COMMON HEALTH PROBLEMS THAT DEVELOP DURING INFANCY

INTUSSUSCEPTION FAILURE TO THRIVE SIDS COLIC TRISOMY 21 LIP AND CLEFT PALATE IMPERFORATED ANUS ADHD

SPINA BIFIDA HYDROCEPHALUS OTITIS MEDIA MENINGITIS FEBRILE SEIZURES AUTISM HIRSCHSPRUNG S DSE

RESPIRATORY PROBLEMS Otitis media GASTROINTESTINAL PROBLEMS

Intussusception Hirschsprung s dse Colic Imperforated anus

Cleft lip and palate

NERVOUS PROBLEMS
Spina Bifida Febrile seizures Meningitis Hydrocephalus

OTHER PROBLEMS
TRISOMY 21 ADHD FAILURE TO THRIVE AUTISM

OTITIS MEDIA
Infection of the middle ear occurred as a result of a block eustachian tube, preventing normal drainage Common complication of ARI Infants and children more prone- ET shorter, wider, straighter

ASSESSMENT
Fever Irritability and restlessness Rolling of head from side to side Pulling or rubbing the ear Earache; signs of hearing loss Purulent ear discharge Otoscopic exam

INTERVENTION
Encourage

fluids Upright position when feeding Avoid chewing- increases pain Have the child lie with the affected ear Appropriate technique to clean drainage Administer analgesics and antibiotics(1014 days) Screening for hearing loss Myringotomy

INTUSSUSCEPTION
Telescoping of bowel into itself Ileocecal region Edema, necrosis of bowel, obstruction Most common at age 6 months More in boys than in girls Associated with cystic fibrosis

ASSESSMENT Piercing cry Severe abdominal pain ( pulls leg up) Vomiting of bile stained fluid Bloody mucus in the stool currant jelly stool

MANAGEMENT Barium enema Surgery Nursing intervention: 1.provide routine pre and post op care 2. monitor for peritonitis

CLEFT LIP /CLEFT PALATE

Clefts of the lip are more common in males Possible causes include maternal drug exposure, a syndrome-malformation complex, or genetic factors Clefts may be unilateral (more often on the left side) or bilateral and may involve the alveolar ridge Deformed, supernumerary, or absent teeth are associated findings

MANAGEMENT
SURGERY: RULE OF 10 10 weeks old At least 10 lbs At least 10 grams Hgb

MANAGEMENT
Feeding Devices CL Breck feeder Syringe/medicine dropper Logan bar after Sx CP Wide-bowl spoon Palate nipple BEST y Covers the defect Position upright Frequent BURPING

MGT AFTER CL-SX AFTER SURGERY

No. 1 goal line protect suture

CL

CP

CL Supine Provide 1 caregiver to minimize crying Elbow restraint Elbow splint BEST Logan Bar prevent overstretching suctioning of the lips

CP Prone - drainage Minimize crying Elbow restraint No deep/vigorous to suctioning Use finer tube

Note: Remove restraint q 2H, then ROM After CL & CP repair refer speech therapy and child psychologist EENT frequent infection because of respiration drying of mouth is common Orthodontist

Shock and DenialFirst reaction of mother upon learning that her child has CL or CP. TALKING-IN period is prolonged (1st 13 days)

HIRSCHSPRUNGS DISEASE
Absence

of autonomic parasympathetic ganglion cells in large intestines Results in decreased motility in that portion of the colon and signs of functional obstruction

ASSESSMENT Failure or delay in passing meconium Abdominal distension Temporary relief after rectal exam Loose and ribbon like stools Nausea, anorexia, fecal vomiting Weight loss, failure to grow Diagnostic test- rectal biopsy

NURSING INTERVENTION
Enema as ordered A. mineral oil or isotonic saline B. do not use water or soap suds C. use volume appropriate to child infants- 150-200 ml children- 250-500 ml provide low residue diet colostomy care

IMPERFORATE ANUS
During embryonic life- membrane that separates the rectum and anus is absorbed, absorption fails to occur. Anus appear as a dimple Fistula may be present- rectovaginal, rectourethral Assessment: absence of stool during 1st 24 hrs, inspection of anus for patency

