1. What are possible complications associated with GORD?
    • Oesophagitis
    • Malnutrition
    • Chronic Respiratory Infections - pneumonia, apnoea, vagal nerve mediated bradycardia
    • Failure to thrive
  2. Is an infant with non complicated colic likely to suffer from failure to thrive?
    No - well fed babies
  3. What advice would you provide to a parent with an infant with GORD?
    • Raise bed slightly - but not seated
    • Lay infant prone while awake
    • Smaller more frequent meals
    • Mother avoids acids and caffeine
    • Thicken feeds with rice cereal
  4. How would you manage an infant with suspected GORD?
    • Refer
    • Chiropractic
    • Advice
  5. What is the known cause of colic?
    • Non-complicated colic - none
    • Complicated Colic:
    • Protein intolerance & Allergy
    • CHO intolerance
    • GORD
    • Pyloric stenosis
    • Intussusception
  6. What is the typical posture associated with suspected colic?
    Clenched fists, knees and flexed hips, flushed face and often kicks legs
  7. What is the typical posture associated with suspected GORD?
    Child has feeding difficulty or discomfort in recumbent position appearing distressed and in pain.

    Also discomfort in the seated position
  8. How is colic diagnosed?
    >3 hrs crying per day for >3 days per week for >3 weeks

    • Onset: 2-4 weeks
    • Abates: 3-4 months
  9. What are the signs and symptoms of colic?
    • Windy or chucky
    • Child appears distressed
    • Characteristic posture
    • Predictable crying episodes - same time of day
    • Intense or unconsolable crying
  10. What needs to be ruled out before a diagnosis of colic is made?
    • Otitis media
    • UTI
    • Reflux
    • Increased ICP
  11. How do you manage Colic?
    • Avoid overstimulation of the infant. Keep room temperature warm, avoid excessive handling. Other helpful tips for the parents include
    • –swaddling
    • –cuddling
    • –rhythmic rocking
    • –going for a walk or ride
    • –warm baths
    • –singing
    • –rhythmic sounds
    • –massages (gentle)
    • –using a dummy
    • –Being cuddled in a snuggly
    • –swing
    • –Of course, chiropractic
  12. What are the signs and symptoms of GORD?
    • Frequent Vomiting – Often curdled milk appearance, may also have mucus appearance, esp. with concurrent infection
    • Child often has feeding difficulty or discomfort in recumbent position, appearing distressed and in pain
  13. What is sandifer syndrome?
    Sandifer syndrome involves spasmodic torsional dystonia with arching of the back and rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, associated with symptomatic gastroesophageal reflux, esophagitis, or the presence of hiatal hernia
  14. What is sandifer syndrome often mistake for?
  15. What causes sandifer syndrome?
    • Dysfunction of the lower esophagus is thought to be the most common precipitating factor. In some children, a cause cannot be found.
    • Gastroesophageal reflux disease (GERD) with varying degrees of esophageal inflammation
    • Dysmotility of the esophagus: Esophageal dysmotility, characterized by low-amplitude waves, lack of normal propagation, and low lower esophageal sphincter (LES) pressure, is not the cause but most likely the consequence of esophagitis.
  16. What are the three principal types of onset for JRA/JIA?
    • 1) Oligoarthritis (Pauciarticular)
