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At what age do temper tantrums typically begin?
Tics are characterized by slow, rhythmic, voluntary movements.
False
What is a common simple vocal tic?
Throat clearing
Tourette's syndrome is characterized by the presence of both motor and vocal tics for at least ___ year(s).
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Match the following types of tics to their descriptions:
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What is a long-term problem associated with growth and development?
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Behavioral therapy is suggested for treatment at 5 years of age.
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What is PICA?
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The consumption of inedible substances like chalk or paint for at least one month is known as __________.
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Match the following issues with their respective categories:
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Which of the following is NOT a cause of congenital developmental delay?
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Developmental deviance refers to the loss of previously acquired milestones.
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Provide an example of a condition associated with regression in developmental milestones.
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___ infections are a known cause of congenital developmental delay.
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Match the following types of developmental disorders with their characteristics:
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What is the developmental quotient (DQ) if a child has a developmental age of 24 months and a chronological age of 30 months?
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A global developmental delay is indicated when there is a delay in only one developmental domain.
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What is the upper limit for achieving head control in infants?
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The formula for calculating corrected age is: Corrected age = Postnatal age - ________.
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Match the developmental screening test with its mnemonic:
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What is a common factor that can trigger a breath holding spell in infants?
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Breath holding spells can persist until the age of 5 years.
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What is the recommended dosage of iron for preterm breastfed babies with a birth weight of 1.5-2.5 kg?
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What management step should be taken during a tonic clonic episode of a breath holding spell?
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Preterm breastfed babies do not require any supplementation.
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What supplements are recommended for preterm breastfed babies weighing 1.5-2.5 kg?
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In the pallid type of breath holding spell, the child becomes _____ and may develop a syncope-like attack.
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Match the type of breath holding spell to its corresponding description:
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For human milk fortification, preterm babies require __________, Vitamin D, and Vitamin K.
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Match the following supplements to their intended purpose for preterm breastfed babies:
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Which of the following is a primary cause of nocturnal enuresis?
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Secondary nocturnal enuresis occurs in individuals who have previously been dry at night for at least 6 months.
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What is the management approach that has the highest success rate for treating nocturnal enuresis?
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Passing urine at night time only is classified as __________ nocturnal enuresis.
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Match the following management strategies with their descriptions:
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What is one of the characteristics of transitional milk?
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Mature milk is secreted before 14 days after birth.
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List two deficiencies commonly found in breast milk.
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The main function of hindmilk is to provide __________.
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Match the following types of vitamins with their supplementation dosages:
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What is the recommended time frame for initiating breastfeeding after birth?
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Exclusive breastfeeding is advised for infants up to 8 months of age.
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What is the primary feeding method for preterm babies born before 28 weeks gestation?
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The baby's mouth should be wide open and the ______ should touch the breast for correct latching.
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Match the gestational age with the appropriate method of feeding:
