School failure / behavioral issues in pediatrics скачать в хорошем качестве

School failure / behavioral issues in pediatrics

This video is on sources of school failure and/or behavioral issues in pediatrics. This presentation was created with Google Slides. ADDITIONAL TAGS: Poor sleep hygiene. Food/phone/reading in bed, screen in bedroom, inconsistent bedtime/routine/alarms, caffeine/alcohol/nicotine intake before sleep, daytime naps, mentally or physically engaging activities or meals or lights too close to bedtime. Tx: improve hygiene, quiet/dark/cool bedroom. Narcolepsy. REM abnormality → daytime sleepiness → forced daytime naps. Hypnopompic/hypnagogic hallucinations; sleep paralysis; cataplexy (sudden loss of muscle tone); sleep attacks (wake up refreshed). Dx: CSF hypocretin-1. Tx: Modafinil, amphetamines, planned naps throughout day. Insomnia. Can’t fall or stay asleep; early morning awakening; often related to worrying. Associated with anxiety, depression. Dx: =3nt/wk for =3 mo. Tx: sleep hygiene, tx underlying anxiety/depression, meds in order of increasing strength: Benadryl → quetiapine → trazodone → zolpidem. Obstructive sleep apnea. Risks: male, overweight, thick neck, loud snore, apneic (choking/gagging) episodes at night, not feeling refreshed after sleeping. Hypertension, headache, depression, bad memory. Px: pharyngeal muscles relax→close airway→nocturnal hypoventilation→hypoxia, hypercapnia→comp met alkalosis. High EPO→polycythemia. Dx: sleep study. Tx: Weight loss, no stimulants, CPAP, surgery (tonsillectomy, tracheostomy), else→pulm htn→RHF Central sleep apnea. Px: brain loses drive to breathe while sleeping. Sx: same symptoms as OSA, usually thin person in comparison. Cheyne-Stokes respiration pattern; no abd or chest movement when they pause breathing. Tx: CPAP or BiPAP with backup vents. Sensory impairment. Screening occurs throughout childhood: hearing screen at birth; vision/hearing indirectly assessed during dev milestones; objective vision and hearing tests at WCCs start at 3- and 4-years old, respectively. Learning disability. Problem with academic skills. Usually normal range IQ with poor academic achievement (math, reading, writing). Associated with behavior/attention problems; one diagnosis warrants evaluation of others (ADHD). Also check for sensory impairment (hearing/vision screen). Red flags: in utero maternal substance abuse, illness; childhood meningitis, head trauma, Pb exposure, psychosocial trauma; famhx → intellectual disability disorder. Autism spectrum disorders. Early onset. Problems with language, behavior, and/or social interactions. First sign→missed developmental milestones: no eye contact, social smile. Poor speech/language, unable to form/maintain relationships, no social connections. Inflexible to change, behavioral rigidity. Fixated interests, sometimes with intense focus. Tx: early intervention, behavioral modification programs; speech/language therapy; socialization Attention-deficit hyperactivity disorder. Low/no attention span (doesn’t follow instructions, forgetful, disorganized, can’t focus) and/or hyperactivity (‘driven by a motor’, overly talkative, fidgety, interrupts) that interferes with (social/academic) daily functioning for =6 mo. Dx: reported in =2 locations, before age 12; → Vanderbilt forms for parents and teachers. Tx: stimulants like methylphenidate, dextroamphetamine; other meds like guanfacine, atomoxetine, clonidine; special ed programs; patient and parent education; +/-behavioral therapy Oppositional defiant disorder. Recurrent hostile, argumentative, negativistic, defiant behavior towards authority figures. Still friends with peers. Tx: teach management skills to parents. Can progress to CD. Conduct disorder. More severe than ODD; aggression, bullying, cruelty, hurts animals, destruction of property, lying, cheating, stealing. Tx: detainment to prevent harm to others, juvenile detention center, antipsychotics. Must attempt to turn their life around, else can progress to antisocial personality disorder, imprisonment as adult Mood disorder. Epi: ~3% of peds (3-17yo). Screen: PHQ9. Dx: 5 of SIGECAPS: sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide. Childhood depression often converts to bipolar disorder in adulthood. Association btwn mood and ADHD. Tx: SSRIs + CBT Anxiety disorder. Epi: 7.1% of children. Screen: GAD7. Dx: =3 of RFCIMS: restless, fatigue, concentrating difficulty, irritable, muscle tension, sleep → significant impairment or distress. Tx: SSRIs + CBT