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Pediatric Neuro and Health Disorders Overview

Apr 28, 2025

Neuro Alterations in Pediatrics

General Characteristics

  • Nervous system is complete but immature until age 4
  • Development from neural tube; large head, poorly developed neck muscles
  • Thin cranial bones, skull expands until 2 years, sutures unfused
  • Excess spinal mobility with risk for cervical injuries

Pediatric Assessment Tools

  • CT: Sedation may be required; used for lesions, tumors, edema
  • EEG: Rule out seizures, continuous brain activity monitoring
  • LP: Assess ICP/CSF, potential sedation for spinal infection or meningitis
  • MRI: Detailed tissue and structure analysis, sedation needed
  • X-Ray: Detect skull fractures
  • EVM: Use in nonverbal assessments, score of 15 is ideal

Intracranial Pressure (ICP)

  • General IPC: Increased ICP risks include meningitis, trauma, seizures
  • Posturing: Late sign of brain injury, decorticate towards body, decerebrate away
  • Signs by Age:
    • Infants: Bulging fontanel, lethargy, high-pitched scream
    • Children: Headache, vomiting, seizures, drowsiness
  • Treatment: Elevate HOB 30Β°, Mannitol, O2, antibiotics, norepinephrine

Seizures

  • General: Diagnosed around age 2, often idiopathic
  • Types:
    • Focal/Partial: One hemisphere involved
    • Generalized: Whole brain, epilepsy
    • Febrile: Related to rapid temperature changes
    • Absence: Brief loss of consciousness, looks like daydreaming
  • Stages: Aura, tonic, clonic, postictal phases
  • Status Epilepticus: Seizure lasting >30 mins, requires emergency care

Hydrocephalus

  • General: Imbalance in CSF production and absorption
  • Infants: Abnormal head growth, bulging fontanels
  • Treatment: Ventriculo-peritoneal shunt to direct excess CSF

Meningitis

  • General: Poor feeding, fever, irritability, photophobia
  • Management: Private room, droplet precautions, antibiotics, seizure precautions
  • Bacterial: More serious, diagnosed with lumbar puncture

Acute Head Injury

  • Symptoms: Changes in LOC, irritability, high BP, apnea in severe cases
  • Medications: Mannitol, steroids, anticonvulsants

Endocrine & Metabolic Dysfunction

Pediatric Variations

  • Immature endocrine system, hormone controls growth and metabolism

Disorders of the PITUITARY

  • Diabetes Insipidus: Low ADH, leads to dehydration
  • SIADH: Excess ADH, water retention
  • Precocious Puberty: Early onset sexual development

Disorders of the THYROID

  • Congenital Hypothyroidism: Delayed growth and development, lifelong levothyroxine

Disorders of the PANCREAS

  • Diabetes Mellitus: Most children have type 1, requires insulin therapy
  • Hypoglycemia: Low blood sugar, "rule of 15" for management

Cardiac Dysfunction

Pediatric Variations

  • Higher risk of HF, congenital or acquired concerns

Cardiovascular Disease in Children

  • Manifestations: Heart murmur, symptomatic after birth
  • Diagnostics: X-ray, ECG, echocardiogram, MRI, cardiac cath

Digoxin Administration

  • Used to improve heart function, monitor pulse closely

Respiratory Dysfunction

Eyes, Ears, Nose & Throat

  • Anatomical differences make children more prone to infections

Upper Airway Disorders

  • Foreign Body Aspiration: Leading cause of death in young children
  • Acute Epiglottis: Medical emergency, prevent with HIB vaccine

Lower Airway Disorders

  • Bronchiolitis: RSV common, symptomatic treatment
  • Pneumonia: Requires antibiotics and supportive care

Chronic Lung Disorders

Asthma

  • Triggers: Exercise, allergens, stress, temperature changes
  • Management: Bronchodilators, inhaled steroids, peak flow monitoring

Cystic Fibrosis

  • Manifestations: Respiratory, digestive, reproductive systems affected
  • Treatment: Chest physiotherapy, high-calorie diet, medications
  • Complications: Infections, diabetes, lung transplants may be needed