Interventions for dyssomnias
Give this one a try later!
-Unmodified extinction - systematic ignoring; allowing the child to cry it out
-Modified graduated extinction - sit with the drowsy child and then leave
before the child falls asleep, promising to return. The parent may start by
leaving for only seconds but always returns, gradually extending the
absence; the goal is for the child to fall asleep independently when the
part is out of the room
-Bedtime pass - preschool to school age; have the child make a ticket and
this may be used for one visit in the child's room at bedtime or one pass to
come out from the room again that night; if the child uses the pass but then
stays in his room until morning, the child gets a reward, such as a favorite
breakfast; if they don't use it at all, they get a free reward; an immediate
reward instead of later is more effective
Sleep disordered breathing
,Give this one a try later!
-Simple snoring and upper airway resistance to OSA
-OSA - upper airway obstruction, abnormal respiratory patterns, and
fragmented sleep; age 2-6
-Has a destructive impact on neurocognitive functioning, leading to
learning difficulties
-Signs - snoring, gasping, apneas, increased work of breathing, neck
hypertextension, night sweating, tachycardia, restless sleep, and disrupted
sleep
-Adenotonsillectomy
Genu valgum (knocked knees) vs. genu varum (bowlegs)
Give this one a try later!
-Genu valgum - knocked knees
-Lower extremity alignment goes through a predictable progression from
varus to vulgus over the first six years of life
-This will improve spontaneously between 4-6 years of life
-Joint pain, stiff gait, knee pain due to the stretching of the medial aspect of
the knee; unilateral deformity, sublaxating patella
-Short stature with this should be referred
-Deformities greater than 15 degrees and occurring after 6 years of life are
unlikely to correct with growth and require surgical intervention; in the
skeletally immature - medial tibial epiphyseal hemiepiphysiodes or stapling;
if mature - osteotomy
-Genu varum - typically seen in children up to 2 years but can be normal til
3
-Symmetrical bowing of both tibias in the first year followed by bowlegs in
the second year
-If persists after 30 months of age or increases, it may be Blount disease,
rickets, tumor, neurologic problems or infection
-Lower extremity length discrepancy, tibial-femoral angle greater than 15
degrees
-Need a weight bearing AP radiograph of the lower extremities
-If physiologic - no active treatment, spontaneous resolution is expected,
, corrective shoes and splinting are not needed; reassure parents, observe
over 3-6 months to ensure its resolving
-Orthopedic evaluation when family history, asymmetric deformity,
unilateral bowing, gait abnormalities, short stature, late walking,
progressive after 18 months of age, if presented at 24 months or later
-If pathologic (increasing) - Blount disease can be treated with bracing in
children younger than 3
Therapies
Give this one a try later!
-Play therapy for preschool and younger
-CBT (cognitive behavioral therapy) for school-aged and older
Sleep issues per age group
Give this one a try later!
1. Early childhood- resisting bed and nighttime awakening is common due
to the toddler's need for independence, as well as increases in moor,
social, and cognitive abilities; also separation anxiety, nighttime fears and
nightmares
2. 3-5 years of age - difficulty falling asleep and waking up during the night
are common, nighttime fears and nightmares, sleepwalking, night terrors
-Regular daytime routines help to promote regular sleep patterns
3. 5-12 years of age - increase screen time and use of computers,
smartphones and TV, also more caffeine products
4. Adolescents - early wake up time for high school, a natural shift of two
hours in sleep schedule, social and school obligations lead to late nights
Costochondritis
, Give this one a try later!
-Common cause of chest pain in children and adolescents
-Inflammation of one or more of the costochondral cartilages that causes
localized tenderness and pain in the anterior chest wall
-Caused by trauma and unaccustomed physical effort
-Treatment - mild analgesia and NSAIDS to relieve discomfort and avoiding
strenuous activity; cough suppressants if cough is aggravating; stretching
exercises and ice
-Not related to cardiac disease
Preparticipation physical examination
Give this one a try later!
-High-risk conditions - asthma, cardiac conditions, DM, HTN, seizures, sick
cell trait
Epilepsy
Give this one a try later!
-A neurological disorder characterized by recurrent unprovoked seizures
-Testing - CBC, LFTs, blood glucose in all patients, urine and serum
toxicology if illicit drug exposure is considered, LP if under six months or
any age with persistent mental status changes
-EEG in all children after first unprovoked seizure
-Medications - based on type of epilepsy; Levetiracetam, Lamotrigine,
Oxcarbazepine, Topiramate, Lacosamide, Valproic acid, Ethusuximide,
Carbamazepine, Phenobarbital
-Restrictions - DTaP immunization on individual basis, don't swim alone, but
swimming, contact sports, and climbing are to be allow if child is well
controlled and there is constant supervision during these activities, always
wear a helmet, driving is a concern with adolescents until they are seizure
Give this one a try later!
