Characterized by severe, paroxysmal crying in the late afternoon.

Involves interaction b/w infant's temp & w/ parental caregiver patterns.

On PE:

Infants knees draw up, fists are clenched,flatus is expelled, facies pained, minimal response to soothing

Healthy well fed infant:

cries for> 3 hrs a day

for more than 3 days a week

for more than 3 weeks

RULE OF 3s

What developmental stage is this:

Lift head & reaches

Cooing

Responds to smile

Early infancy

0-6 months

What developmental stage is this:

Reach & obtains object

sit

walk

Jargon

Few words

Stranger anxiety

Dependence

LATE infancy

6-18 months

What developmental stage is this:

Walks well

scribbles

Speaks in phrases

Stranger anxiety

Autonomy

TODDLER

18-36 months

What developmental stage is this:

runs well

colors

speaks spontaneously

magical thinking

PRESCHOOL

3-5 years

What developmental stage is this:

School work

sports

concrete thinking

task oriented

SCHOOL AGE

5-12 years

What developmental stage is this:

Adult

Abstract thinking

Autonomy

Rebellion

ADOLESCENTS

12-17 years

Pt education and reassurance

Meds:  Phenobarbitol & Dicyclomine

limited use d/t ADR

Teething:

when do they begin to erupt

physical signs

when do they begin to erupt:

6 months

early 3-4 months

late 12-16 months

physical signs:

Diarrhea

Drooling

Fever

Rash

Teething:

Treatment

Complications

Treatment:

Topical anesthetic / teething gel 

Benzocaine-SE numbness & suppress of gag reflex

Tylenol/Motrin

Solid rubber/Chilled fluid/ Massage

Complications:

Swelling of gums red/purple

 "eruption cyst" "eruption hematomas"

disappear spontaneously

At what age is the brain ready for toilet training:

18 months-brain is setting the stage

After 18 months, sensory capacity for awareness of full rectum/bladder are physically able to control B/B sphincters

Toilet training:

Goal

Encompass

Goal:

Positive reinforcement & children have some control over elimination

Encompass:

General theme of social behavior & overall body cleanliness

??

Pattern of substance use leading to impairment in fufilling major role obligations-work, home school

Used in situations in which its physically hazardous, legal problems, continued use despite have recurrent social/interpersonal

How old are 1st time users of substance abuse?

Most common abused drug

2nd ??

How old are 1st time users of substance abuse?

12-14 yrs

Most common abused drug:  ETOH

2nd ??: Marijuana

Substance Abuse:

General psychosocial assessment ??

CAGE questions & PERCIEVED benefits of drinking scale

Define extent of problem:

age of onset

which substance

how, when, what results

Substance Abuse/Physical Exam:

Eyes ??

Mydriasis-stimulants, amphetamines

Mioisis-ETOH, barbituates, Benzo, Opiods, PCP

Conjunctiva injection-LSD, Marijuana

Lacrimation-Inhalant, LSD, Withdrawal from opiods

Substance Abuse/Physical Exam:

Cardiovascular ??

Tachycardia & HTN

Stimulants, majijuana, ETOH withdrawal, Benzos, Barbs

Hypotension

Barbs, opiods, Depressant withdrawal

Arrhythmias

Stimulants

Substance Abuse/Physical Exam:

Respiratory

Depression

Pulmonary Edema

Substance Abuse/Physical Exam:

Temperature

There is a:

DECREASE or INCREASE of temperature

Substance Abuse/Physical Exam:

Peripheral Nervous System response ??

Hyperreflexia-stimulants

Hyporeflexia-depressant

Tremor-ETOH withdrawal, Stimulant

Ataxia- ETOH withdrawal, Stimulant

Substance Abuse/Physical Exam:

Central Nervous System response??

GI response

Hyperalertness

Sedation, Somnolence

Seizures

Hallucinations

GI:  N, V

Substance Abuse:

Treatment/Management??

