Peds Exam 1 Content PDF

Changes in Systems during Infancy, Childhood, and Adolescence Changes in all systems begin before birth  Skeletal System o Dynamic structure, changes caused by growth, external forces/loading, internal forces/muscle pull o Typical changes in hip o Asymmetric growth in hemiplegia o Increasin...

Changes in Systems during Infancy, Childhood, and Adolescence Changes in all systems begin before birth  Skeletal System o Dynamic structure, changes caused by growth, external forces/loading, internal forces/muscle pull o Typical changes in hip o Asymmetric growth in hemiplegia o Increasing height during childhood = LE length; in adolescence = trunk length o When bone growth outpaces changes in muscle length à (temporary) decreased flexibility o Children and adolescents more susceptible to injury involving stresses at/across epiphysis and epiphyseal plate, and apophysis o Importance of nutrition and physical activity o 50% peak bone mass by 10 yrs, 90% by 20 yrs  Spinal curves develop as infants gain control/experience in various positions (see above) With upright WBing/walking: Sacral curvature increases, ilia thicken, acetabular depth increases, acetabular roof rotates (near-vertical to forward inclination)  Femoral angle of inclination decreases – Better hip abductor force production Femoral torsional changes, femur becomes less anteverted Changes in tibial torsion – From initial internal torsion, to external torsion Femur:tibia – Genu varum at birth, max genu valgum 3 yrs, decreases to adult values Initial varus in calcaneus and forefoot – Forefoot varus may persist until 2 yrs Muscular System o Strength increases associated with increased muscle size and muscle maturation o After birth, growth in muscles is mainly due to increase in size of fibers o Continued differentiation of fiber type o e.g., Children < 15 yrs have significantly greater distribution of Type I fiber in VL (compared to adults) o “slow-twitch” muscles: needed for postural control o “predominantly fast-twitch” muscles: not until young adulthood o Muscle length must keep up with skeletal growth, by adding sarcomeres o If not, _________-_________ ____________ is disturbed o Linear increase in strength, accelerates for males after puberty o Greatest differences (male:female) in upper body strength o Testosterone, growth hormone, insulin, thyroid hormone o Differences in preferred physical activity, and amount of PA Neuromuscular System o Brain increases in size and weight, due to… o Neuroplastic changes happen continually, especially with activity o Myelination of sensory and motor nerves continues o Into adolescence for some systems (e.g., proprioceptive neurons from LEs) Cardiopulmonary System o Heart and lungs increase in size/capacity o Heart size closely associated with weight, fat-free mass, and height o Arteries and veins grow/adapt to body and activity o Changes to walls of arteries -- increased thickness o Pulmonary structures grow/adapt to body growth and activity o Age-appropriate adaptations with physical activity/exercise Vital Signs Newborn (0-28 days) Preschool (3-5 years) Axillary Temp: 97-100.4 Axillary Temp: 97-100.4 HR: 70-120 HR: 120-140 Premie HR: 100-199 Respiratory Rate: 20-30 Respiratory Rate: 30-60 BP: 92-116/56-75 BP: 60-80/35-55 Premie/LBW BP: 40-60/20-35 Gain 5-6 lbs per year Grow 2.5 – 3” per year Infants (1 – 12 months) Axillary Temp: 97-100.4 School age (6-12 years) HR: 80-180 Apical Temp: 97-100.4 Respiratory Rate: 30-60 HR: 60-105 BP: 50-100/25-70 Respiratory Rate: 18-26 Premie BP: 40-60/20-35 BP: 94-130/56-85 Gain 4-7 lbs per year Toddlers (1-3 years) Average onset of puberty (US): Axillary Temp: 97-100.4 10 yrs for females, 12 yrs for males HR: 70-160 Respiratory Rate: 24-34 BP: 80-110/54-73 Adolescent (13-18 years) Axillary Temp: 96.4-99.4 Gain 4-6 lbs per year HR: 50-95 Grow 3” per year Respiratory Rate: 12-20 BP: 100-140/60-88 Peds-specific Outcome Measures Assessment labs with typically developing infants/children Assessments of typically developing infants/children BEFORE labs: Become familiar with assessment tools (watch videos, in lab 1/21), determine chronological age, know what to expect, have forms/paper ready DURING labs: Observe posture and movement in all positions Complete developmental test What other movements would you want to see? How might you encourage/elicit movements by placement of toys, playing games, verbal requests, demonstration, etc.)