COMMON HEALTH PROBLEMS THAT

DEVELOP DURING INFANCY

 INTUSSUSCEPTION SPINA BIFIDA

FAILURE TO THRIVE HYDROCEPHALUS

SIDS OTITIS MEDIA
COLIC MENINGITIS
TRISOMY 21 FEBRILE SEIZURES

LIP AND CLEFT PALATE AUTISM

IMPERFORATED ANUS HIRSCHSPRUNG’S DSE

ADHD
 RESPIRATORY PROBLEMS

Otitis media
GASTROINTESTINAL
PROBLEMS

Intussusception Colic

Hirschsprung’s dse Imperforated anus

Cleft lip and palate

 NERVOUS PROBLEMS

Spina Bifida Meningitis

Febrile seizures Hydrocephalus

OTHER PROBLEMS

TRISOMY 21 FAILURE TO THRIVE

ADHD AUTISM
 OTITIS MEDIA
 Infection of the middle
ear occurred as a
result of a block
eustachian tube,
preventing normal
drainage
 Common complication
of ARI
 Infants and children
more prone- ET
shorter, wider,
straighter
COMMON CAUSES: BACTERIAL/VIRAL
INFECTIONS
RISK FACTORS:
1. PASSIVE SMOKING

2. BEING FED FORMULA MILK RATHER THAN

BREASTMILK
3. FEEDING A CHILD IN SUPINE POSITION

4. HAVING A CLEFT PALATE

5. HAVING DOWN’S SYNDROME

COMPLICATIONS:
1. MASTOIDITIS
2. LABYRINTHITIS
3. MENINGITIS
ASSESSMENT
 Fever
 Irritability and restlessness

 Rolling of head from side to side

 Pulling or rubbing the ear

 Earache; signs of hearing loss

 Purulent ear discharge

 Otoscopic exam
INTERVENTION
 Encourage fluids
 Upright position when feeding
 Avoid chewing- increases pain
 Have the child lie with the affected ear
 Appropriate technique to clean
drainage
 Administer analgesics and
antibiotics(10-14 days)
 Screening for hearing loss
 Myringotomy
NURSING MANAGEMENT
 Assess the child for fever and pain level and
assess for possible complications
 Administer prescribed meds.

 Reduce fever

 Relieve pain

 Prevent skin breakdown

 Provide pre-operative and post-operative

care
 Provide child and family teaching
INTUSSUSCEPTION
 An invagination or
telescoping of one
portion of the intestine
into an adjacent
portion causing
obstruction.
 Ileocecal region

 One of the common

causes of intestinal
obstruction in children
 Most common between
ages 3 and 12 months
 More in boys than in
girls
ETIOLOGY
 Unknown (children)
 Maybe associated with viral
infection, intestinal polyps,
lymphoma, diverticulum
PATHOPHYSIOLOGY
 Invagination typically begins with
hyperperistalsis in an intestinal segment,
usually at or near the ileocecal valve
RISK FACTORS
 AGE – young children are much more
likely to develop intussusception than
adults
 SEX – more often affects boys

 ABNORMAL INTESTINAL FORMATION AT

BIRTH (intestinal malrotation)
 PRIOR HISTORY OF INTUSSUSCEPTION

 FAMILY HISTORY
COMPLICATIONS

 BOWEL PERFORATION which can cause

an infection of the lining of the
abdominal cavity (PERITONITIS)
- abdominal pain
- abdominal swelling
- fever
ASSESSMENT
 Piercing cry
 Severe paroxysmal abdominal pain ( pulls leg
up)
 Vomiting of bile stained fluid

 Tender, distended abdomen, possibly with a

palpable mass
 Bloody mucus in the stool

 “currant jelly” stool

DIAGNOSTIC EXAM
 UTZ, CT SCAN
 AIR/BARIUM ENEMA (can’t be used if
intestine is torn)
MANAGEMENT
 Barium enema – can fix
intussusception
 Surgery – main tx for adults

 Nursing intervention:

