* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download medley of updates - Paediatric Society
Separation anxiety disorder wikipedia , lookup
Bipolar disorder wikipedia , lookup
Schizophrenia wikipedia , lookup
Abnormal psychology wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Rumination syndrome wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
Mental disorder wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Conduct disorder wikipedia , lookup
Autism therapies wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
History of mental disorders wikipedia , lookup
Conversion disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Spectrum disorder wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Autism spectrum wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
PAEDIATRIC SOCIETY Dr Sridevi Arikala Updates ALTE- Acute Life threatening Event SIDS- Sudden infant death syndrome. ADHD- Attention deficit hyperative disorder Autism Cows milk allergy. Acute Life Threatening Event An episode in an infant that is frightening to the observor Apnoea 20 seconds or longer Colour change – cyanosis or pallor Marked change in muscle tone Choking or gagging Diagnosis based on symptomatology rather than pathophysiology Differential diagnosis Central Obstructive Seizure GE reflux Breath holding spell Acute abdomen Metabolic LRTI Cardiovascular Foreign body Infection NAI Drugs Paediatrics in Review June 2012 50% - Cause not known GE reflux ; Seizure and LRTI- 50% Recently recognised risk factors Post conceptional age of < 48 weeks in preterm babies Post natal age of < 1 month First 2 hours after birth-Most cases are obstructed airway; frequent checks by health personnel. Investigations- Dutch Pediatric Association. CBC C-reactive protein Blood glucose Arterial blood gas Urine analysis ECG RSV/Bordetella What this update adds EEG Diffiult to obtain in emergency setting Sensitivity of EEG 15 % in diagnosis( Bonkowsky et al2008) Patients with epilepsy will return with a second episode EEG reserved for children with recurrent ALTE What this update adds CT scan reserved for children with suspected child abuse. Multiple history taking from caregivers to note discrepancies. Fundus exmination and Skeletal surveys to follow. Serum Metabolic Studies – Organic acidemias ; Urea cycle disorders ; fatty acid oxidation defects and mitochondrial disorders cause 2-5% of ALTE Serum electrolytes – Na;K; Ca; Mg; Ammomia; lactate pyruvate What this update adds Urine toxicology- Usually cold and cough mixtures. Gastroesophageal reflux- Ph probe testing showing reflux should coincide with respiratory symptoms Reserved for infants with frequent GE reflux ; ALTE preceded by feeding; milk found in mouth and nose Hospital admission –Recommend 24 hours of observation . Resources for infant basic life support Courses. Paediatrics in Review June 2012 American academy of Paediatrics SIDS Task force recommendations. Definition Of SIDS Sudden unexplained death before 1 year of age. Previously healthy infant. Cause of death unexplained despite case investigation. complete autopsy. death scene investigation. review of clinical history. Risk reduction factors for SIDS Back to sleep for every sleep. Use a firm sleep surface. Keep soft objects and bedding out of the crib. Avoid tobacco smoke. Room sharing without bedsharing. Pacifier at nap time and bed time. Avoid overheating. Do not use cardiorespiratory monitors as strategy to reduce risk of SIDS. What this update adds Reduction in SIDS cases. Rise in cases of ASSB- Accidental suffocation and strangulation in bed. What this update adds. Bed sharing particularly dangerous Infant < 2-3 months of age One or both parents are smokers. Infant is placed on sofa; arm chairs or waterbeds. Multiple bed sharers. Person bed sharing has consumed alcohol; medications or illicit drugs. What this update adds. Breast feeding- protective effect on SIDS. Decreased infectious diseases. Breast fed infants more easily aroused than formula fed infants. Pacifier- protective effect on SIDS However to be introduced 2 to 4 weeks of age. What this update adds Room ventilation and fans- Currently no recommendation for or against fan use as SIDS risk reduction strategy. Swaddling- No recommendation for or against swaddling as risk reduction strategy. Swaddle should not be tight so as to effect respiration or exacerbate hip dysplasia. Not loose as to create head covering; suffocation or strangulation. Update Diagnostic and statistical manual of mental disorders. Attention deficit Hyperactive disorder Update based only on Diagnostic Criteria. Previously Diagnostic and Statistical Manual of mental disorders IV was used. DSM-5 published in May 