Within the first 100 days of gestation

Then they divide and multiply

Don't regenerate or if they do it's very slowwwwwly.

Any complications are SERIOUS! and often permanent

Spina bifida

Spina Bifida oculta

Spina bidia cystica (meningocele, myelogmeningocele)

Failure of posterior lamina of the vertebrae to close.

Meninges and spinal cord can protrude.

Cause: genetic predisposition, folic acid deficiency

hidden defect. Nothing external.

L5S1, slight dimple in skin or tuft of hair.

Doesn't present any problems.

protrusion.

(meningocele, myelomeningocele)

Meninges protrude, sac protrudes.

Herniation of the meninges, but no nerves roots of the tissue.

No paralysis/sensory loss.

Sac could rupture/perforate and can get meningitis.

spinal nerves and sometimes part of the spinal cord protruding out of the defect.

no innervation, no sensation. paralysis below site.

*more severe form

nerve roots embedded in sac.

impacts bowel and bladder spchinter.

In utero 13-16weeks. Alpha fetoprotein blood test. Look for elevated levels which can indicated possible neural tube defects. Not 100%

Ultrasound, CT/MRI (after born, to see extent of involvement of nerves)

Have to do C section if cyst is protruding (spina bifida cystica), surgical correction usually within 12-18 hours ideally.

Protect integrity of sac

Cover with sterile dressing

monitor for infection

have them lie in prone position

if paralysis do ROM and skin care

Emotional support

Post op care and teaching

*does not affect their intelligence!

excesssss of cerebrospinal fluid within ventricles of brain "water in the brain"

Noncommunicating & communicatingg

Can result from head injury/meningitis

Obstruction present so CSF cannot pass b/w ventricles and spinal cord.

Most cases.

enlarged head at birth, anterior fontanel buldges, shiny scalp, veins prounounced and dilated, setting sun eyes

Increased intracranial pressure, lethary, vommitting, irritability, high pitched cry*

ultrasound in utero

Catscan, MRI

ventriculography (watch flow of fluid to see if it's communicating or noncommunicating)

relive ventricular pressure

Shunt placement. Divert fluid from ventriculars to different part of body.

Most common: VP- ventriculoperitoneal (ventricles to peritoneum where it's absorbed)

VA-ventriculoatria (ventricles to R atrium)

Both will need revised when child grows.

Possible for infection or obstruction especially in first month

Keep them flat, take head circumferences, postion on non operative side, do neuro checks

Observe for abdominal distention, check incision sites, monitor for infection, check bowel sounds & abd girth

Do parent teaching

chromosomal abnormality (most common in infants)

Etiology unknown.

Risk increases for women pregnant 35 and older.

3 chromosomes at position 21.

Should be only two at every postion.

can cause mild to severe mental impairment

shortness of head, flat forehead (can sometimes be picked up on ultrasound)

upward and outward slant to eyes with epicanthic fold. (fold of skin over inner canthus of eyes)

short fattened bridge of the nose, neck short and wide

hands short with simian crease (straight across instead of angle)

moro/startle reflex is abscence. tongue tends to be thick and may protrude.

congential heart defects, respiratory infection

diabetes, leukemia and hearing loss

their growth in ht and wt is diminished.

Wt is disproportionate to body, Tend to be overweight.

clinical symptoms, AFP, ultrasound

Choirinac villus sampling (12 weeks)

amniocentesis (final-20 weeks)

No cure.

Manage respiratory issues.

They need some amount of lifelong assistance.

can still be productive in society!

Acute encephalitis or inflammation of brain following viral illness (chicken pox, upper respiratory infection)

Can have fatty degeneration of liver and other abd organs (spleen & stomach)

Linked to administration of ASA during viral illness or ASA compounds or salicilayte base products.

3 days to 3 weeks after initial illness child starts severe vomitting.

irritability, lethargy and confusion.

early dx and aggressive tx essential

often child is in ICU

tx based on symptoms

meds to reduce cerebral edema

do neuro checks, I&O, med admin, and parental support

reenforce avoidance of ASA use!!!