1.provide routine pre and post op care

2. monitor for peritonitis
CLEFT LIP /CLEFT PALATE
 CLEFT LIP – congenital anomaly that
occurs at a rate of 1 in 800 births
- it ranges in severity from a slight
dimple to a large fissure that extends from
the lip up into the nasal structures.
- can be unilateral (more often on the
left side) or bilateral and may involve the
alveolar ridge
- Clefts of the lip are more common in
males
 CLEFT PALATE – a congenital anomaly
that occurs in approximately 1 of every
2,000 births
- more common in girls than boys
- ranges in severity from soft palate
involvement alone to a defect including
the hard palate and portions of the maxilla
- may be associated with cleft lip
- may have associated dental
malformations, speech problems, and
frequent otitis media (results from
improper functioning of the eustachian
tube)
ETIOLOGY
 CL with or without CP is developmentally
and genetically different from isolated CP
 Genetic factors

 maternal drug exposure

 Exposure to viruses or chemicals

PATHOPHYSIOLOGY
 During embryonic development, the
lateral and medial tissues forming the
upper lip fuse between weeks 7 and 8
of AOG
 The palatal tissues forming the hard
and soft palates fuse between weeks 7
and 12 of AOG
 CL and CP result when these tissues
fail to fuse
MANAGEMENT
 SURGERY: RULE OF “10”
 10 weeks old

 At least 10 lbs

 At least 10 grams Hgb

NURSING MANAGEMENT
1. Assess for problems with feeding, breathing,
parental bonding, and speech
2. Ensure adequate nutrition and prevent
aspiration
o Provide special nipples or feeding devices

- CL – Breck feeder
Syringe/medicine dropper
- CP – Wide-bowl spoon
o Hold the child in semi-upright position; direct

the formula away from the cleft

o Feed slowly and burp frequently

o Stimulate sucking by gently rubbing the

nipple against the lower lip

3. Support the infant’s parents
emotional and social adjustment
4. Provide preoperative care
 Explain surgical procedure
 Provide mouth care to prevent
infection
Sx: CL – 1-3 months of age
CP – 6-18 months of age
5. post-operative care
- assess airway patency and v/s
- clean the suture line and apply an
antibacterial ointment to prevent
infection and scarring. Monitor for
signs of infection
- Feed with rubber-tipped medicine
dropper, bulb syringe, Breck feeder
- keep the child from putting tongue
up to palate sutures
- administer analgesics for pain
AFTER SURGERY
No. 1 goal – protect suture
line

CL CP

 Supine  Prone - ↑ drainage

 Clean the suture  Minimize crying
line  Elbow restraint
 minimize crying  No deep/vigorous to
 Elbow restraint suctioning
 Logan Bar  Use finer tube
prevent

overstretching
suctioning of the
lips
Note: Remove restraint
q 2H, then ROM
 After CL & CP repair

 refer speech therapy • Shock and Denial-

and child psychologist First reaction of
 EENT – frequent mother upon
infection because of
learning that her
respiration – drying
of mouth is common child has CL or CP.
 Orthodontist • TALKING-IN period
is prolonged (1st
1-3 days)
 
HIRSCHSPRUNG’S DISEASE

 Absence of
autonomic
parasympathetic
ganglion cells in
large intestines
 Characterized by
the absence of
nerves to a
section of the
intestines
 Results in mechanical intestinal
obstruction due to inadequate
motility
 Four times more common in boys
than in girls
 Seen more common in children
with Down Syndrome
 It can be acute and life-
threatening or chronic
ETIOLOGY
 Familial,congenital defect
 Results from failure of the
craniocaudal migration of
ganglion nerve cell precursors
along the GI tract between the 5th
and 12th weeks of gestation
PATHOPHYSIOLOGY