? Also get as much BSF/impairment level info as possible (ROM, strength, muscle tone, developmental reflexes, sensory systems, etc.) Determine Chronological Age Testing Date: Year Month Day Date of Birth: Year Month Day Start at the right, work your way left, carry over when needed. Is child less than 2 years of age? o No-STOP o Yes---->Was child born 4 or more weeks early? § No-STOP § Yes--->Subtract the weeks early to determine ADJUSTED age that you use for standardized test Practice Chronological Age Date of Testing: Today's Date Date of Birth: November 10, 2022 Child was  2025 Possible DOB of Baby Volunteers Calculated Chronological Age DOB (use next week's testing date) Students Assigned 4/5/24 4/5/24 05/06/24 04/01/2024 06/12/2024 09/16/2024 07/01/2024 02/25/2024 05/30/2024 5/26/2024 12/5/2024 10/18/24 4/11/2024 05/08/2024 HAMMERSMITH INFANT NEUROLOGICAL EXAMINATION (HINE)  HINE Early neurological examination tool for the diagnosis of Cerebral Palsy (CP) Since its introduction, the HINE has been used in different high- and low-risk populations, both for preterm and for term-born infants Proposed as a tool for prognosis, diagnosis, and rehabilitation Recommended in the International Clinical Practice Early Diagnosis of Cerebral Palsy Guidelines Bosanquet M, Copeland L, Ware R, Boyd R. Dev Med Child Neurol 2013; 55: 418–26 Haataja L, Mercuri E, Guzzetta A, et al. J Pediatr 2001; 138: 332–37 Frisone MF, Mercuri E, Laroche S, et al. J Pediatr 2002; 140: 57–60  HINE Simple and scorable method Designed for evaluating infants between 2-24 months Includes 26 items 5 subsets: cranial nerves, posture, movement, tone, and reflexes Can be performed in 5-10 minutes Good sensitivity and high predictive value for risk of CP in high risK populations under 5 months Good interobserver reliability Bosanquet M, Copeland L, Ware R, Boyd R. Dev Med Child Neurol 2013; 55: 418–26 haataja l, mercuri e, regev r, et al. J Pediatr 1999; 135: 153–61 HINE Scoring Each item is scored separately Score ranges from 0-3 0- minimum score 3- maximum score Individual scores can be added to achieve Global Optimality Score Global score ranges from 0-78 Minimum 0 (if all the items score 0) maximum score of 78 (if each item scores 3) Romeo D, Ricci D, Brogna C., Mercuri E. Dev Med Child Neurol 2016; 58: 240-245 Optimal HINE Scores Global scores are reported as optimal if they are: equal or above 67 at 3 months equal or above 70 at 6 months equal or above 73 at 9 to 12 months The lower scores with decreasing age are due to a small number of items that follow the development of some activities related to trunk control. Romeo D, Ricci D, Brogna C., Mercuri E. Dev Med Child Neurol 2016; 58: 240-245  HINE Scores for Prediction of CP HINE scores at 3, 6, 9 or 12 months: 50-73 indicates likely unilateral cerebral palsy (i.e. 95-99% will walk) hands out vs. on hips Verbal instructions vs demonstration (e.g., kids with autism) Document adaptations, observed performance if items modified What can they do? (best performance; capacity) vs What do they do? (usual/typical performance) Assessment labs with typically developing infants/children Assessments of typically developing infants/children BEFORE labs: Become familiar with assessment tools (watch videos, in lab 1/16), determine chronological age, know what to expect, have forms/paper ready DURING labs: Observe posture and movement in all positions Complete developmental test What other movements would you want to see? How might you encourage/elicit movements by placement of toys, playing games, verbal requests, demonstration, etc.)? Also get as much BSF/impairment level info as possible (ROM, strength, muscle tone, developmental reflexes, sensory systems, etc.)  