els 2010...peds ! mch protocols and peds exam for adult trainees
TRANSCRIPT
ELS 2010...PEDS !
MCH protocols and peds exam for adult trainees
Headaches and Migraines
Migraines in childhood
• Prevalence– 3 to 7 years
• 1 to 3 %• ♂ > ♀
– 7 to 11 years• 4 to 11%• ♂ = ♀
– Above 15 years• 8 to 24%• ♀ > ♂
Migraines in childhood
• 2003 IHS Diagnostic Criteria for Pediatric Migraine without auraA) At least 5 attacks fulfilling criteria B through DB) Lasting 1 to 72 hoursC) At least 2 of the following
• Unilateral or bilateral frontotemporal (not occipital)• Pulsing quality• Moderate or severe pain• Aggravation by or causing avoidance of routine physical activity
D) During the headache, at least 1 of the following• Nausea and/or vomiting• Photophobia and phonophobia with may be inferred from behavior
E) Not attributed to another disorder
Migraines in childhood
• Migraine equivalents– Benign paroxysmal torticollis
• Attacks of head tilt lasting hours to days• Onset between 2 and 8 months of age
– Benign paroxysmal vertigo of childhood• Abrupt and brief episodes of unexplained unsteadiness • Onset usually in toddlers
– Abdominal migraine• Recurrent episodes of moderate-to-severe intensity midline
epigastric pain lasting 1 to 72 hours associated with vasomotor symptoms (flushing, pallor) and N/V
• Onset during childhood– Cyclic vomiting
• Recurrent episodes of intense vomiting recognizable by their stereotypical time of onset, duration and symptomatology
• Onset during childhood
Febrile seizures
Febrile seizures
• 2 to 5% of children• Most common form of childhood seizures• Definition: (International League Against
Epilepsy)– “Seizure occurring in association with a febrile illness
in the absence of a central nervous system infection or acute electrolyte imbalance in children older than 6 month of age without prior afebrile seizures.”
• Peak incidence: 18 months
Febrile seizures
• Simple vs complex
Simple Complex (30%)
6 months to 6 years <6 months, >6 years
Generalized Focal
Brief
<15 minutes
Prolonged
>15 minutes
Isolated
1 seizure per 24 hrs
Multiple
> 1 seizure per 24 hrs
Normal development & neurological exam
Abnormal
Febrile seizures
• Recurrence of Febrile Seizures: – 1/3 will experience
recurrence– 10% will have ≥3
episodes
Factors for development of Epilepsy
(Swaiman, Fourth Edition)
Definite Risk Factor
• Neurodevelopmental abnormality
• Complex Febrile Seizure• Family history of Epilepsy• Duration of fever
Possible Risk Factor
• More than one complex feature
Not a Risk Factor• Family history of Febrile Seizures
• Age at first Febrile Seizure• Height of peak temperature
• Gender and Ethnicity
First seizure, status epilepticus and breakthrough seizure in a
known epileptic
Tics and Tourette syndrome
Peds Neuro Exam
Primitive ReflexesReflex Method Response Disap-pearance
Palmar grip Placing index in palm of infant
Flexion of fingers 6 months
Plantar grip Pressing a thumb against the sole just behing the toe
Flexion of toes 15 months
Galant Scratching the skin of the infant’s back from the shoulder downward, 2-3 cm lateral from the spinous process
Incurvation of the trunk with the concavity on the stimulated side
4 months
ATN Rotation of the infant’s head to one side for 15 sec
Extension of the extremities on the chin side and flexion of those on the other side
3 months
Moro Sudden head extension produced by a linght drop of the head
Abduction followed by adduction and flexion of the upper extremities
6 months
Questions ?