 Absence of autonomic parasympathetic

ganglion cells in one segment of the
colon causes lack of innervation in that
segment
 Lack of innervation leads to absence of
propulsive movements, causing
accumulation of intestinal contents and
distention of the bowel proximal to the
defect
 Enterocolitis, inflammation of the small
bowel and colon, is the leading cause of
death in children.
ASSESSMENT FINDINGS
NEONATES:
 Failure or delay in passing meconium
 Reluctance to ingest fluids
 Abdominal distension
 Bile-stained vomitus

INFANTS:
 Failure to thrive
 Constipation
 Vomiting (fecal)
 Episodic diarrhea
OLDER CHILDREN:
 Anorexia
 Chronic constipation
 Foul-smelling and ribbon-like
stools
 Abdominal distention
 Palpable fecal mass
 Malnourishment or poor growth
 Signs of anemia
 hypoproteinemia
 Rectal examination – rectum
empty of stool, a tight anal
sphincter and stool leakage
 Ominous sign signifying
enterocolitis include explosive
bloody diarrhea, fever and severe
prostration
LABORATORY AND DIAGNOSTIC
STUDY FINDINGS:
 Barium enema reveals megacolon
 X-ray – using a contrast dye
 Rectal biopsy reveals absence of
ganglionic cells
 Anorectal manometry – external
sphincter contracts normally but fails
to relax
NURSING INTERVENTION
 Assess for and promptly report signs
of enterocolitis
 Promote adequate hydration
 Assess bowel functioning

- assess passage of meconium in

neonates
- note and record the frequency and
characteristics of stools in infants and
older children
- periodically measure abdominal
girth to assess for increasing
 Promote adequate nutrition
according to the child’s age and
nutritional requirements – smaller
and frequent feeding
 Administer enema as prescribed –
relieve constipation
 Avoid taking temperature rectally
 Administer prescribed medication

- antibiotic
- stool softener
 Decreased discomfort caused by
abdominal distention
- elevate the head of the bed
- change the child’s position frequently
- asses for any respiratory difficulty
 Support the child and parents

 Prepare the child and the parents for

procedures and treatments
- manual dilation of anus
- dietary management
- cleansing enemas
- temporary colostomy before surgery
 PRE-OPERATIVE NX RESPONSIBILITIES:
- Prepare the bowel for surgery with
repeated saline enemas, systemic
antibiotics and colonic antibiotic
irrigations to decrease bowel flora (not
necessary for neonate)
 POST-OP CARE:

- NPO
- monitor I and O; NGT drainage
- keep the infant’s diaper away from the
dressing to prevent contamination
- providing ostomy care if indicated
IMPERFORATE ANUS

 During embryonic life- membrane that

separates the rectum and anus is absorbed,
absorption fails to occur.
 Anus appear as a dimple
 Fistula may be present- rectovaginal,
rectourethral
 Assessment: absence of stool during 1st 24
hrs, inspection of anus for patency
INTERVENTION
 Anoplasty- if possible
 Temporary colostomy

 Nasogastric suction – if with distension

 Nursing intervention:

keep operative site clean

observe for signs of hypovolemic shock
if anoplasty heals- reg. dilation of anus
post op- side lying or prone with hips
elevated
COLIC
 Colic is a form of pain which
starts and stops abruptly.
 Baby colic, a condition,
usually in infants,
characterized by incessant
crying
 It usually starts a few weeks
after birth and often
improves by age 3 months.
By ages 4 to 5 months, the
majority of babies with colic
have improved.
CAUSES

 overfeeding
 drinking milk too quickly in a bottle-fed baby

 hunger or thirst

 tiredness

 lack of contact

 temperature

 itchiness

 Pain
SYMPTOMS
 Predictable crying episodes.
  Intense or inconsolable crying. 

 Crying that occurs for no apparent

reason. 
 Posture changes. 
INTERVENTIONS
- Hold baby as upright as possible
during feedings
 Switch baby's formula. 