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What is the primary immunoglobulin found in colostrum?
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Human milk oligosaccharides (HMOs) are digestible substances that promote gut health.
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What is the caloric value of breast milk per 100 mL?
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The predominant protein type in breast milk has a whey to casein ratio of ___ to ___.
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Match the following types of milk with their characteristics:
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Study Notes
Temper Tantrums
- Begins around 18-36 months of age and can persist until 6 years old
- Characterized by physical and emotional outbursts, such as crying, kicking, pushing, and head banging
- Management includes:
- Reassuring parents to remain calm
- Leaving the child alone in a safe space
- Distraction techniques
- Time-out techniques
Tics
- Rapid, involuntary, repetitive movements or vocalizations
- Onset usually occurs between 4-6 years old, peaking at 10-12 years old and persisting until 18-20 years old
Motor Tics
- Simple: Eye blinking, Neck jerking, Shoulder shrugging
- Complex: Echopraxia (repeating movements or postures of others)
Vocal Tics
- Simple: Repeated throat clearing, Coughing, Sniffing
- Complex: Echolalia (repeating other's speech), Palilalia (repeating one's own words or sentences)
Tourette's Syndrome
- Onset before 18 years old
- Characterized by both motor and vocal tics for at least one year
- Management includes:
- Behavioral therapy
- Neuroleptics (Haloperidol, Clonidine) for long-lasting tics
Growth and Development
- Long-term problems: Dental malocclusion, Jaw pain
- Treatment: Behavioral therapy for children over 5 years old
PICA
- Consumption of non-nutritive substances (e.g., chalk, mud, paint) for at least one month
- Inappropriate for the child's developmental stage and cultural practices
Causes of Developmental Delay
Congenital Causes
- Chromosomal abnormalities (e.g., Down's syndrome)
- Genetic syndromes (e.g., Fragile X syndrome, Rett syndrome)
- Congenital hypothyroidism
- Brain anomalies
- TORCH infections
Acquired Causes
- Severe head trauma
- Meningitis
- Perinatal asphyxia
Variants of Developmental Disorders
-
Developmental dissociation: Variation in milestone attainment between two or more domains
- Example: Isolated language delay due to a hearing deficit
-
Developmental Deviance: Attainment of milestones out of the normal sequence
- Example: Early rolling (head control develops later) due to increased extensor tone in cerebral palsy
-
Regression: Loss of previously acquired milestones
- Example: Rett syndrome, Subacute sclerosing panencephalitis (SSPE), Leukodystrophy
Disorders of Development
-
Developmental quotient (DQ)
- Formula: DQ = (Developmental age (DA) / Chronological age (CA)) x 100
- Developmental delay: DQ < 70
- Global developmental delay: Delay in ≥ 2 domains, indicating a significant neurological disorder (e.g., cerebral palsy)
-
Evaluation of a preterm baby:
- Corrected age = Postnatal age - Preterm correction
- Preterm correction (calculated up to 2 years): 40 weeks - Actual weeks of gestation of preterm baby
Red Flag Signs for Developmental Delays
-
Milestone: Visual fixation or following
- Upper limit: 5 months
-
Milestone: Head control
- Upper limit: 6 months
-
Milestone: Vocalization
- Upper limit: 10 months
-
Milestone: Sitting without support
- Upper limit: 12 months
-
Milestone: Standing with support
- Upper limit: 12 months
-
Milestone: Standing/walking without support
- Upper limit: 18 months
-
Milestone: Single words
- Upper limit: Not specified
Tests for Developmental Assessment
Screening tests (Mnemonic: Good Doctor Treats Patients)
- Goodenough-Harris 'Draw a man' test
- Denver II
- Trivandrum development screening test
- Phatak's Baroda screening test
Definitive tests
- Bayley II scale (Infant and toddler development)
- Stanford Binet Intelligence scale
- Wechsler Intelligence scale
- Vineland adaptive behavior scale II
Behavioral Disorders in Children
Breath Holding Spells
- Reflexive event
- Begins around 6 months of age, peaks by 2 years, and persists till 5 years
- Sequence of events: Provocative factors (anger, pain) → baby cries → holds breath in full expiration
Types
- Cyanotic breath holding spells: Due to increased sympathetic activity (most common); Cyanosis occurs, but the child returns to normal after a few seconds; If persistent, may develop tonic-clonic movements
- Pallid type: Due to increased parasympathetic activity; Child becomes pale and develops a syncope-like attack (lasting a few seconds); If persistent, an ECG should be performed to rule out Long QT syndrome
Management
- Reassure parents (benign condition that resolves spontaneously)
- Turn the child sideways during a tonic-clonic episode (to prevent aspiration)
- Avoid picking up the child during the episode (can cause sudden decrease in cerebral perfusion)
- Evaluate and treat for iron deficiency anemia
- Atropine can be used for long-duration pallid spells
Bruxism
- Teeth grinding
- Onset and occurrence:
- Usually occurs after 5 years old (but can occur in preschool children)
- Associated with anxiety and stress disorders
- Often occurs during sleep
Management
- Reassure parents
- Treat underlying stress or anxiety
- Mouth guards may be used during sleep
PICA
- Consumption of inedible, non-nutritive substances, such as dirt, paint, or plaster
