ELS 2010...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 auraA) At least 5 attacks fulfilling criteria B through DB) Lasting 1 to 72 hoursC) 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

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

Simple Complex (30%)

6 months to 6 years <6 months, >6 years

Generalized Focal

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 ReflexesReflex Method Response Disap-pearance

Palmar grip Placing index in palm of infant

Flexion of fingers 6 months

Plantar grip Pressing a thumb against the sole just behing the toe

Flexion of toes 15 months

Galant Scratching 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

ATN Rotation 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

Moro Sudden head extension produced by a linght drop of the head

Abduction followed by adduction and flexion of the upper extremities

6 months

Questions ?