    • 2) Polyarthritis
    • 3) Systemic onset disease
  17. What are the initial Sx of JIA?
    • Initial Sx:
    • –Morning stiffnes
    • –Ease of fatigue
    • Joint pain later in day
    • Joint swelling
    • Involved joint:
    • warm
    • lacks full ROM
    • Occasionally painful on motion
  18. JRA/JIA
    Describe pauciarticular/oligoarthritis:
    • Chronic arthritis involving few joints
    • MC the large weight bearing joints
    • Usually the knee
    • Asymmetrical
    • Ofter hot swollen joint, limp worse in am
    • Chronic inflam can lead to premature epiphyseal closure, LLD
  19. JRA/JIA
    Describe Polyarthritis:
    • Polyarticular
    • Affects >5 joints
    • Both large and small joints involved
    • ADI instability
    • Low grade fever, fatigue, rheumatoid nodules and anaemia
  20. JRA/JIA
    Describe systemic/stills
    • Joint involvement plus fever, rash, lymphadenopathy
    • Fever of at least 2 weeks duration
    • Hepatosplenomegaly
    • Salmon macular rash
  21. Describe reactive arthritis:
    • Ass. with recent, prior or co-existing extra-articular infection
    • HLA-B27
    • Extra-articular findings: conjunctivitis, urethritis
    • sausage digit
    • heel pain
    • LBP
  22. What are growing pains?
    • Benign nocturnal limb pain
    • Pain usually knee, calf and shin
    • Often pm
    • No inflam
  23. How do you manage growing pains?
    Heat, massage, Ca, Mg, chiropractic, paracetamol, exercise
  24. How does SLE present in an infant?
    • 1) Constitutional: wt loss, fever, fatigue, weakness, anorexia
    • 2) Jt pain: non deforming arthritis, often symmetrical, tenderness, swelling, effusion of 2 or more peripheral jts
    • 3) Skin: malar butterfly rash (spare nasolabial folds), purpura, alopecia, skin photosensitivity to sunlight, Raynaud’s phenomenon
    • 4) Polyserositis: pleurisy, peritonitis, pericarditis
    • 5) GI: hepatosplenomegaly, lymphadenopathy
    • 6) Renal: renal complications leading cause of death of pt w/ SLE. Nephritis, nephrosis, uremia, hypertension
    • 7) CNS: seizures, coma, chorea, focal neuropathies, hemiplegia, psychosis.
    • Morbidity in children mostly related to degree of renal involvement.
  25. What is Henoch Schonlein Purpura and how does it present?
    • Small vessel vasculitis
    • Crops of palpable purpura, mostly legs and buttocks
    • Abdominal pain and melaena may precede rash, vasculitis can happen in GI tract
    • Nephritis fever, fatigue
    • Large jt migratory arthritis
  26. What causes chicken pox?
    Varicella Zoster Virus
  27. What are the signs and symptoms of chicken pox?
    • Begins as fever, malaise, headache (1-2 days)
    • Macules and papules on face and trunk, may occur in scalp, nose, mouth, vagina, conjunctiva
    • Progress to painful and itchy vesicular lesions/ pustules, targeting mainly trunk & face
  28. How do you manage chicken pox?
    • To relieve itching and improve comfort:
    • Rest
    • Fluids
    • Paracetamol
    • Pintarsol, Topical agents
    • If severe, antivirals
    • Antibiotics if infection
    • Keep nails trimmed
  29. What are the complications of Varicella Zoster?
    • Secondary Bacterial Infection: Stph, Group A Strep: imetigo, cellulitis, fascitis, scarlet fever, sepsis
    • Encephalitis
    • Reye’s syndrome (using salicylates)
    • Pneumonia
    • Can be life threatening in immunosuppressed
    • If occurs during first 20 weeks of pregnancy, may cause congenital infection
    • Rare: optic neuritis, orchitis, trabnsverse myelitis, arthritis
  30. What are the signs and symptoms of measles?
    • Fever can spike, simply monitor
    • Prodrome of fever, cough, conjunctivitis, conjunctivitis, coryza
    • “Characteristic dry cough and red eyes”
    • photophobia
    • 2-3 days later Koplik spots appear on buccal mucosa (white macules). These are pathognomic for measles, yet they may be absent
    • Following this is a maculopapular rash, affecting face/trunk/limbs, fever peaks
  31. How is measles diagnosed?
    IgM antibody is present in serum, lymphopenia, leukopenia
  32. What are the complications of measles?
    • Complications: occur in 15% of patients.