 Change bottles

 Consider changing your diet, if

breast-feeding.
HYDROCEPHALUS
 Imbalance of CSF production
and absorption in the
ventricular system
 Caused by malformations,
tumors, hemorrhage,
infection trauma
 Types:

1. communicating- impaired
absorption within arachnoid
space
2. non-communicating-
obstruction of CSF flow within
the ventricular system
ETIOLOGY

 Congenital hydrocephalus - Results

from a defect (Chiari’s
malformation)
 Associated with spina bifida
 Acquired hydrocephalus – results
from space-occupying lesion,
hemorrhage, intracranial infection,
or a dormant developmental defect
PATHOPHYSIOLOGY
 Primary site of CSF formation: choroid
plexus of the lateral ventricles
 Impaired absorption of CSF in the
arachnoid space or obstruction to the
flow of CSF through the ventricular system
 Impaired absorption can result from
meningitis, prenatal maternal infection,
meningeal malignancy, an arachnoid
cyst and TB
ASSESSMENT FINDINGS
CLINICAL MANIFESTATIONS IN INFANTS:
 Abnormal rate of head growth - increased
HC
 Anterior fontanel tense, bulging

 Dilated scalp veins

 Macewen’s sign- cracked-pot sound on

percussion of bones of head
 Frontal bossing, Setting sun sign

 Sluggish and unequal pupils

 Irritability and lethargy

 Cranial nerve damage

MANIFESTATIONS IN CHILDREN:
 Signs and symptoms of ICP:

- headache on awakening with improvement

after emesis, papilledema, strabismus,
ataxia, irritability, lethargy, confusion
DIAGNOSTIC EXAMS:
 UTZ – as early as 14 weeks
 COMPUTED TOMOGRAPHT SCAN –
postnatal diagnosis
 MAGNETIC RESONANCE IMAGING –
used if a complex lesion is suspected
NURSING MANAGEMENT:
1. Teach the family about the management
- treatment is surgical – direct removal of
the obstruction and insertion of shunts to
provide primary drainage of CSF
- major complications of shunts:
 infections and malfunction

 Subdural hematoma
2. Provide Preoperative care:
- assess HC, fontanels, cranial sutures, and
LOC
- check for irritability, altered feeding
habits, high-pitched cry
- firmly support the head and neck when
holding the child
- provide skin care for the head to prevent
breakdown
- give small frequent feedings to decrease
the risk of vomiting
3. Provide postoperative nursing care:
- assess for signs of ICP
- check HC daily, anterior fontanel for size
and fullness
- administer antibiotic and analgesic as
prescribed
- provide shunt care for infection and
malfunction:
 rapit onset of vomiting, severe headache

 Irritability, Lethargy

 Fever

 Redness along the shunt tract

 Fluid around the shunt valve

SURGICAL IMPLEMENTATION
 VP shunt- CSF drains into the peritoneal
cavity from the lateral ventricle
 AV shunt- CSF drains into the right atrium
 Post op care:
1.keep child flat as prescribed – (10 – 15
days)
2. observe increase ICP
3. monitor for infection, I and 0
4.measure HC OD
5. provide comfort measures; administer
medications ( diuretics, antibiotics or anti
convulsants)
6. prevent skin breakdown
SPINA BIFIDA
 CNS defect that occurs as a result of neural
tube failure to close during embryonic
development
 Defect closure usually done during infancy
RISK FACTORS:
1. Folate deficiency
2. Family history of neural tube
defects
3. Some medications
4. Diabetes
5. Obesity
6. Increased body temperature
 TYPES

1. SPINA BIFIDA OCCULTA- The mildest form,

spina bifida occulta results in a small
separation or gap in one or more of the
bones of the spine (vertebrae).
 posterior vertebral arches fail to close in the
lumbosacral area
 no surgical mgt. just protect the area
2. MENINGOCELE- the protective membranes
around the spinal cord (meninges) push out
through the opening in the vertebrae,
forming a sac filled with fluid.
3. MYELOMENINGOCELE- Also known as open
spina bifida, it is the most severe form.
protrusion of meninges, CSF, nerve roots,
portion of SC
ASSESSMENT
1. Depends on spinal cord involvement
- Occulta: does not affect spinal cord
 dimpling of the skin, nevi or hair tufts

