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 30°, 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