    • –bacterial superinfections of lung, middle ear, sinus and cervical nodes
    • Bronchospasm, croup
    • Bronchiololitis
    • Pneumonia
    • Encephalitis (1 in 2000 cases)
    • SSPE (1 in 100,000 previously infected)
  33. What is the management for measles?
    • Rest
    • Recovery generally occurs 7-10 days after onset
    • Fluids
    • Eye care, cough relief
    • Fever reduction (not salicylates) Paracetomol
    • Tx for secondary bacterial infxn
  34. What is rubella also known as?
    German measles
  35. What are the signs and symptoms of rubella?
    • Maculopapular rash, beginning on face to body
    • Generally a mild disease, complications rare
    • Fever is mild
    • Malaiseà Lymphadenopathy-Cold, Conjunctivitis - Rash
    • Few systemic Sx
  36. What are the complications associated with rubella?
    • Congenital infection:
    • Retarded growth, development
    • Cataracts, retinopathy, glaucoma
    • Deafness
    • Jaundice in neonate, and purpuric rash
    • Congenital heart defect (PDA, VSD, Pulmonary a. stenosis)
    • Chronic encephalitis, hepatitis, thrombocytopenia, immune disorders, malabsorption, diabetes.
    • Arthralgia/Arthritis
    • Encephalitis
  37. What is the management for rubella?
    • Rest
    • Fluids
    • Paracetamol
    • Symptomatic therapy
    • Anti-inflammatory for arthritis
    • Px good for children and adults
    • Poor Px for congenitally affected infants
  38. What is glandular fever also known as and what is it caused by?
    • Mononucleosis (MONO)
    • Epstein-Barr virus
  39. What are the signs and symptoms of mono?
    • Prolonged fever, diarrhea, tonsillitis, pharyngitis (exudative), OM, pneumonia, lymphandenopathy, hepatosplenomegaly
    • Atypical lymphocytes
  40. What are the complications of mono?
    • Splenic rupture
    • Anemia
    • Thrombocytopenia
    • Neutropenia
    • Encephalitis
    • Meningitis
    • Bell’s palsy
    • Guillan Barre Syndrome
    • Atypical pneumonia
    • Myocarditis
    • Pericarditis
    • Chronic EBV
  41. What is infectious meningitis caused by?
    • Haem. influenzae B, (esp under 5 years)
    • N. meningitidisStrep. Pneumoniae, group B strep in neonate
    • Enterovirus, Herpes Virus
  42. What are the signs and symptoms of infectious meningitis?
    • Recent history of otitis media or URTI
    • Temperature above 38.5, commonly above 38.8
    • Systemically ill, fever, headache, neck stiffness, photophobia, nausea, vomiting, lethargy, confusion, arthralgia, seizures
    • Rash develops truck and extensor surfaces
  43. What are the complications of bacterial meningitis?
    • Abnormal electrolyte and H20 balance from low or high ADH production
    • Seizures
    • Cerebral edema
    • Increased ICP
    • Mental retardation
    • Severe behavioural disorders
    • Hydrocephalus
    • Focal deficits, hearing loss, visual impairments
  44. What are the signs and symptoms of an infant with UTI?
    • Fever
    • Hypothermia
    • Jaundice
    • Poor feeding
    • Irritability
    • Vomiting
    • Failure to Thrive
    • Sepsis
    • Strong smelling urine, cloudy
  45. What is whooping cough caused by?
    Bordetella pertussis
  46. What are the signs and symtoms of croup?
    • Afebrile or Low-grade fever, barking cough, inspiratory stridor
    • Following an URTI
    • Usually autumn and winter
    • Can lead to airway obstruction
    • Older children Mycoplasma Pneumoniae,
    • Leads to hypoxia and weakness, increased pulse rate
    • May observe nasal flaring and retracted sternocostal margins
  47. What is the management for croup?
    • Mild croup (no stridor) = rest, steroids
    • Mod and Severe (stridor at rest) = hospital / ICU, steroids, O2, nebulized epinephrine
  48. What are the signs and symptoms of bronchiolitis?
    • Follows 1 week URTI
    • Can lead to hypoxemia
    • >60 breaths/min – Urgent hospital.