INTERVENTION Anoplasty- if possible Temporary colostomy Nasogastric suction if with distension Nursing intervention: keep operative site clean observe for signs of hypovolemic shock if anoplasty heals- reg. dilation of anus post op- side lying or prone with hips elevated

COLIC
Colic is a form of pain which starts and stops abruptly. Types include: Baby colic, a condition, usually in infants, characterized by incessant crying

CAUSES
winding - sit a bottle-fed baby upright when feeding to reduce his or her air intake (ask your health visitor for advice on how to do this properly) drinking milk too quickly in a bottle-fed baby - you may find it helpful to try different teat sizes hunger or thirst tiredness lack of contact - some babies want to be cuddled all the time temperature - your baby may be too hot or too cold itchiness - itchy clothes or labels, or eczema pain - there may be an identifiable source of pain, such as nappy rash

FACTORS
overfeeding

in a futile attempt to lessen the

crying; feeding certain foods, especially those with high sugar content, for example, undiluted juices may increase the amount of gas in the intestine and worsen the situation; the presence of excessive anger, anxiety, fear, or excitement in the household; probably a multitude of other factors as yet unknown.

SYMPTOMS

Crying can be intense and furious and it may last for several hours a day over a few weeks. Although crying can occur at any time, it usually gets worse in the late afternoon and evening, and can affect your baby's sleep. Although colic isn't thought to be due to pain, your baby may look uncomfortable or appear to be in pain. Babies may arch their backs, draw up their legs to their tummy, become red in the face and pass wind. Colic isn't a serious condition. Research shows that babies with colic continue to eat and gain weight, despite the crying. If your baby doesn't do this, see your health visitor or GP. The main problem with the condition is the stress and anxiety it creates at home, especially if it's your first child. You may find being unable to comfort your new baby stressful, as well as finding it difficult to cope with the constant crying, so it's important for you to have support and to take a break if things get on top of you.

INTERVENTION

Hold the baby and walk or dance around with him or her. Carry in a front sling or backpack. Try using a baby swing. Sing softly and talk Change position by propping him or her up, so he or she can look around more. Soothe the baby w/ continuos noise or vibrations from household appliances like the dishwasher, vacuum cleaner or washing machine. Car ride or a walk in the buggy. Dummy to suck on. Bathe w/ warm water

HYDROCEPHALUS
Imbalance of CSF absorption or production Caused by malformations, tumors, hemorrhage, infection trauma Types: 1. communicating- impaired absorption within arachnoid space 2. non-communicatingobstruction of CSF flow within the ventricular system

ASSESSMENT Infant- increased HC Macewens sign- cracked-pot sound on percussion of bones of head Anterior fontanel tense, bulging Frontal bossing, sun setting eyes Headache, nausea and vomiting Ataxia, nystagmus

SURGICAL IMPLEMENTATION
VP shunt- CSF drains into the peritoneal cavity from the lateral ventricle AV shunt- CSF drains into the right atrium Post op care: 1.keep child flat as prescribed (10 15 days) 2. observe increase ICP 3. monitor for infection, I and 0 4.measure HC OD 5. provide comfort measures; administer medications ( diuretics, antibiotics or anti convulsants) 6. prevent skin breakdown

SPINA BIFIDA
CNS defect that occurs as a result of neural tube failure to close during embryonic development Defect closure usually done during infancy

TYPES
1. SPINA BIFIDA OCCULTA- posterior vertebral arches fail to close in the lumbosacral area no surgical mgt.just protect the area Dx Exam to determine the contents of the sac ( TRANSLUMINATION) 2. SPINA BIFIDA CYSTICA- incomplete closure of the vertebral and neural tubes MENINGOCELE- protrusion involves meninges and a sac like cyst MYELOMENINGOCELE- protrusion of meninges, CSF, nerve roots, portion of SC

ASSESSMENT Depends on spinal cord involvement Visible spinal defect Flaccid paralysis of legs Altered bowel and bladder function

IMPLEMENTATION
Administer antibiotics, anticholinergics, laxatives and antispasmodic Evaluate sac; measure lesion Monitor for increase ICP Protect the sac 1.cover with sterile, moist ( normal saline) 2. change dressing every 2-4 hours Place in prone position

MENINGITIS
Infectious process of the CNS caused by bacteria and viruses Acquired as a primary or as a result of complications Diagnosis- CSF analysis ( increase pressure, cloudy CSF, high protein, low glucose).

