Describe sleep hygiene. - Answer-establishing bedtime sleep patterns that promote
going to sleep easily:
- turning off electronics
- having bedtime routine - brushing teeth, showering, reading before bed
- not using bed for anything else but sleep
List common sleep problems and treatment - Answer-confusional arousal: sleep drunk
a. child is waken from deep sleep during 1st part of sleep. Child will sit up in bed,
appear dazed, react slowly to questions
b. occurs around 2 yo
c. diminishes around 5 yo
sleep walking:
a. begins as confusional arousal
b. child gets out of bed, dazed w/ open eyes, speech is mumbled and slurred
c. occurs in 1-15% of children
d. common around 4 yo and resolve around 8 yo
e. most dangerous parasomnia
night terrors:
a. extreme state of agitation when child awakes from N3 sleep screaming in the 1st part
of the night. *** child is generally still asleep w/ no recollection of events
b. dilated pupils, increased HR, sweating
c. can be prolonged with parent interference
d. occur in 1-6% of children
e. occur after 18 mnths & resolve around 6 yo
nightmares:
a. occur during REM sleep during last part of noc
, b. sudden arousal from sleep to fully awake state
c. nightmare can typically be recalled
d. average onset 36-72 mnths
e. reoccurring can be associated with daytime stressors
TMNT: sleep study, referral to sleep provider, pulmonologist or otolaryngologist, sleep
hygiene, place bell on childs door/ safety proof home
What should you tell a parent who says a child is head banging when going to sleep? -
Answer-disorder is self limiting
generally resolves around 2 yo.
requires NO intervention
Define obstructive sleep apnea - Answer-OSA:
- upper airway obstruction, abn respiratory pattern and fragmented sleep
- occurs between 2-6 yo in children 2-5% of the time
- can result in obesity, physical, mental problems
TMNT: adenotonsillectomy (primary tmnt), sleep study, CPAP, saline rinses,
central sleep apnea - Answer-disruption in signals sent from the brain that regulate
breathing cause periods of interrupted breathing
What is the recommended exam sequence in children? - Answer-NB- least distressing
1st
Older Infant- least distressing 1st
toddler- ENT last
Preschooler- Head to toe
School age - head to toe
Adolescents- genitalia last
When should an infant be able to turn his/her head from side to side while prone? -
Answer-1 month
When should an infant be able to hold his/her head erect at midline? - Answer-4 months
When should there be no head lag? - Answer-6 months
Visual acuity reaches 20/20 by what age? - Answer-5-6 yo
Transient nystagmus is relatively common until what age? - Answer-6 months
At what age do the lacrimal ducts open?______; At what age do infants produce
tears - Answer-4- 6 wks 3 mnths
A white reflex may be indicative of - Answer-retinoblastoma
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