-Unmodified extinction - systematic ignoring; allowing the child to cry it out
-Modified graduated extinction - sit with the drowsy child and then leave
before the child falls asleep, promising to return. The parent may start by
leaving for only seconds but always returns, gradually extending the
absence; the goal is for the child to fall asleep independently when the
part is out of the room
-Bedtime pass - preschool to school age; have the child make a ticket and
this may be used for one visit in the child's room at bedtime or one pass to
come out from the room again that night; if the child uses the pass but then
stays in his room until morning, the child gets a reward, such as a favorite
breakfast; if they don't use it at all, they get a free reward; an immediate
reward instead of later is more effective
Sleep disordered breathing
,Give this one a try later!
-Simple snoring and upper airway resistance to OSA
-OSA - upper airway obstruction, abnormal respiratory patterns, and
fragmented sleep; age 2-6
-Has a destructive impact on neurocognitive functioning, leading to
learning difficulties
-Signs - snoring, gasping, apneas, increased work of breathing, neck
hypertextension, night sweating, tachycardia, restless sleep, and disrupted
sleep
-Adenotonsillectomy
Genu valgum (knocked knees) vs. genu varum (bowlegs)
Give this one a try later!
-Genu valgum - knocked knees
-Lower extremity alignment goes through a predictable progression from
varus to vulgus over the first six years of life
-This will improve spontaneously between 4-6 years of life
-Joint pain, stiff gait, knee pain due to the stretching of the medial aspect of
the knee; unilateral deformity, sublaxating patella
-Short stature with this should be referred
-Deformities greater than 15 degrees and occurring after 6 years of life are
unlikely to correct with growth and require surgical intervention; in the
skeletally immature - medial tibial epiphyseal hemiepiphysiodes or stapling;
if mature - osteotomy
-Genu varum - typically seen in children up to 2 years but can be normal til
3
-Symmetrical bowing of both tibias in the first year followed by bowlegs in
the second year
-If persists after 30 months of age or increases, it may be Blount disease,
rickets, tumor, neurologic problems or infection
-Lower extremity length discrepancy, tibial-femoral angle greater than 15
degrees
-Need a weight bearing AP radiograph of the lower extremities
-If physiologic - no active treatment, spontaneous resolution is expected,
, corrective shoes and splinting are not needed; reassure parents, observe
over 3-6 months to ensure its resolving
-Orthopedic evaluation when family history, asymmetric deformity,
unilateral bowing, gait abnormalities, short stature, late walking,
progressive after 18 months of age, if presented at 24 months or later
-If pathologic (increasing) - Blount disease can be treated with bracing in
children younger than 3
Therapies
Give this one a try later!
-Play therapy for preschool and younger
-CBT (cognitive behavioral therapy) for school-aged and older
Sleep issues per age group
Give this one a try later!
1. Early childhood- resisting bed and nighttime awakening is common due
to the toddler's need for independence, as well as increases in moor,
social, and cognitive abilities; also separation anxiety, nighttime fears and
nightmares
2. 3-5 years of age - difficulty falling asleep and waking up during the night
are common, nighttime fears and nightmares, sleepwalking, night terrors
-Regular daytime routines help to promote regular sleep patterns
3. 5-12 years of age - increase screen time and use of computers,
smartphones and TV, also more caffeine products
4. Adolescents - early wake up time for high school, a natural shift of two
hours in sleep schedule, social and school obligations lead to late nights
Costochondritis
, Give this one a try later!
-Common cause of chest pain in children and adolescents
-Inflammation of one or more of the costochondral cartilages that causes
localized tenderness and pain in the anterior chest wall
-Caused by trauma and unaccustomed physical effort
-Treatment - mild analgesia and NSAIDS to relieve discomfort and avoiding
strenuous activity; cough suppressants if cough is aggravating; stretching
exercises and ice
-Not related to cardiac disease
Preparticipation physical examination
Give this one a try later!
-High-risk conditions - asthma, cardiac conditions, DM, HTN, seizures, sick
cell trait
Epilepsy
Give this one a try later!
-A neurological disorder characterized by recurrent unprovoked seizures
-Testing - CBC, LFTs, blood glucose in all patients, urine and serum
toxicology if illicit drug exposure is considered, LP if under six months or
any age with persistent mental status changes
-EEG in all children after first unprovoked seizure
-Medications - based on type of epilepsy; Levetiracetam, Lamotrigine,
Oxcarbazepine, Topiramate, Lacosamide, Valproic acid, Ethusuximide,
Carbamazepine, Phenobarbital
-Restrictions - DTaP immunization on individual basis, don't swim alone, but
swimming, contact sports, and climbing are to be allow if child is well
controlled and there is constant supervision during these activities, always
wear a helmet, driving is a concern with adolescents until they are seizure
