ELS 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 aura A) At least 5 attacks fulfilling criteria B through D B) Lasting 1 to 72 hours C) 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

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 SimpleComplex (30%) 6 months to 6 years 6 years GeneralizedFocal 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 Reflexes ReflexMethodResponseDisap-pearance Palmar gripPlacing index in palm of infant Flexion of fingers6 months Plantar gripPressing a thumb against the sole just behing the toe Flexion of toes15 months GalantScratching 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 ATNRotation 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 MoroSudden head extension produced by a linght drop of the head Abduction followed by adduction and flexion of the upper extremities 6 months

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