Determining “percent delay” in development Determine “Age Equivalent” or “Developmental Age” on a standardized exam Use adjusted chronological age if needed (Chronological age – Age equivalent) divided by Chronological age, x100 = % delay Chronological age – Age equivalent X 100 = % delay Chronological age  PDMS-3 Gross and fine motor developmental assessment, birth-72 months (6 years) Start at recommended place for child’s age Administer items in that area to establish “Basal age”, then proceed with increasingly difficult items to establish “Ceiling age” basal age: Three consecutive “2s” ceiling age: Three consecutive “0s” Administer three subtests (Body Control, Body Transport, Object Control) Supplemental Subtest: Physical Fitness Scoring -- Online Scores for each subtest Raw score Percentile Standard Z score Age equivalent Gross Motor Quotient (GMQ), GMQ percentile, GMQ Z score  AIMS Gross motor development, birth to ~18 months Observe infant in four “sequences”: supine, prone, sitting, standing Mark each item/posture/movement you observe, in each sequence Mark with an “O” for “Observed” Create “window” for each sequence (earliest skill observed to latest/highest skill observed) Similar to “basal” and “ceiling” on PDMS Give 1 point for each item observed within the window, and all items left of/before the window Record total score in each sequence Find percentile/percentile range on chart on back Total score on y-axis, age on x-axis On chart, be specific to WEEKS of age (each vertical line = one week) HINE Standardized neurological exam for 3-24 months 26 items in five domains cranial nerve function, posture, quality and quantity of movements, muscle tone, and reflexes and reactions. Score 0-3 for each, based on description/observation maximum global score=78 Cutoffs available for predicting cerebral palsy A HINE score < 57 at 3 months 96% predictive of cerebral palsy (sensitivity 96%; specificity 87%) Can predict severity of motor deficits in children with cerebral palsy Also includes developmental milestones and behavioral items (not scored) HINE videos Link to HINE Video (how to) and Score Sheet Video is 43 minutes, but the abbreviated helpful sections are listed below Easy to playback at 1.5-2x speed Cranial Nerves 7:37-8:50 (good video) Posture 10:07-14:00 Can provide as much support as needed Movement 14:08-15:05 Tone 15:05-19:20 (good descriptions) Reflexes and Reactions (good videos) 19:40-27:00 Scoring 27:09-28:52 Psychometrics PDMS-3 Test-retest reliability: r=.95,.96-.98 (gross motor and subtests) Concurrent validity: gross motor r=.61-.89 r=0.84, total motor r=.81-.95 High sensitivity and specificity to identify developmental delay AIMS Inter-rater reliability: r= 0.95 Test-retest reliability: r= 0.86-0.99 Concurrent validity with PDMS2: r=0.90-0.99 (TD), r=0.84-0.98 (at risk/atypical) HINE Inter-rater reliability: r= 0.97 (global score) Test-retest reliability: r= 0.97 (global score) Concurrent validity: global score with Infanib and pediatrician exam: r=0.94-0.98 Toddler/Child Prep and Debrief Infant Lab Lab Logistics 1. Instruction on PDMS3 administration and Scoring (30 minutes) 2. Work in your groups to (60 minutes) 1. Review PDMS3, all sections. 2. Plan for your toddler. What is their chronological age? Where and what are their entry skills on the PDMS3? How can you differentiate 0, 1, 2 3. View power point and video about Sensory Processing (see slides below) 4. Review the first slides in the typical development video class (1/16/2025-also attached end of this ppt) about other domains of development. To solidify your learning, go to pathways.org and watch videos about 1. https://pathways.org/ 2. Click on an age, click on milestones/abilities, view sensory, communication and social/play. 5. Discuss your infant goals and activities with faculty one-on-one (we will come around) 3. Debrief Infants and watch Videos of kids fast walking, running, and jumping. (30 minutes)  2025 Possible DOB of Toddler Volunteers DOB