Introduction to Pediatric Rehabilitation PDF

OT1028 MEDICAL-SURGICAL FOUNDATIONS IN PEDIATRICS SHIFT 1 Introduction to Pediatric Rehabilitation...

OT1028 MEDICAL-SURGICAL FOUNDATIONS IN PEDIATRICS SHIFT 1 Introduction to Pediatric Rehabilitation LESSON Dra. Arlene Ledesma| August 16, 2024 01 TABLE OF CONTENTS BIRTH 1. Periods of Growth # Average of 280 (37-42 weeks) 2. Pediatric Rehabilitation 2.1. Growth POST NATAL 2.1.1. Factors affecting growth and # development Infancy Birth to 2 years 2.1.2. Neurologic lesions that affect Neonate (newborn/ early First 4 weeks after birth growth infant) 2.1.2.1. Anterior fontanel 2.1.2.2. Posterior fontanel Infancy (middle or nursing) 1 year 2.1.3. APGAR 3. Developmental Assessment Infancy (transition, toddler, or 1-2 years 3.1. Red Flags run about) 3.2. Stages 4. Reflex Development Childhood 2-6 years 5. Stages of Growth and Development Early childhood 6-10 years (girls) 5.1. Milestones in Child Development (preschool) 5.2. Adolescents 5.2.1. Physical Growth Later childhood (school 6-12 years (boys) chld) LEGEND Adolescents First year ★ Important / Take Note ✤ Textbook Information 10-18 (girls) ➤ Lecturer’s Verbatim ❐ Other Transes/Resources 12-20 (boys) PEDIATRICS Prepubescent (late school child 10 - 12 years (girls) Pediatrics - branch of medicine that involves the medical or early adolescent) 12 - 14 years (boys) care of infants, children, up to adolescence Pubescent (adolescents 10 - 20 years (girls) The American Academy of Pediatrics recommends be proper) 12 - 14 years (boys) under pediatric care up to the age of 21 Puberty (average) 12 years (girls) AGE GROUPS 15 years (boys) Perinatal period - from 20th week of gestation to the first P (late adolescent or youth) 16 - 20 (boys) six days after birth Neonatal period - first 28 days after birth Under five 1st trimester ○ Early infancy - under 1 mo. to 1 year very critical for the genetic error of the child. ○ Later infancy (toddler) - 2-3 years If you take any medications in this stage, it would have a School age - from 6 years significant impact on the quality of life of the child. Adolescence - 10-19 years Girls mature earlier than boys due to menarche PERIODS OF GROWTH ○ Early menarche (menstruation) and late menopause pose higher risk for breast cancer Depends on the number of children. PRENATAL (0-280 days) Ovum 0-14 days PEDIATRIC REHABILITATION Children with disabilities represent a unique population Embryo 14 days to 9 weeks within pediatrics ○ Need attention in improving their function → Fetus 9 weeks to birth pediatric rehabilitation Early Fetal life 2nd focuses on maximizing the function and enhancing trimester lives Late Fetal life 3rd trimester ○ Mobility, speech, and strength Premature infant 23 weeks to 37 weeks ○ Gadgets can cause delays in children High risk of cerebral palsy. Not For children with congenital disabilities, getting all but high risk. pediatric rehabilitation can make a huge improvement in quality of life UST OT 2026 | MEDICAL-SURGICAL FOUNDATIONS FOR ADULT PHYSICAL DYSFUNCTION 1 OT1026 SHIFT #1 | LESSON #1 | Introduction to Pediatric Rehabilitation GROWTH The typical 2-3 y/o has a mild lumbar lordosis with Increase in physical size and dimension protuberant abdomen Most rapid growth rate during infancy and prepubescent ○ In females, lumbar lordosis is visible during through adolescence pregnancy ○ In males, lumbar lordosis is visible during middle age By early school age, increased abdominal strength leads to a more mature pelvic alignment and decreased lordosis ○ Abdominal strength increases as we age ○ Lumbar lordosis disappears The rate of growth is a sensitive indicator of health or disease. ○ Anthropometric measurements of weight, height, head, abdomen indicate health status Ie. increase in head circumference may FOUR CHARACTERISTIC STAGES OF GROWTH indicate microcephaly FROM BIRTH TO ADULT: It should be serially measured and recorded on the Rapid growth in infancy and early childhood standard growth chart for comparison Slow, steady growth in middle childhood (8-10 y/o) Rapid growth during puberty ○ Secondary sexual characteristics emerge Gradual slowing down of growth in adolescence until adult height is reached FACTORS AFFECTING GROWTH AND DEVELOPMENT Hereditary Environmental factors ○ Prenatal environment (significant stunting) Nutritional Important in-utero, natally, and Newborn: postnatal ○ Head is large Diabetic mother (maternal condition) ○ Abdomen is prominent Radiation, infection Due to lordotic curve in newborns ○ Related to fetus ○ Trunk and extremities are short (compared with Malposition, placental implantation adults) ○ Postnatal Environment With changing body proportion, there is a shift in body’s Socio-economic status COG from the xiphoid process to the sacral Child’s nutrition promontory Number of siblings ○ Change in gait pattern as well Internal environment ○ Child’s intelligence ○ Hormonal influences ○ Emotions Infants with neurologic impairment and oral motor dysfunction require supplemental feeding (NGT) Some endocrine dysfunctions or systemic skeletal diseases may lead to generalized growth retardation ○ Pituitary tumors, dwarfism UST OT 2026 | MEDICAL-SURGICAL FOUNDATIONS FOR ADULT PHYSICAL DYSFUNCTION 2 OT1026 SHIFT #1 | LESSON #1 | Introduction to Pediatric Rehabilitation NEUROLOGIC LESIONS THAT AFFECT GROWTH MICROCEPHALY AND HYDROCEPHALUS Brachial plexus palsy ○ If the baby is too big due to mother‘s diabetes, the head and shoulders may be compromised. ○ Shoulder may incur shoulder traction injury Klempke’s or Nerve’s Palsy Congenital varicella syndrome ○ Chickenpox of mother Myelodysplasia (Spina Bifida) ○ Folic acid deficiency of mother Hydrocephalus Microcephaly DISORDERS INSIDE THE BRAIN Head Circumference Hydrocephalus – a lot of fluid or having obstruction in the ventricles. Birth 35 cm Microcephaly – mother incurred virus like Zika virus 4 months 41 cm RESPIRATION HEART RATE (APICAL) 12 months (+12cm from birth) 47 cm 30 to 60 respirations per min 100 to 160 beats per min Maturity 57 cm Ave. 40 respirations per min 100 while sleeping 160 while crying TEMPERATURE BLOOD PRESSURE (AT BIRTH) Rectal Average: 75/42 90.0° F to 99.5° F (35.6° C to 37.5° C) Systolic: 60 to 80 mmHg Axillary Diastolic: 40 to 50 mmHg 97.6° F to 98.6° F (36.5° C to 37.0° C) APGAR SCORE RATES: APGAR SCORING CHART SIGN 0 1 2 1 min 5 mins Heart Rate Absent Less than Over 2 2 ANTERIOR FONTANELLE 100 100 Diamond in shape Respiratory Absent Slow, Good 1 2 The junction of the sagittal, coronal and frontal sutures Effort/Rate Irregular Cry forms it ○ Does not close because it allows growth Muscle Limp Some Active 1 2 Between 2 frontal & 2 parietal bones Tone Flexion Motion 3-4 cm in length and 2-3 cm width Reflex No Grimace Cry 1 2 Closes at 12-18 months of age Irritability Response POSTERIOR FONTANELLE Color Pale Body Pink, All 1 2 Extr. Blue Pink Triangular in shape Located between occipital & 2 parietal bones TOTAL SCORE 6 10 Closes by the end of the 1st month of age Score Interpretation Status An adult patient that incurred a hemorrhagic bleed or ventricular obstruction can have hydrocephalus, but their head does not 7 - 10 Normal enlarge like this anymore because the anterior fontanelle is 4-6 Moderately depressed already closed, which leads to increased intracranial pressure and ataxia 0-3 Severely depressed UST OT 2026 | MEDICAL-SURGICAL FOUNDATIONS FOR ADULT PHYSICAL DYSFUNCTION 3 OT1026 SHIFT #1 | LESSON #1 | Introduction to Pediatric Rehabilitation MEASUREMENTS IN GROWTH Failure to alert to Sensory impairment environmental stimuli Height / Stature 4 to 6 months Evaluate for… Birth 50 cm Poor head control Hypotonia 12 months (increase by 50%) 75 cm Failure to reach for objects by Motor, visual, or cognitive 4 years 100 cm 5 months deficits Early school age 5 cm annually Absent smile Visual loss, attachment Prepubescent/adolescence 5-8 cm annually problems, maternal major depression, consider child abuse or child neglect in Recumbent length more precise for children below 5 severe cases years of age For children with deformity of the spine of LE, height 6 to 12 months Evaluate for… prediction can be obtained by measuring arm span Persistence of primitive Neuromuscular disorder Adult height can be estimated by doubling length at 2 reflexes > 6 months years Girls attain maximal growth velocity before menarche and Absent babbling by 5 months Hearing deficits cessation 2 years after Absent stranger anxiety by 9 May be related to multiple care Boys grow fastest late in puberty concurrent with the months providers appearance of facial hair W-sitting and bunny hopping at Evaluate for adductor spasticity 7 months or hypotonia (cerebral palsy) Weight Inability to localize sound by 10 Unilateral hearing loss Birth (full term) 3.4 kg months 5 months Double Persistent mouthing of objects May indicate lack of intellectual at 12 months curiosity 12 months Triple Until adolescent growth spurt 2 kg annually Identify Developmental Delay and (Age-appropriate) Functional Delay Newborns