- meningocoele: spinal cord is not involved (no

neurologic involvement)
- myelomeningocoele: similar to meningocoele but
the SC and accompanying nerve roots are involved.
 Most severe and most common type of spina
bifida
 Involves sensorimotor deficits

 Urinary and bowel problems

 Utero joint deformities s.a. dislocation of the hip

and club foot
COMPLICATIONS
 Orthopedic complications
 Accumulation of fluid in the brain
(hydrocephalus). 
 Infection in the tissues surrounding the
brain (meningitis).
 Sleep-disordered breathing

 Skin problems.
IMPLEMENTATION
 Administer antibiotics, anticholinergics,
laxatives and antispasmodic
 Evaluate sac; measure lesion

 Monitor for increase ICP

 Protect the sac

1.cover with sterile, moist ( normal saline)

2. change dressing every 2-4 hours
 Place in prone position
MENINGITIS
 Infectious process of the
CNS caused by bacteria
and viruses
 Acquired as a primary or
as a result of
complications
 Diagnosis- CSF analysis (
increase pressure,
cloudy CSF, high protein,
low glucose).
ASSESSMENT

 S/S vary depending of age group

 Fever, chills

 Vomiting, diarrhea

 Poor feeding or anorexia

 Headache with nausea and vomiting

 Sensitivity to light

 seizures

 Altered LOC

 Bulging fontanel

 Nuchal rigidity
NEWBORNS AND INFANTS MAY SHOW
THESE SIGNS:

 High fever
 Constant crying

 Excessive sleepiness or irritability

 Inactivity or sluggishness

 Poor feeding

 A bulge in the soft spot on top of a baby's head

(fontanel)
 Stiffness in a baby's body and neck
MOST COMMON STRAINS
OF BACTERIA
 Streptococcus pneumoniae
(pneumococcus). 
 Neisseria meningitidis
(meningococcus). 
 Haemophilus influenzae
(haemophilus).
 Listeria monocytogenes
(listeria). 
IMPLEMENTATION
 Isolation; at least 24 hours after antibiotics
are initiated
 Monitor VS and neuro status

 Monitor I and 0

 Assess nutritional status

 Determine close contacts of the child with

meningitis
FEBRILE SEIZURES
 Febrile seizures are convulsions brought on
by a fever in infants or small children. 
 Rectal temperatures greater than 102
degrees F.
 Most febrile seizures occur during the first
day of a child's fever.
FACTORS
 young age (less than 15 months) during the
first seizure
 frequent fevers

 having immediate family members with a

history of febrile seizures.
DURING SEIZURES
 loses consciousness and shakes, moving
limbs on both sides of the body
  rigid or has twitches in only a portion of the
body
 last a minute or two
INTERVENTION DURING SEIZURE
 PRIORITY: SAFETY
 Place on a protected surface such as the floor
or ground
 Not be held or restrained

 Placed on his or her side or stomach to

prevent choking
 Gently remove any objects from the mouth

  Look at your watch when the seizure starts –

lasts 10 mins – medical facility
 Oxygenation
ATTENTION-
DEFICIT/HYPERACTIVITY DISORDER
 Attention-deficit/hyperactivity disorder
(ADHD) is the most common behavioral
disorder of childhood, 1 of the most
prevalent chronic health conditions
affecting school-aged children (5-10%)
 (1) inattention, including increased
distractibility and difficulty sustaining
attention
 (2) poor impulse control and decreased
self-inhibitory capacity
 (3) motor overactivity and motor
restlessness
EPIDEMIOLOGY
 Studies of the prevalence of ADHD
across the globe have generally
reported that 5–10% of school-aged
children are affected
 Many children with ADHD also present
with co-morbid psychiatric diagnoses,
including oppositional-defiant disorder,
conduct disorder, learning disabilities,
and anxiety disorders
WHO IS AT RISK?
 The average age of onset: 7 years old
 Boys are four times at risk than girls
WHAT CAUSES ADHD?
 It is not caused by vaccines, too much sugar
or poor parenting
 It has biological origins that are not yet
clearly understood
 Experts have found that certain areas of the
brain are about 5-10% smaller in size and
activity
 Recent research also links
smoking/alcoholism during pregnancy to
later ADHD in a child
 Other risk factors may include premature
delivery, very LBW, and injuries to the brain
at birth
WHAT CAUSES ADHD?
 Some studies have even suggested a link
between excessive early television watching
and future attention problems
ETIOLOGY
 Evidence suggests that there is no
single factor that determines the
expression of ADHD
 Multiple factors have been implicated