Inflamm of meninges caused by 

bacterial-meningococci, pneumococci, haemophilus influenza (most severe form)

virus

TB

Bacterial: vaccines avaliable meningococcal most severe form.

Viral meningitis can't do anything about. Have to just let it run it's course.

high pitched cry, fever, diarrhea, muchal rigidity (stiff neck), vomitting, h/a, irritability

convlusions, coma in less than 24 hours (especially older child)

hemorrhagic rash(meningococcal)

DX: early dx is essential for complete recovery. LP, possibly nose & throat cultures.

TX: isolation, possibly ICU, IV antibiotics for bacterial, hydration, NSAIDs for fever and pain, steriods will help decrease risk for neurological complications (deafness)

Anticonvulsants (if convulsions), needle aspiration of fluid in subdural space (this fluid can cause symptoms)

Close observations of vital signs & LOC, side lying postion, I&O and electrolyte check, emphasize need for immunizations

Periods of sudden discharge of electrical activity in brain that causes involuntary muscle activity, changes in LOC or altered beavior and sensory manifestation.

May be a result of genetic favots, pathologic condition or rapid temp elevation.

peidatrics usually

rise in temperature at any temp can happen.

Recurrent/chronic seizures

Primary-no known cause

Secondary-head trauma/disease

febrile seizures occur suddenly, child is irritable, restless

may have tonic clonic movements-sustained contractions of skeletal muscles that occur involuntary followed by clonic phase-quick jerking movement of arms, legs, and facial muscles.

epileptic seizures may be partial seizures which are limited to particular area of the brain or generalized which involve both hemispheres.

DX: EEG, CT scans, MRI

TX: anticonvulsants, surgery if cause is tumor, ketogenic diet (high in fat, low in carbs)

Safety of child is imporant, note time when seizure starts and stops as well as factors occuring before onset.

Evaluate after for LOC, pupil response, general behavior.

Teach parents to avoid triggers like blinking lights, excess activity/exercise.

Group of disorders that is a result of malfunction of motor centers and neural pathways in brain affecting motor function and posture.

Most common permanent physical disability in childhood.

Prenatal, perinatal, and postnatal factors may contribute to development.

Prenatal: maternal infection, nutritional deficiences, RH incapability, any O2 problems

Perinatal: anoxia (without O2) before, during, or after birth, birth trauma, prematurity, interference with respiratory function

Postnatal:head trauma, infection, CVA

Prenatal-keep track of nurtion

Perinatal-babies response to contraction. Possible with c sections to reduce trauma.

Postnatal-teach parents how to keep child safe and prevent injuries.

Primarily characterized by abnormal muscle tone and lack of coordination.

Seizures, mental impairment, sensory defects, behvarior disorders, difficulty meeting milestones.

Signs right after birth: weak/absent sucking, jitterness, and slow/absent reflexes.

Involves one or both sides

Impairment of fine and gross motor skills.

Hyperactive stretch reflex in affected muscle groups.

Increased activity of deep tendon reflexes.

Clonus (rapid, involuntary muscle movement)

Scissor like gait. Contractures affecting extensor muscle of legs especially heels (walk on toes)

Abnormal involuntary movement. Can't sit still.

Constant slow, wormlike writhing movement. Usually of extremities, trunk, neck, facial muscles, and tongue.

Involvement of pharyngeal, laryngeal, and oral muscles cause drooling and poor speech.

May not be diagnosed until child starts to walk.

Wide based gait, lack of coordination particullarly of upper extremities.

Sometimes have combinations of CP, which are more severe.

May not occur until child tries to walk

Neuro exam

HX are primary focus

MRI and nerve conduction studies to show abnormal motor function

Focus on improving motor functions and communication skills to help child read highest potential.

Child needs to maintain muscle tone as much as possible.

Wear braces, do exercises, prevent further contractures.

They don't focus clearly until 2 months.

Visual acuity is 20/20 by age 7.

Is acute from the beginning.

Eustachian tube is straight then begins to angle down. Ear infections are common.

eye muscles are uncoordinated so they can't direct their focus at an object at the same time.