Students Assigned 10/12/2021 Sydney P and Madison G 9/21/2023 Katie and Alexis 5/17/2022 Danielle & Tanner 1/17/2024 Anna & Cassie T 11/1/2023 Megan & Abigail 7/4/2021 Kali H, Sawyer P 5/21/2019 Lucas & Logan 6/25/2021 Sam Morgan & Caitlyn Burkett 6/25/2021 Caroline F. & Caroline P. 12/8/2022 Erin C and Haley S 6/29/2021 Mallory, Sydney S., Alexis 9/25/2019 Alex M and Jess W 10/4/2022 McKenzie S and Cassie E 7/30/2021 Adam and Tyler 12/28/2022 Madison D and Jenny Practice Chronological Age/Adjusted Age 2025 1 30 Date of Testing: Today's Date - 2023 11 9 1 2 21 Date of Birth: November 10, 2023 (14x4) + 3 = 59 weeks - 13 weeks Child was born at 27 weeks gestation 46 weeks/4 11 months 14 days Corrected Age Change months to weeks if necessary Subtract weeks (ok to round days 5/7 or more up) Convert back to months/years  PDMS-3 Gross and fine motor developmental assessment, birth-72 months (6 years) Start at the recommended place for child’s age Administer items in that area to establish “Basal age”, then proceed with increasingly difficult items to establish “Ceiling age” basal age: Three consecutive “2s” ceiling age: Three consecutive “0s” Administer three subtests (Body Control, Body Transport, Object Control) Supplemental Subtest: Physical Fitness Scoring -- Online Scores for each subtest (only for toddler lab) Raw score Percentile Standard Z score Age equivalent Gross Motor Quotient (GMQ), GMQ percentile, GMQ Z score  Determining “percent delay” in development Determine “Age Equivalent” or “Developmental Age” on a standardized exam Use adjusted chronological age if needed (Chronological age – Age equivalent) divided by Chronological age, x100 = % delay Chronological age – Age equivalent X 100 = % delay Chronological age Other Areas/Domains of Development  Communication Development 3 MONTHS OF AGE 12 months Quiets or smiles in response to sound or voice Uses simple gestures like shaking head “no” or Turns head towards sound or voice waving “bye-bye.” Shows interest in faces Says “mama” and “dada.” Makes eye contact Tries to say words. Cries differently for different needs (e.g. hungry Responds to simple requests such as shaking head vs. tired) when asked, “are you all done?” Coos and smiles 6 Months 2 years Coos and babbles more than two vowel sounds (“ah,” “eh,” “oh”), squeals and laughs. Uses two or three words together. Copies sounds that others make. Points to things or pictures in a book when named. Responds to own name. Follows simple directions. Begins to say consonant sounds like “b” and Knows names of familiar people, and body parts. “m.” Communication 3 years 4 years Uses three-word sentences and carries on a conversation. Tells stories and recalls parts of Talks clearly enough so that stories. strangers can usually understand. Follows two- or three-part Knows some basic rules of instructions. grammar and uses words Says words like “I,” “me,” “you,” and correctly. “we” and uses some plurals. Understands words such as “in,” Sings a song or says a rhyme “on” and “under.” from memory. Asks “why,” “where,” “what,” “when” Says first and last name. and “how” questions. Names a friend. Communicates clearly and speaks in complete sentences.  4 months Social/Emotional Smiles spontaneously, especially 3 months at people. Shows excitement by waving arms Is able to be comforted/calmed and legs. by cuddling or a parent’s touch, Enjoys playing with people and rocking and calm sounds. imitating smiles and frowns. Is usually happy when not 6 months hungry or tired Knows familiar faces and begins Enjoys varied playful to know if someone is a stranger. movement experiences, e.g. Enjoys playing with others, bouncing on knees especially family (such as “peek- a-boo”). Enjoys playful face-to-face Likes to look at self in mirror. interaction with people Responds to other people’s Begins to smile at people emotions and often seems happy. Makes sounds to express happiness or displeasure Social/Emotional 9-12 months 18 months Shows feelings by smiling, Shows interest in other crying and pointing. children. Prefers