 Abnormal brain structures are linked to

an increased risk of ADHD
PATHOGENESIS
 MRI studies indicate a loss of normal
asymmetry in the brain
 5–10% reduction on brain volumes of
specific structures, such as the
prefrontal cortex and basal ganglia
 low blood flow to the striatum

 Fluorodopa positron emission

tomography scans have also supported
the dopamine hypothesis through the
identification of low levels of dopamine
activity in adults
CLINICAL MANIFESTATIONS
 The 1st subtype: inattentive type
- often includes cognitive impairment
and is more common in females
 2nd subtype: impulsive/hyperactive type

 3rd subtype: combined type

- are more commonly diagnosed in males

DIAGNOSIS
Clinical Interview and History.
 The clinical interview allows for a
comprehensive understanding of whether
the symptoms meet the diagnostic
criteria for ADHD
Behavior Rating Scales.
 Behavior rating scales are useful in
establishing the magnitude and
pervasiveness of the symptoms, but are
not sufficient alone to make a diagnosis
of ADHD
DIAGNOSIS
Physical Examination and Laboratory
Findings.
 There are no laboratory tests available
to identify ADHD in children
 Impaired fine motor movement and poor
coordination and other soft signs (finger
tapping, alternating movements, finger-
to-nose, skipping, tracing a maze,
cutting out paper)
TREATMENT
 Psychosocial Treatments
 Behaviorally Oriented Treatments

 Medications.

The most widely researched medications

used in the treatment of ADHD are the
psychostimulant medications, including
methylphenidate (Ritalin, Concerta,
Metadate), amphetamine, and/or various
dextroamphetamine preparations
PROGNOSIS

 A childhood diagnosis of ADHD often

leads to persistent ADHD throughout the
life span
 These risk factors include engaging in
risk-taking behaviors (sexual activity,
delinquent behaviors, substance use),
educational underachievement or
employment difficulties, and relationship
difficulties
 AUTISM

