High-yield comprehensive revision notes on Paediatric Neurology and Development for the University of Cambridge Medicine Course. Written by a top-decile student.
Covers:
- Behavioural Disorders
- Neurology
- Neurodevelopment
- Social Paediatrics
- Congenital and genetic disorders
,Behavioural Disorders
1. Developmentally inappropriate
behaviour – enuresis, soiling/encopresis
Enuresis
Overview
- Most children achieve day and night urinary incontinence by ¾.
- Enuresis is synonymous with bed-wetting.
- Risk factors:
o Male sex
o Genetics – sphincter competence
o Emotional stress
- Most children with enuresis are psychologically normal.
- Most grow out of enuresis by the age of 15. Only 1% patients
continue having symptoms into adulthood.
- Secondary enuresis – relapse after a period of dryness. Emotional
upset is the commonest cause.
Investigations
Urine sample
- Check for glucose, protein and infection ?constipation ?UTI ?DM
Secondary enuresis
- Urine sample
- Assessment of urine concentrating ability
- Ultrasound of renal tract
Management
Conservative
- Explanation and reassurance – advise on fluids, diet and toileting
behaviour
- Check for any psychological issues – ask about school performance,
friends and home life
- Star chart
- Enuresis alarm – first-line < 7years after advice
Medical
- Desmopressin – analogue of ADH: short-term relief: first-line > 7
years
Daytime Enuresis
Overview
,Causes:
- Lack of attention to bladder sensation – psychogenic/developmental
problem
- Detrusor instability
- Bladder neck weakness
- Neuropathic bladder
- UTI
- Constipation
- Ectopic ureter
Investigations
- Urine sample
- Assessment of urine concentrating ability
- Ultrasound of renal tract
- Urodynamic studies
- X-ray of spine – vertebral anomaly?
- MRI – exclude non bony spinal defect
Management
Conservative
- Star charts
- Treat underlying cause
Medical
- Oxybutynin – anticholinergic drug to dampen bladder contractions.
Soiling/Encopresis
Overview
- It is abnormal to soil >4y
- Important to check whether rectum is loaded or not – abdo
examination. Loaded rectum is most common.
- Loaded rectum may be hard to shift – loaded rectum inhibits the
anus via the rectoanal reflex and stool may seep out with
spontaneous rectal contractions beyond the child’s control.
Factors with loaded rectum:
- Constipation (dehydration or illness)
- Inhibition – pain from fissure
- Inhibition – anxiety for punishment
- Anxieties about using toilet
Management
Conservative
- Treat underlying factors if presents e.g. anal fissure
- Scoring system
Medical
- Stool softener e.g. macrogol
- Stimulant if necessary e.g. docusate, sodium picosulfate
- Osmotic laxative e.g. lactulose
- Maintainance therapy
2. Developmentally abnormal
behaviour – hyperkinetic disorder,
conduct disorder, sleep disorder, autism
Attention Hyperactivity Deficit Disorder
Overview
- Inherent variation in hyperactivity of children
- When their level of motor activity exceeds that regarded as normal,
they may be termed ‘hyperactive’.
- ADHD: child is undoubtedly overactive; impaired concentration
with short attention span/distractibility.
- Powerful genetic predisposition – possibly underlying dysfunction in
dopamine neural circuits.
Presentation
Core Features
- Inattention
- Impulsivity: Inability to control impulses – disorganised, poorly-
regulated and excessive activity
- Hyperactivity
Other Features
- Short tempered and poor relationships
- Poor performance in school
Often assessed by educational psychologist
DSM V
Les avantages d'acheter des résumés chez Stuvia:
Qualité garantie par les avis des clients
Les clients de Stuvia ont évalués plus de 700 000 résumés. C'est comme ça que vous savez que vous achetez les meilleurs documents.
L’achat facile et rapide
Vous pouvez payer rapidement avec iDeal, carte de crédit ou Stuvia-crédit pour les résumés. Il n'y a pas d'adhésion nécessaire.
Focus sur l’essentiel
Vos camarades écrivent eux-mêmes les notes d’étude, c’est pourquoi les documents sont toujours fiables et à jour. Cela garantit que vous arrivez rapidement au coeur du matériel.
Foire aux questions
Qu'est-ce que j'obtiens en achetant ce document ?
Vous obtenez un PDF, disponible immédiatement après votre achat. Le document acheté est accessible à tout moment, n'importe où et indéfiniment via votre profil.
Garantie de remboursement : comment ça marche ?
Notre garantie de satisfaction garantit que vous trouverez toujours un document d'étude qui vous convient. Vous remplissez un formulaire et notre équipe du service client s'occupe du reste.
Auprès de qui est-ce que j'achète ce résumé ?
Stuvia est une place de marché. Alors, vous n'achetez donc pas ce document chez nous, mais auprès du vendeur cambridgemedic. Stuvia facilite les paiements au vendeur.
Est-ce que j'aurai un abonnement?
Non, vous n'achetez ce résumé que pour €11,65. Vous n'êtes lié à rien après votre achat.