certain people and Plays simple pretend, such as toys. feeding a baby. Imitates sounds, gestures or Imitates your behavior. actions to get parent's Tries new things with familiar attention. adults nearby. Cries when parent leaves and Shows feelings, for example, is shy around strangers. temper tantrums, fear of Puts arm or leg out to help with strangers, affection with dressing. familiar people or clinging to a Enjoys playing games like familiar adult in new situations. “peek-a-boo” and “pat-a-cake.” Points to show things to others. Social/Emotional 2 years Parallel play 4 years Shows defiance, such as doing Plays cooperatively with other what he/she was told not to do. children. Begins to play with other children, Negotiates solutions to as in chasing one another. conflicts. 3 years Prefers playing with other Shows concern and affection for children than playing alone.. others without prompting. Copies adults and friends (for Becomes more creative in example, runs when other make-believe play. children run). Confuses what’s real and Separates easily from parents. what’s make-believe. Enjoys routines and may get upset Expresses likes and dislikes. with a major change  Communication Listen and Watch for Social/Emotional Development of Fine Motor SENSORY PROCESSING 101 Dr. Turbeville Department of Occupational Therapy  Low registration High neurological thresholds with passive self-regulation They need a lot to fill their large cup Miss sensory cues that occur in the environment May not notice you calling their name or may not notice clothing twisted on the body This Photo by Unknown Author is licensed under CC BY-ND May not detect sensory input. Even if they do, they may not react to it…  Sensation seeking High neurological threshold, but have an active self-regulation strategy They also need a lot to fill their large cup Constantly touching things or people Might mouth or chew non-food items Unable to sit still, fidgety, ‘on the go’ Impulsive  Sensation avoiding Low neurological thresholds with active self-regulation It takes very little to fill their small cup Easily upset or distracted by loud or sudden noises Avoid messy activities May struggle with balance activities This Photo by Unknown Author is licensed under CC BY-NC-ND Sensory sensitive Low neurological thresholds with passive self-regulation strategies Also takes very little to fill their small cup Similar to avoiding, but these kids don’t do much to change the situation Might get irritated by the tag on a shirt or the hum of a refrigerator but won’t necessarily move to change the situation  If you see this, try this The child won't stay seated… Try a move and sit cushion (wiggle cushion) or stool. If using a chair, secure TheraBand around the chair legs. Allow movement breaks and opportunities for ‘heavy work.’ Pulling, pushing, carrying, etc. This Photo by Unknown Author is licensed under CC BY Use a timer. Allow the child to stand or lie prone (if appropriate for activity). If you see this, try this The child doesn’t seem to know what to do after instruction… Have child repeat the instructions to you Write the directions on the board or on paper (if age-appropriate). Give one direction at a time. Allow time to respond/react.  If you see this, try this The child overreacts to or avoids movement… Let them watch you ‘go first.’ Verbalize how to use equipment. “Go up the stairs and down the slide.” Reinforce body awareness. Play Simon Says Ensure knowledge of spatial concepts. Over, under, etc. This Photo by Unknown Author is licensed under CC BY  If you see this, try this The child seems unmotivated or tired… Offer gross motor play. Jumping, balance beam, swing Offer a crunchy or cold snack (if allowed). Change how you interact. Volume or tempo of your voice Why ots do the things we do  QUESTIONS? Email: [email protected] 1. Recognize birthweight categories Large for Gestational Age (LGA) Birth Weight >90th percentile Appropriate for Gestational Age (AGA) Birthweight 10-90th percentile Small for Gestational Age (SGA) Birthweight