 A complex developmental disability that

typically appears during the first 3 years of
life.
 It develops and is typically diagnosed before
36 months of age.
 It is characterized by a behavioral phenotype
that includes qualitative impairment in the
areas of language development or
communication skills, social interactions and
reciprocity, and imagination and play
DIAGNOSIS
A.    A total of 6 (or more) items from (1),(2),
and (3), with at least 2 from (1) and 1 each
from (2) and (3):   
1.    Qualitative impairment in social
interaction, as manifested by at least 2 of the
following:   
a.    Marked impairment in the use of multiple
nonverbal behaviors, such as eye-to-eye gaze,
facial expression, body postures, and
gestures to regulate social interaction   
b.    Failure to develop peer relationships
appropriate to developmental level   
c.    Lack of spontaneous seeking to share
enjoyment, interests, or achievements with
other people (e.g., by a lack of showing,
bringing, or pointing out objects of interest)   
d.    Lack of social or emotional reciprocity   
2.    Qualitative impairments in communication,
as manifested by at least 1 of the following:   
a.    Delay in, or total lack of, development of
spoken language (not accompanied by an
attempt to compensate through alternative
modes of communication, such as gesture or
mime)   
b.    In individuals with adequate speech,
marked impairment in ability to initiate or
sustain a conversation with others   
c.    Stereotyped and repetitive use of
language or idiosyncratic language   
d.    Lack of varied, spontaneous make-believe
play or social imitative play appropriate to
developmental level   
3.    Restricted, repetitive, and stereotyped patterns of
behavior, interests, and activities, as manifested by at
least 1 of the following:   
a.    Encompassing preoccupation with ≥1 stereotyped
and restricted pattern of interest that is abnormal in
either intensity or focus   
b.    Apparently inflexible adherence to specific,
nonfunctional routines or rituals   
c.    Stereotyped and repetitive motor mannerisms (e.g.,
hand or finger flapping or twisting or complex whole
body movements)   
d.    Persistent precoccupation with parts of objects
B.    Delay or abnormal functioning in at least 1 of the
following areas, with onset < age 3 yr:(1) social
interaction,(2) language as used in social
communication, or (3) symbolic or imaginative play   
C.    The disturbance is not better accounted for by Rett
disorder or childhood disintegrative disorder
CLINICAL FEATURES
 Impairment in joint attention- is the inability
to use eye contact and pointing for the
purposes of sharing experiences with others
-It is a skill that typically develops by 18 mo
 Imapairment in protoimperative pointing -the
inability to use pointing to obtain an object of
desire
 Inability to protodeclarative pointing -the
inability to use pointing to an object of
interest simply to have another share in the
interest with him or her
CLINICAL FEATURES
 make no eye contact and seem totally aloof
 show intermittent engagement with their
environment
 can range from being nonverbal to having
advanced speech, capable of imitating songs,
rhymes, or television commercials
 speech may have an odd prosody or intonation
and may be characterized by echolalia, pronoun
reversal, nonsense rhyming, and other
idiosyncratic language forms
CLINICAL FEATURES
 Intellectual functioning can vary from mental
retardation to superior intellectual
functioning in select areas
 Play skills in children with autism are
typically aberrant, characterized by little
symbolic play, ritualistic rigidity, and
preoccupation with parts of objects
 Stereotypical body movements, a marked
need for sameness, and a very narrow range
of interests are also common
CLINICAL FEATURES
 The autistic child is often withdrawn and spends
hours in solitary play
 Ritualistic behavior prevails, reflecting the child's
need to maintain a consistent, predictable
environment
 Tantrum-like rages may accompany disruptions of
routine
 Eye contact is typically minimal or absent

 Visual scanning of hand and finger movements,

mouthing of objects, and rubbing of surfaces may
indicate a heightened awareness of and sensitivity
to some stimuli
 ETIOLOGY

 The exact cause of autism is unknown, but is

believed to be multifactorial, with a strong genetic
influence
- identical twins – if one has ASD, the will be
affected about 36-85%
- fraternal twins – 0-31%
- parents who have a child of ASD have a 2-18%
chance of having a second child who is also affected.
- ASD tends to occur more often in people who
have certain genetic or chromosomal conditions
- about 10% of children with autism are also
identified as having Down Syndrome
- almost half (46%) of children identified with ASD
has average to above average intellectual ability
ETIOLOGY
 Additional studies of neuroanatomy in
children with autism have demonstrated
anatomic changes in the anterior cingulate
gyrus, an area of the brain associated with
decision-making and the ascription of
feelings and thoughts
 Environmental factors influencing early brain
development
ENVIRONMENTAL FACTORS:

 Advanced age at time of conception (both

parents)
 Maternal illness during pregnancy

 Certain difficulties during birth, particularly those

involving periods of oxygen deprivation to the
baby’s brain
INCIDENCE
 1 out 68 children (US CDC)
 Boys are nearly 5 times more likely than girls
to have autism (an estimated 1 out of 42
boys and 1 in 189 girls are diagnosed with
autism in the US)
 ASD affects over 3 million individuals in the
US and tens of millions worldwide
 DIAGNOSIS