2013 Diagnosis still based on Inattention- 6/9 criteria and/or 6/9 of hyperactive/impulsivity criteria What this Update adds DSM IV DSM V Grouped under Disruptive Grouped under Diagnostic criteria Illustrated examples of behavior behavioural disorder predominantly for children Easily distracted- extraneous objects Forgetful of dialy activitiesRunning errands Child runs about Neurodevelopmental disorder for adults/children Adults- Unrelated thoughts Forgetful of daily activitiesPaying bills/keeping appointment Adult- Feeling restless DSM IV DSM V 6/9 of inattentive and or 6/9 Over 17 years 5 criteria are of hyperactive/impulsive criteria Symptoms should have been present before 7 years Symptoms should cause significant impairment in social; academic or occupational functioning. sufficient Symptoms should have been present before 12 years. Symptmoms should intefere with or reduce quality of life in social academic or occupational functioning. DSM IV DSM V Exclusion criteria for ADHD Exclusion criteria for ADHD Pervasive devt disorder Schizophrenia Other psychotic disorder Schizophrenia Other psychotic disorder Subtype Classification Subtype Classification Combined Type. Predominantly inattentive Predominantly hyperactive Severity Combined presentation Predominantly inattentive hyperactive presentation Mild ; moderate; severe Update on Autism. DSM-IV DSM-V Pervasive developmental disorders Autism Aspergers syndrome PPD-NOS Retts syndrome Childhood disintegrative disorder Autism Spectrum disorder Autism Aspergers syndrome PPD-NOS Childhood disintegrative disorder Shift from categorical to Dimensional Categorical subtypes- clinical diagnosis not reliable. Few differences between high functioning Autism and Asperger’s One spectrum of autistic disorders defined purely by behaviours 3 key domains become 2 DSM IV DSM V 3 criteria Social impairment and communication Restricted and repititive behaviour Rationale for dyad Multiple criteria assess same symptom Deficits in communication and social behaviors are inseparable. Delays in language are not unique nor universal in ASD . Social Impairment and Communication Deficits in social-emotional reciprocity Deficits in nonverbal communicative behaviors Deficits in developing and maintaining relationships, appropriate to developmental level. All three need to be present- increase specificity. Restricted/Repetitive behaviour Stereotyped or repetitive speech Excessive adherence to routines Highly restricted, fixated interests Hyper-or hypo-reactivity to sensory input Two RRB instead of one- improves specificity. ASD –DSM5 Specifiers and Modifiers With the new criteria, if the child meets for ASD he / she will receive a diagnosis with the etiology as a specifier –ASD with Rett Syndrome –ASD with Fragile X OR with a modifier indicating another important factor –ASD with tonic-clonic seizures –ASD with intellectual disabilities Levels of severity DSM V Level One - Requiring support. Level Two- Requires substantial support Level Three- Requires very substantial support. Cows milk Allergy – ESPGHAN guidelines 2012 Immediate Reaction Late Reactions Dermatological: Angio-oedema, urticaria, pruritis, erythema. Respiratory: Rhinitis, chronic cough/ wheeze (unrelated to infection), acute laryngoedema. Systemic: Anaphylaxis. Gastrointestinal: Quick onset vomiting and diarrhea (within 2 hours) Dermatological: Atopic eczema. Gastrointestinal: Reflux, diarrhoea constipation, blood in stools (colitis) iron deficiency anaemia growth faltering Investigations for CMPA Skin tests and positive IgE Indicate sensitisation and may not mean allergy. Quantification of these tests useful in prognosis Negative in gastrointestinal reactions. Elimination diet and Oral challenge- Gold standard for diagnosis Breast Fed Infants Continue breast feeding Elimination of CMP from mother’s diet No improvement- Diagnosis unlikely Improvement- Oral challenge and if symptoms recur elimination diet for the mother weaning onto EHF Formula fed infants- Elimination diet Extensively hydrolysed formula First choice for most infants.. Aminoacid formula If EHF does not work. Costly. Soy based formula > 6 months. Taste better. Less costly. Risk of micronutreint deficiency Formula fed infants- Severe reactions Skin prick test positive or IgE positive oral challenge not required. CMP protein free diet for one year. Reevalaution done after 1 year under controlled circumstances Neither clear nor severe Reactions Oral challenge for 2 weeks. If positive; elimination diet for 6 mon. Skin test negative or low titres of IgE antibody reevalation after 6 months and can be done at home. Prognosis 50% tolerance by 1 year 75% tolerance by 3 years 90% tolerance by 6 years.