PREVENTION-drug awareness, prevent progression from iniation to progression stage, prevent comorbidities

COUNSELING

REFERRAL-drug program, AA

SMOKING CESSATION

nicotine, antidepressant Bupropion 

These are complications for what:

Leading cause of death & injuries with adolescents

Comorbidities-affective dis., anxiety & mania dis., depression

These are clinical features of what condition:

anhedonia

dysmorphic mood-tearful, sad, unhappy, slumped posture, irritable, anger

Fatigue

morbid ideation

somatic sx- stomach

change is sleep & appetite

Depression Epidemiology:

% before puberty & adolescent

Family hx component

Puberty ration

%:  1-3% before puberty

8 % adolescent

Family hx component:  Higher with family hx

Puberty ration:  female to male 5:1

Depression:

What question should you ask??

Are you a threat to yourself or others

test:

Child Depression Inventory

Beck Depression Rating Scale

Reynolds

Adolescent Depression scale-self reporting scale

Depression:

What tests are done to rule out organic causes??

CBC

ESR

U/A

Serum Electrolytes

 BUN

Serum Calcium

Thyroxine & TSH

RPR

VDRL

Liver enzymes

Depression:

Treatment ??

Comprehensive:  tx episodes, family support, medical assessment

Cognitive Behavioral Therapy

Antidepressants-only in mod-severe depression

need to monitored in1st 4 wks & follow in 3 months

Depression:

comorbidites ???

mental illness- ADHD, Conduct, Anxiety, Substance abuse

Risk of SUICIDE

Self medicating

Self injurious

Poor school performance

What is this:

Deficits on standardized testing in cognitive & adaptive functioning > than 2 standard deviation below the mean for the population & IQ <70

These are some identified causes of ??:

chromosonal abnormalities

fragile x syndrome

fetal alcohol syndrome

monogenetic conditions

structural CNS abnormalities

complications of prematurity

environmental / teratogenic causes

metabolic / endocrine

Mental Retardation- what test dx:

0-3 1/2 yrs of age

>3 yrs

0-3 1/2: 

developmental delay

Bayley Scales of Infant Development

>3 yrs:

standard cognitive testing

Ex. Wechler Intelligence Scale for Children

Mental Retardation:

Besides developmental testing what other tests are used to dx the condition??

full psychological eval

emotional assessment

hearing & vision test

Cytogenic-high resolution karotyping

FISH studies-use florescent DNA probe

DNA-deletion or duplication is suspected

MRI-more superior than CT

CT-intracranial calcifications

Metabolic screening

Speech, Occupational, Physical THERAPY

Special ED

Behavior therapy/couseling

Psychopharmacology

Between grade school to middle school

school work becomes more comples

Physical & Social maturation takes place

Limited intellectual ability

Specific learning disabilities

Depression/Emotional problems

Excessive absenes d/t chronic disease

Lack of ability to concentrate

ADHD

Lack of motivation-depression

Drug & Alcohol problem

How should the tx be based for :

ADHD

Depression

ADHD: Stimulant

Depression:  Psych

Magage:  address specific needs

foster strengths

implement feasible program

What is this:

Child will throw self down, kick, scream, strike people

Temper Tantrum:

What age does this occur and how often?

12 months - 4 yrs

1x a week in 50-80% of kids

NO

Use:

Positive reinforcement for desired behaviors

Have fewer restrictions

Use distractions when frustration increases

Give child options

??

Occurs during expiration & is REFLEXIVE

Not volitional paroxsmal even

Child cries then becomes silent in expiratory phase & is followed by color change acyanotic-with injury

or cyanotic- with anger

Spontaneously

Severe cases:

LOC

Limp body

Opisthotonos

Body jerks

Urinary incontinence

Rare-asytole/seizure

What is this:

Frightening dream, typically followed by awakening

Child is alert & can describe the dream

They remember

What are nightmares associated with??

Stress

Trauma

Anxiety

Sleep deprivation can cause rebound in REM sleep

Meds that increase REM

Self limiting

Parental reassurances

Comforting

2 hours after falling asleep

During the deepest stage of NREM

Screaming, Thrashing, Tacky, Sweating

Incoherent & Unresponsive to comforting

Episodes last 30 minutes

child has NO MEMORY

How should parents manage night terrors?