ASSESSMENT S/S vary depending of age group Fever, chills Vomiting, diarrhea Poor feeding or anorexia Altered LOC Bulging fontanel Nuchal rigidity

IMPLEMENTATION
Isolation; at least 24 hours after antibiotics are initiated Monitor VS and neuro status Monitor I and 0 Assess nutritional status Determine close contacts of the child with meningitis

FEBRILE SEIZURES
Febrile seizures are convulsions brought on by a fever in infants or small children. Rectal temperatures greater than 102 degrees F. Most febrile seizures occur during the first day of a child's fever.

FACTORS young age (less than 15 months) during the first seizure frequent fevers having immediate family members with a history of febrile seizures.

DURING SEIZURES
loses consciousness and shakes, moving limbs on both sides of the body rigid or has twitches in only a portion of the body last a minute or two

INTERVENTION DURING SEIZURE

PRIORITY: SAFETY Place on a protected surface such as the floor or ground Not be held or restrained Placed on his or her side or stomach to prevent choking Gently remove any objects from the mouth Look at your watch when the seizure starts lasts 10 mins medical facility Oxygenation

ATTENTIONDEFICIT/HYPERACTIVITY DISORDER
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, 1 of the most prevalent chronic health conditions affecting school-aged children (1) inattention, including increased distractibility and difficulty sustaining attention (2) poor impulse control and decreased self-inhibitory capacity (3) motor overactivity and motor restlessness

ETIOLOGY
Evidence suggests that there is no single factor that determines the expression of ADHD Multiple factors have been implicated Abnormal brain structures are linked to an increased risk of ADHD

EPIDEMIOLOGY
Studies of the prevalence of ADHD across the globe have generally reported that 5 10% of school-aged children are affected Many children with ADHD also present with co-morbid psychiatric diagnoses, including oppositional-defiant disorder, conduct disorder, learning disabilities, and anxiety disorders

PATHOGENESIS
MRI studies indicate a loss of normal asymmetry in the brain 510% reduction on brain volumes of specific structures, such as the prefrontal cortex and basal ganglia low blood flow to the striatum Fluorodopa positron emission tomography scans have also supported the dopamine hypothesis through the identification of low levels of dopamine activity in adults

CLINICAL MANIFESTATIONS
The 1st subtype, attentiondeficit/hyperactivity disorder, predominantly inattentive type, often includes cognitive impairment and is more common in females other 2 subtypes, attentiondeficit/hyperactivity disorder, predominantly hyperactive-impulsive type, and attention deficit/hyperactivity disorder, combined type, are more commonly diagnosed in males

DIAGNOSIS
Clinical Interview and History. The clinical interview allows for a comprehensive understanding of whether the symptoms meet the diagnostic criteria for ADHD Behavior Rating Scales. Behavior rating scales are useful in establishing the magnitude and pervasiveness of the symptoms, but are not sufficient alone to make a diagnosis of ADHD

DIAGNOSIS
Physical Examination and Laboratory Findings. There are no laboratory tests available to identify ADHD in children Impaired fine motor movement and poor coordination and other soft signs (finger tapping, alternating movements, finger-tonose, skipping, tracing a maze, cutting out paper)

TREATMENT
Psychosocial Treatments Behaviorally Oriented Treatments Medications. The most widely researched medications used in the treatment of ADHD are the psychostimulant medications, including methylphenidate (Ritalin, Concerta, Metadate), amphetamine, and/or various dextroamphetamine preparations

PROGNOSIS
A childhood diagnosis of ADHD often leads to persistent ADHD throughout the life span These risk factors include engaging in risktaking behaviors (sexual activity, delinquent behaviors, substance use), educational underachievement or employment difficulties, and relationship difficulties

AUTISM
Autism is a neurodevelopmental disorder of unknown etiology, but with a strong genetic basis It develops and is typically diagnosed before 36 mo of age It is characterized by a behavioral phenotype that includes qualitative impairment in the areas of language development or communication skills, social interactions and reciprocity, and imagination and play