- Occurs between 18-24 months of age
- Often associated with iron deficiency anemia, developmental disabilities, or psychological disorders
- Requires medical evaluation and management
Supplementation in Preterm Breastfed Babies
| Birth weight | Supplements | Preterm birth | Human milk fortification (HMF) |
|---|---|---|---|
| 1.5-2.5 kg | Iron (2 mg/kg/day) up to 1 year of age, Vitamin D, Vitamin K | Yes | Vitamin D, K, and Iron |
| < 1.5 kg | Iron (2 mg/kg/day) up to 1 year of age, Vitamin D, Vitamin K | Yes | Vitamin D, K, and Iron |
Nocturnal Enuresis
- Nearly complete bladder evacuation at night (≥ 5 years) for at least 2 times a month for 3 months
- More common in males than females
Types
Based on Etiology
- Primary (most common): Bedwetting since birth; Etiology: Delayed bladder maturation, Decreased ADH secretion at night
- Secondary: Previously dry at night but now bedwetting; Etiology: UTI, Diabetes Insipidus (DI)/Diabetes Mellitus (DM), Stress, Bowel-bladder dysfunction
Based on Symptomatology
- Monosymptomatic (most common): Passing urine at night
- Polysymptomatic: Passing urine at night + lower urinary tract symptoms (LUTS) (hesitancy, urgency, dribbling)
Management
-
Motivational + alarm therapy: Highest success rate (60-70%)
-
Non-Pharmacological:
- Reassurance
- Behavioral modifications (voiding before bed, restricting fluids in the evening, avoiding caffeine)
- Motivational therapy (verbal praise, rewards for dry nights)
- Alarm therapy: Conditioning the child to the sensation of a full bladder (sensors in underwear to detect wetness and wake the child; simple alarms set to the usual bedwetting time)
-
Pharmacological:
- Short-term: Oral desmopressin
- Long-term: Oxybutynin / Tolterodine (decrease uninhibited bladder contractions)
- Imipramine: Not used due to adverse cardiovascular side effects
Breastfeeding
- Initiation: As early as possible within 1 hour after birth
- Exclusive breastfeeding: Infant only receives breast milk for the first 6 months of life
-
Correct latching position:
- Mouth covers areola
- Lips are flanged out (eversion)
-
Correct infant latch on position:
- Mouth wide open
- Chin touches the breast
Neonatal Reflexes Assisting Breastfeeding
- Rooting reflex: Nipple touches the mouth, initiating the reflex
- Sucking and swallowing reflex: Facilitates milk intake
Feeding in Preterm Babies
| Gestational age at birth | Method of feeding |
|---|---|
| < 28 weeks | Total Parenteral Nutrition (TPN) |
| 28-31 weeks | Expressed breast milk via nasogastric or orogastric tube |
| 32-34 weeks | Feeding breast milk by paladai or katori spoon |
| > 34 weeks | Direct breastfeeding |
Properties of Breast Milk
Immunological Properties
- PLABB: Low levels of Para Amino Benzoic Acid (PABA) protect from malaria, Lactoferrin protects from E.coli, IgA is the predominant immunoglobulin in colostrum, Bifidus factor promotes the growth of Lactobacillus bifidus, Bile salt-stimulated lipase protects from giardiasis, Epidermal Growth Factor (EGF) promotes intestinal maturation, reducing the risk of bacterial infection
Human Milk Oligosaccharides (HMOs)
- Most abundant solid in breast milk
- Non-digestible, acting as a prebiotic
- Increase favorable gut bacteria, reducing the risk of diarrhea and necrotizing enterocolitis
Nutritional Properties
- Nutritive value: 67 kcal/100 mL
| Nutrient | Features |
|---|---|
| Carbohydrates | 6-7 g/dL (more than in cow milk). Lactose breaks down into Glucose + Galactose; Galactocerebroside promotes myelination |
| Proteins | 0.9-1.1 g/dL (lower than in cow milk). Less protein means a lower solute load on kidneys, making it kidney-protective. Whey: Casein ratio is 80:20; Amino acids: Taurine & cysteine |
| Fats | 3.5-4 g/dL (equal to cow milk). Rich in Polyunsaturated Fatty Acids (PUFAs) (e.g., DHA: Docosa Hexanoic Acid); Promotes myelination. Easily digestible. Promote brain growth. |
- Note: Cow milk is high in casein, which coagulates in the intestine, forming curd that is not easily digestible.
Composition of Breast Milk
-
Colostrum:
- Secreted during the first 3-4 days
- Thick and lemon yellow-colored
- Rich in IgA, Vitamin A, and anti-infective protein (Lactoferrin) (mnemonic: 3 AS)
Transitional Milk
- Secreted after 5-14 days
- Increased sugar and fat
- Decreased protein and lactose
Preterm Milk
- Milk secreted by mothers of preterm babies
Mature Milk
- Secreted after 14 days
- Compared to colostrum:
- Contains more Sodium, Iron, Protein, and Sugars (Calories) (mnemonic: SIPS)
Fore Milk and Hind Milk
| Foremilk | Hindmilk | |
|---|---|---|
| Production | At the initiation of feeding | Towards the end of feeding |
| Consistency | Thin | Thick |
| Main component | Water | Fats |
| Function | Quenches thirst | Satiety (energy dense) |
| Appearance | White | Yellow |
Deficiencies in Breast Milk
Micronutrients
Vitamins
- Vitamin K
- Vitamin D
- Vitamin B12 (in vegetarian/vegan mothers)
Supplementation
| Vitamin | Dose |
|---|---|
| Vitamin K | 1 mg IM on the anterolateral aspect of the thigh (0.5 mg dose if birth weight < 1 kg) |
| Vitamin D | 400 IU/day orally up to 1 year of age |
Others
- Iron
- Zinc (not supplemented due to good bioavailability)
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Description
This quiz covers essential concepts related to temper tantrums and tics in children, including their onset, characteristics, and management strategies. Explore the complexities of motor and vocal tics, alongside insights into Tourette's Syndrome, all crucial for understanding child behavior and psychology.
