only using one side of the body or favoring a particular arm or leg · No improvement in head control · Lack of response to sounds or visual cues, such as loud noises or bright lights · Resistance to making eye contact · No interest in reaching for objects or putting objects in his or her mouth · No attempts to roll over or sit
when would you want to refer for further evaluation of a child from age birth- 3 months?
· When to consider referral for further evaluation of development · No improvement in head control from birth, No attempts to lift the head when lying facedown · Extreme floppiness · Lack of response to sounds or visual cues, such as loud noises or bright lights · Inability to focus on a caregiver's eyes · Poor weight gain
what motor skills develop between 4-6 months of life?
·Motor skills evolve. Baby's arms and legs probably kick more purposefully now. Soon, rocking on his or her stomach leads to rolling over. As baby gains muscle strength, he or she will have better head control. Most babies this age raise their heads when lying facedown. They may even try to push themselves up or bear weight on their legs. By age 6 months, many babies begin sitting alone. Creeping or crawling typically follows. ·Hand-eye coordination improves. Baby will probably grasp fingers, a rattle or a soft object. Anything w/in reach likely to end up in baby's mouth. Baby begins pulling objects closer with a raking motion of the hands. Soon, baby may start bringing his or her hands together, clapping hands, and transferring objects from 1 hand to the other.
what is Pervasive Developmental Disorders PDD NOS?
·PDD NOS will present similarly to the kids who have autism (some people argue that these conditions should be combined as one), but will have a lesser degree of a severe impairment. · These kids are more likely to be verbal and have some degree of verbal or non-verbal effective communication, yet they must have the autistic features (as per the DSM IV criteria) and a severe impairment in social interaction, communication, or repetitive stereotypical behavior. · These kids are more likely to be verbal and have some degree of verbal or non-verbal effective communication, yet they must have the autistic features (as per the DSM IV criteria) and a severe impairment in social interaction, communication, or repetitive stereotype behavior. · This term is reserved for children with a severe impairment who do not fully qualify for any other autistic dx, due to age of onset or combination of autistic features
what vision changes occur during birth to 3 months old? what communication skills develop? what reflexes are present at this time?
·Vision. Most newborns focus best on objects about 12" away, or distance to your face during a feeding. Soon your baby may begin to examine more complex designs, along with various colors, sizes and shapes. Baby studies his or her hands and feet. By age 3 months, baby may be easily distracted by an interesting sight or sound. ·Communication. Newborns are sensitive to the way you hold, rock and feed them. By age 2 months, baby may smile purposefully, blow bubbles and coo when talked to or gently played with . Babies may mimic your facial expressions. Baby may begin to reach for when he or she needs attention, security or comfort.