 Aberrant social skill development is the hallmark of

autism spectrum disorders (ASDs), and early social
skill deficits may include abnormal eye contact,
failure to orient to name, failure to use gestures to
point or show, a lack of interactive play, failure to
smile, lack of sharing, and lack of interest in other
children
 The Checklist for Autism in Toddlers (CHAT)
is a screening tool designed for use with 18 mo
old children in primary care settings
Thereis no medical
cure for autism.
AUTISM TRIAD OF IMPAIRMENTS:

1. SOCIAL INTERACTION
 Exhibits poor or atypical eye contact

 Failure to respond or has a delayed response to

his/her name
 Prefers to be alone

 Does not seem to be aware of others or their

feelings
 Fails to develop appropriate peer relationships
AUTISM TRIAD OF IMPAIRMENTS:

2. COMMUNICATION:
 Atypical language development; little or no
language abilities
 May have marked impairment in initiating
and/or maintaining a conversation
 May repeat words or phrases instead of
normal language
 May demonstrate lack of make-believe or
socially imitative play
AUTISM TRIAD OF IMPAIRMENTS:

3. BEHAVIOR:
 Exhibits restricted/ or stereotyped pattern of
activities, interest and behaviors
 Inflexible adherence to routine, strong
resistance to change of routine or
environment
 May exhibit repetitive motor movements

 Obsessive interest interests

 Unusual play and interaction with objects

TRISOMY 21
 Down syndrome (DS),
 Condition in which extra genetic material
causes delays in the way a child develops,
both mentally and physically.
 It affects about 1 in every 800 babies.

 Gets an extra chromosome 21 — for a total

of 47 chromosomes instead of 46. 
 Women age 35 and older have a significantly
higher risk of having a child with the
condition.
TRISOMY 21
 The disorder was first identified in 1866 by
John Langdon Down, a British physician
ASSOCIATED MEDICAL PROBLEMS:
 Congenital heart disease
 Gastrointestinal abnormalities

 Musculoskeletal and movement problems

 Spine disorders such as scoliosis, kyphosis or

lordosis
 Endocrinologic disorders

 Epilepsy

 Hearing loss

 Speech apraxia (difficulty making speech sounds)

 Sleep disorders

 Feeding disorders

 Developmental disabilities (learning disabilities,

intellectual disabilities and autism)
SIGNS AND SYMPTOMS
 Distinctive facial features
 Mild to moderate intellectual disabilities

 Heart, kidney and thyroid issues

 Numerous respiratory infections, from colds to bronchitis

and pneumonia
 Skeletal abnormalities, including spine, hip, foot and
hand disorders
 Flexible joints and weak, floppy muscles

 Overly quiet baby

 Less responsive to stimuli

 Vision and hearing impairment

 Inwardly curved little finger

 Abnormal space between the great and second toe

 Unusual creases on the soles of the feet and one or both

hands
DIAGNOSIS
 Amniocentesis
 DNA testing

 X-rays, MRI

 CT scan
Thereis no cure for
Down syndrome.
FAILURE TO THRIVE
 Significant interruption in the expected rate
of grow
 Weight less than the third to fifth percentile
for age on more than one occasion or weight
measurements that fall 2 major percentile
lines using the standard growth charts of the
National Center for Health Statistics (NCHS)
during early childhood
CAUSES
 Non organic failure to thrive - result of
inadequate energy intake
 organic failure to thrive - compromised use of
ingested calories and excessive metabolic
demands
 a combination of non organic and organic
failure to thrive.
ASSESSMENT
 Edema including ascites - Renal disease, liver disease,
protein-losing enteropathy
 Wasting - Cancer, HIV, CP, poorly controlled inflammatory
disease
 Hepatomegaly - Liver infiltration by tumor, storage disease, or
cirrhosis
 Heart murmur - Congenital heart disease

 Respiratory compromise -Cystic fibrosis, bronchopulmonary

dysplasia
 Rash or skin changes - HIV, congenital syphilis, cow's milk
protein allergy, lupus
 Hair color and texture changes - Zinc deficiency, Menkes
kinky hair disease
 Mental status changes - CP

 Signs of vitamin deficiency -Celiac disease, parasites, other

enteropathy