ELS 2010...PEDS - McGill University

ELS 2010...PEDS - McGill University

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 aura A) At least 5 attacks fulfilling criteria B through D

B) Lasting 1 to 72 hours C) 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 Reflexes Reflex 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 infants 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 infants 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 ?

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