Child gets diplopia (double vision)

They squint/close one eye often or frown.

They reach for object and grab next to it.

If one eye they path the unaffected eye. Forces the bad eye to develop muscles to focus.

Eyedrops, orthoptics, lenses

Last resort: surgery

DX & early TX to prevent vision loss.

Strabismus can lead to this! 

Reduced visual acuity in an eye.

S/SX: deviation of eye, can be asymptomatic.

TX:by 5 or 6 patching, corrective lenses, early tx!

Styes, inflammation right around inner canthus, not usually contagious.

S/SX: bump, sore

TX: warm compress, tea bags

Inflamm of eye.

Can be caused by allergies, irritants/foreign bodies, viruses, bacterial (contagious)

S/SX: drainage, crusting, yellow gunk (isolate) Not all forms are contagious

Infants can get blocked lacrimal ducts.

DX: culture any drainage or by symptoms.

TX: antibiotics, wash linens, good handwashing, good disposal.

Common in infants (3/1,000)

Causes: inherited, prenatal infection, perinatal anoxia, childhood infection.

Can range from slight hearing loss to total deafness.

Vary depending on hearing loss.

Not responding. No startle reflex.

Speech affected. (use nonverbals)

They ask you to repeat things a lot.

Talk loudly.

DX: by audiometer when older.

message is not getting from ear to brain.

Hearing aide is useful!

cochlear implant surgically implanted electrically stimulates cochlear nerve to hear.

can take from deafness to hearing sound, but person won't hear the same as you and I hear.

Very common b/c of structure of eustacian tube. It's shorter & wider so bacteria sits in there.

Increased incidence in babies that are bottle fed, 2nd hand smoke, and upper respiratory infections.

Similiar to upper respiratory infection.

Congestion & fever

Ear discomfort & pain

Crying & pulling on ear

Waking up during night

Vomitting & diarrhea

Bleeding (d/t rupture)

DX:  Visual look at internal ear. Normally looks pearly gray and has light reflex.

If otitis media it will be red, inflammed, buldging, and have no light reflex.

If eardrum ruptures purulent discharge and bleeding will occur. They'll not be as irritable b/c pressure will be released.

TX:  for eardrops for children pull down & back.

Antibiotics & decongestants.

Use prophalatic antibiotics or do myringotomy (tubes in ears so drainage can leak out)

Tubes are in for 6-12 months. Can cause hearing loss for as long as 6 months.

Any hearing loss can affect child's speech.

Prevention: Don't prop bottle, hold them properly.

Deficiency in growth hormone.

Slows down childs growth in ht & development

Can be a result of injury/disease of hypothalamus or pituitary gland

Such as tumor, infection, or if it's inherited.

CHild will look well nourished, but short stature.

They might even be over weight.

B/c growth hormone affects all cells they are prone to hypoglycemic seizures, hyponatremia (low sodium), jaundice, and some males are prone to undescened testes.

if not treated they'll keep high pitched voices, youthful faces, delayed skeletal and sexual maturity

DX: test for levels of growth hormones, check growth patterns, and check blood levels

TX: based on cause. injections of growth hormone 3-7 times a week for about a year until normal ht is achieved. 

Freq monitoring.

thyroid disorder. absent/deficient in thyroid hormone.

S/SX: few months after birth symptoms occur.

Thickening of tongue and lips, puffy eyes

dull expression, often develop jaundice

feeding problems, lethargic

poor muscle tone affects mobility so they have chronic constipation and abdominal bloating

All newborns are required to have mandatory T4 and TSH levels drawn.

If TX is not started early enough it can lead to mental impairment and cannot be undone.

TX: Synthroid/thryoid drug for rest of life.

Usually dysfunction of the ceells that are supposed to be secreting insulin.

S/SX: polyuria, polydypsia, polyphagia

Have ABRUPT onset. Adults tend to have gradual onset.

Kids may also have wt loss, H/A, fatigue

DX: checking glucose levels.

TX: insulin, diet, exercise, going to need insulin almost all cases. many children are on insulin pump. 

It's a lifelong experience.

***watch for S/SX of hypo & hyperglycemia