DIAGNOSIS

A. A total of 6 (or more) items from (1),(2), and (3), with at least 2 from (1) and 1 each from (2) and (3): 1. Qualitative impairment in social interaction, as manifested by at least 2 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. 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 1 of the following: a. Delay in, or total lack of, 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 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

Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least 1 of the following: a. Encompassing preoccupation with 1 stereotyped and restricted pattern of interest that is abnormal in either 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 precoccupation with parts of objects B. Delay or abnormal functioning in at least 1 of the following areas, with onset < age 3 yr:(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 disorder or childhood disintegrative disorder
3.

CLINICAL FEATURES
Impairment

in joint attention- is the inability to use eye contact and pointing for the purposes of sharing experiences with others -It is a skill that typically develops by 18 mo Imapairment in protoimperative pointing the inability to use pointing to obtain an object of desire Inability to protodeclarative pointing -the inability to use pointing to an object of interest simply to have another share in the interest with him or her

CLINICAL FEATURES
make no eye contact and seem totally aloof show intermittent engagement with their environment can range from being nonverbal to having advanced speech, capable of imitating songs, rhymes, or television commercials speech may have an odd prosody or intonation and may be characterized by echolalia, pronoun reversal, nonsense rhyming, and other idiosyncratic language forms

CLINICAL FEATURES
Intellectual functioning can vary from mental retardation to superior intellectual functioning in select areas Play skills in children with autism are typically aberrant, characterized by little symbolic play, ritualistic rigidity, and preoccupation with parts of objects Stereotypical body movements, a marked need for sameness, and a very narrow range of interests are also common

CLINICAL FEATURES
The autistic child is often withdrawn and spends hours in solitary play Ritualistic behavior prevails, reflecting the child's need to maintain a consistent, predictable environment Tantrum-like rages may accompany disruptions of routine Eye contact is typically minimal or absent Visual scanning of hand and finger movements, mouthing of objects, and rubbing of surfaces may indicate a heightened awareness of and sensitivity to some stimuli

ETIOLOGY
The exact cause of autism is unknown, but is believed to be multifactorial, with a strong genetic influence Additional studies of neuroanatomy in children with autism have demonstrated anatomic changes in the anterior cingulate gyrus, an area of the brain associated with decision-making and the ascription of feelings and thoughts

DIAGNOSIS

Aberrant social skill development is the hallmark of autism spectrum disorders (ASDs), and early social skill deficits may include abnormal eye contact, failure to orient to name, failure to use gestures to point or show, a lack of interactive play, failure to smile, lack of sharing, and lack of interest in other children

The Checklist for Autism in Toddlers (CHAT) is a screening tool designed for use with 18 mo old children in primary care settings

TRISOMY 21
Down syndrome (DS), Condition in which extra genetic material causes delays in the way a child develops, both mentally and physically. It affects about 1 in every 800 babies. Gets an extra chromosome 21 for a total of 47 chromosomes instead of 46. Women age 35 and older have a significantly higher risk of having a child with the condition.

FAILURE TO THRIVE
Significant interruption in the expected rate of grow Weight less than the third to fifth percentile for age on more than one occasion or weight measurements that fall 2 major percentile lines using the standard growth charts of the National Center for Health Statistics (NCHS). th during early childhood

CAUSES
nonorganic failure to thrive - result of inadequate energy intake organic failure to thrive - ompromised use of ingested calories and excessive metabolic demands a combination of nonorganic and organic failure to thrive.

ASSESSMENT

Edema including ascites - Renal disease, liver disease, protein-losing enteropathy Wasting - Cancer, HIV, CP, poorly controlled inflammatory disease Hepatomegaly - Liver infiltration by tumor, storage disease, or cirrhosis Heart murmur - Congenital heart disease Respiratory compromise -Cystic fibrosis, bronchopulmonary dysplasia Rash or skin changes - HIV, congenital syphilis, cow's milk protein allergy, lupus Hair color and texture changes - Zinc deficiency, Menkes kinky hair disease Mental status changes - CP Signs of vitamin deficiency -Celiac disease, parasites, other enteropathy