Reassure parent that child is not in pain

Let it run its course

Avoid stress, irregular sleep schedule, sleep deprivation

Schedule to awake child 30-45 minutes  before it occurs

Sleep Walking

occurs same as night terrors

Avoid injuries, obstacles in way, lock doors

Avoid stress & sleep deprivation

schedule awakeings

Mood disorder

Substance abuse disorder

Conduct disorder

What are the signs of suicide in children?

Unable to keep up with school work

Does not participate in social activities

Social Withdrawal

Sleep & Appetite disturbances

Feelings of hopelessness & helplessness

Angry teenager-trying to get back at someone

Adolescent w/ serious pysch condition-schizophrenia, true psychotic depressive disorder

Severe deficit in

SOCIAL RESPONSES

INTERPERSONAL RELATIONSHIPS

Impaired COMMUNICATION

LANGUAGE

SPEECH

Lack of interest in interaction with others

Bizarre responses to sensory stimuli:

repetitive

stereotypical motor behaviors-twirling, handflapping

odd posturing

self-injurious behavior

abnormal patterns of sleeping & eating

In Autism, 40-60% of children will have

IQ  ________ 70???

LESS THAN 70

IQ < 70

Early intervention- Speech, Language, Social skills

OT-sensory integration

Behaviorally oriented Sped ED classes

What are the 1st signs of puberty:

girls

boys

girls:  BREAST development

boys:  Increase size in TESTES

Signs of progression of puberty:

girls

boys

girls:

1. BREAST development

2. Pubic hair

3. Menses

boys:

1. TESTES enlarge

2.  Penis enlarge with growth Pubic hair

What Tanner Stage is this:

 testes enlarge

scrotum larger with texture altered & reddened

What Tanner Stage is this:

Penis is especially enlarged

&

testes & scrotum continue to enlarge

What Tanner stage is this?

Testes, Scrotum, Penis continue to enlarge

&

Glans now develop

What Tanner stage is this?

Preadolescent-NO pubic hair except for vellous fine body hair

SAME FOR GIRLS & BOYS

What Tanner Stage is this for both girls & boys:

Pubic hair quantity same as an adult

What Tanner Stage is this for girls :

Breast bud

elevation of breast & nipple / small mound

Enlargment of areolar diameter

What Tanner Stage is this for girls :

Further enlargement of elevation of breast & areolar

No separation of their contours

What Tanner Stage is this for girls :

Projection of areolar & nipple to form a secondary mound above the level of breast

Puberty starts at what age & peaks when & ends??

girls

boys

girls

9-14 yrs

peaks- 11.5

boys

11-18

peaks 13.5

Adolescent behavior is a period of progressive individualization & separation from family, what stage is this:

body image , self concept & esteem fluctuate d/t physical changes

Peer relationship with same sex

more importance of peer relationships

concrete thinkers, vague, unrealistic professional goals

Early stage

10-13 years

Adolescent behavior is a period of progressive individualization & separation from family, what stage is this:

More comfortable with bodies

intense emotions & mood swings

thinking changed to formal operations & able to think abstractly

Self centered, narcissistic, peers utmost importance

struggle w/ autonomy & independence

dating & experimenting w/ sex

Middle stage

14-16 yrs

Adolescent behavior is a period of progressive individualization & separation from family, what stage is this:

Less self centered, cares about others

peer relationships to more individuals

more intimate dating

idealism thinking

more realistic goals, future plans

Late Adolescent

17+ yrs

Impulsivity

Inattention

Hyperactivity

Hyperactive Impulsive

Inattentive

Combines

Fidgetiness-difficulty remaining in seat

Difficulty in:

 engaging in quiet activities

taking turns

Excessive :

running/climbing

talking/blurting out answers

Interupting/Intruding on others

Failure:

give close attention to details

listen when spoken to

follow directions

Difficulty:

in sustainind intention in task

organizing task/activities

Reluctance to engage in tasks

Lose utensils for tasks

Easily distractable

Forgetfulness of daily activities

ADHD has a genetic component and the etiology is unknown.

What are some associated disorders with ADHD??

Genetic disorders-Fragile X

Fetal Alcohol Disorder

CNS trauma/dysfuntion

Metabolic disorders

THINK BEES:

Behavior modification-structure,+reinforcement

Educate Parents

Educational & Social intervention

Stimulant meds-Methylphenidate/Dextroamphetamine