    • Fever, nasal drip, cough, dyspnea ,expiratory wheezes and crackles, hyperinflated chest, laboured breathing, hypoxia
    • Irritability, poor feeding, vomitting
    • Wheezing and crackles on auscultation
  49. What is the management for bronchiolitis?
    • Prevention is by proper hand washing
    • Can be managed in outpatient, but some require hospitalization (especially young infants)
    • Adequate fluids for hydration
    • Supplemental 02
    • Sometimes use of bronchodilators and steroids
  50. What are the differentials for back pain in a child?
    • trauma
    • UTI
    • discitis
    • tumours
    • infections
  51. What range of motion will a child refuse to do if they have discitis?
    Flexion of the spine
  52. On an x-ray what will you see in a child who has discitis?
    Disc space narrowing
  53. What is the management for a child with discitis?
    Immobilisation and antibiotics
  54. What is the management for a child with osteomyelitis?
    • IV antibiotics
    • Oral antibiotics
    • Limb immobilization: reduce spreading of infxn via lymphatic channels, pain reduction
    • Surgical drainage if pus in bone
    • Px: dependent on length until diagnosed, late detection (7-10days) bone structure loss, growth abnormality
  55. What is the most common malignancy diagnosed in children?
    Leukaemia ALL
  56. What is the pain with osteoid osteoma relieved with?
  57. What is ADHD?
    A disorder affecting neural connections and pathways, leading to problems with fouc attention, and/or behaviour
  58. What are the hyperactivity S + Sx?
    6/9 criteria DSM-IV
    • 1. Often fidgets with hands or feet or squirms in seat
    • 2. Often leaves seat in classroom or in other situations in which remaining seated is expected
    • 3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents and adults, may be limited to subjective feelings of restlessness)
    • 4. Often has difficulty quietly playing or engaging in leisure activities
    • 5. Often on the go or often acts as if driven by a motor
    • 6. Often talks excessively
    • 7. Often blurts out answers before questions have been completed
    • 8. Often has difficulty awaiting turn
    • 9. Often interrupts or intrudes on others (eg, butts into conversations or games)
  59. What are the innattention S + Sx?
    6/9 criteria DSM-IV
    • 1.Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
    • 2.Often has difficulty sustaining attention in tasks or play activities
    • 3.Often does not seem to listen when spoken to directly
    • 4.Often does not follow through with instructions and often fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
    • 5.Often has difficulty organizing tasks and activities
    • 6.Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (eg, schoolwork, homework); often loses things necessary for tasks or activities (eg, school assignments, pencils, books, tools, toys)
    • 7.Often is easily distracted by extraneous stimuli (eg, toys, school assignments, pencils, books, tools)
    • 8.Often is forgetful in daily activities
  60. What is the management for ADHD?
    • Behavioural modification, psychology, counselling
    • Meds: Ritalin, Dexamphetamine
    • Avoiding food additives, colours, caffeine, evidence for other dietary modification
    • Chiropractic!
  61. What are the side/adverse effects of ritalin?
    • Nervousness, insomnia
    • Hypersensitivity (skin), anorexia, nausea, dizziness, blood pressure and pulse changes, both up and down, tachycardia, angina, cardiac arrhythmia, abdominal, weight loss during prolonged therapy.
  62. Why recommend heart check ups for a kid on ritain?
    • Increases heart rate
    • Increases blood pressure
    • Very important if child has congenital heart disease or arrhythmias with pre-disposition for cardiac arrest
    • ECG suggested as some conditions may not be detected on routine physical examination
    • ECG will be likely to detect cardiac conditions
  63. What is PDD (pervasive developmental disorder)?
    a category of neurological disorders characterized by "severe and pervasive impairment in several areas of development," including social interaction and communications skills (DSM-IV-TR).
  64. What are the 5 disorders under PDD?
    Autistic Disorder, Asperger's Disorder, Childhood Disintegrative Disorder (CDD), Rett's Disorder, and PDD-Not Otherwise Specified (PDD-NOS).
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