Medical Conditions Review

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Medical Conditions Review

• Gretchen Vigil, MD
• May 2009

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Medical Conditions Review

• Neurological Issues
• Obesity
• Behavioral challenges

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Neurological IssuesDevelopmental DelayCerebral
Palsy/Static EncephalopathyBrain Injury
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DevelopmentalDelay

• Failure to reach developmental milestones at the
  expected age
• 10-15 prevalence

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Development
goes in
an orderly
step-wise
fashion.
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DevelopmentalDelay

• Can be in one or multiple areas
• Physical, cognitive, communicative, social,
  emotional
• Physical or motor delay is called cerebral palsy

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Developmental Delays

• Slower than normal rates of acquisition of
  developmental skills including behavioral and
  motor skills.
• Associated with a number of medical conditions,
  including prematurity, low birth weight, and
  congenital anomalies.
• Some children with developmental delays will
  catch up.
• Other children will need on-going support of
  medical and rehabilitation services.

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Cerebral Palsy (CP)Static Encephalopathy

• A group of disorders of movement and posture due
  to a non-progressive defect or lesion of the
  brain.
• Damage can occur before or after birth.
• Developmental delays in an infant or toddler are
  usually the first indicators.
• Symptoms range from slight speech impairment to
  total inability to control body movements.

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Source Automotive Safety Program
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Source Automotive Safety Program
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Source Automotive Safety Program
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Hypertonia- increased tone
Hypotonia- decreased tone
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Brain Injury

• Multiple causes
• Can create local or global issues
• Resultant mental retardation or hypertonia or
  hypotonia can create transportation needs

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Brain Injury

• Primary damage
• Secondary damage
• Brain cell injury
• Cerebral edema (swelling)
• Free radicals, chemical mediators create more
  damage and cell death
• All of the above creates more brain damage

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Brain Injury -1

• Child Abuse
• Trauma to head, shaken baby, shaken-impact
• Diffuse axonal injury, intracranial bleeding,
  scalp bruising
• Secondary brain injury
• Usually with retinal hemorrhages, fractures,
  bruises, etc

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Brain Injury -2

• Hypoxia-Ischemia
• Decreased oxygen to brain
• Decreased blood flow to brain
• Multiple causes near drowning, suffocation,
  anything requiring CPR, shock, drug exposure,
  pulmonary cause
• Often with multiple organ damage

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Brain Injury -3

• Central Nervous System Infection
• Meningitis
• Brain abscess
• Encephalitis

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Transporting Children with Neurological Issues

• Group discussion

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Obesity
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Obesity

• Epidemic numbers!

• 2/3 adults are overweight or obese

www.cdc.gov
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Obesity

• Childen with obesity can develop
• Type 2 diabetes
• Hypertension
• Asthma
• Sleep problems
• Liver disease
• Early puberty
• Infections
• Joint problems

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Obesity

• In 5-17yo.
• 70 obese children had 1 cardiovascular risk
  factor
• 40 obese children have 2
• 80 of overweight preteens/teens will be obese as
  adults

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Obesity

• Group discussion of obese children and
  transportation issues

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Behavioral Challenges
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Behavioral Challenges

• Behaviors such as impulsiveness, distractibility,
  defiance, aggressive behavior.
• May be associated with conditions such as autism,
  fragile X, or cognitive impairment.
• May resist consistent use of restraints and be
  serious distractions to drivers.
• Many parents need guidance with management of
  behavioral problems.

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Transporting Children with Behavioral Challenges

• Families may need to try a variety of restraints
• Full harness to higher weight.
• Make sure harness straps are snug.
• An upright travel vest with back closure or large
  medical seat may be required for older children.
• Behavioral management
• Group discussion

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Premature and Low Birth Weight Infants
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Low Birth Weight Infants

• Low birth weight (LBW) less than 2500 g.
• Includes pre-term and full term infants.
• LBW related to inadequate prenatal care, teenage
  pregnancy, multiple deliveries, genetic
  syndromes, prenatal infections.
• One of leading causes of infant mortality.
• LBW infants have problems with decreased oxygen
  and resultant brain injury, genetic syndromes and
  dysmorphology.

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Premature Infants

• Less than 37 weeks gestational age at birth.
• At risk for multiple medical problems
• Respiratory-
• Apnea- may need home monitoring
• Respiratory distress syndrome
• need for ventilator
• resultant lung damage and need for home oxygen
  and monitors

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Premature Infant

• Cardiovascular
• Patent Ductus Arteriosus
• Bradycardia, hypotension, hypertension
• Congenital heart defect
• Gastrointestinal
• Poor motility
• Constipation
• Gastroesophageal reflux
• May need feeding tube

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Premature Infant

• Neurologic
• Intraventricular hemorrhage
• Hypoxic Ischemic Encephalopathy
• Retinopathy of Prematurity
• Seizures
• Drug withdrawal
• Infection
• Prenatally or NICU acquired

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Premature Infant

• Consequences
• Mental retardation, delays, and cerebral palsy
• Lung damage, asthma, home oxygen
• Apnea, SIDS
• Hearing or vision impairments
• GERD, feeding problems
• Social stressors, child abuse

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Transporting LBW and Premature Infants

• Monitor prior to discharge.
• Select car seats/beds with appropriate weights
• Do NOT add padding
• Center with rolled receiving blankets crotch
  roll to prevent submarining.
• Maintain appropriate recline angle during
  monitoring and in vehicle.
• Dont use car seat for positioning other than for
  travel

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Transporting LBW and Premature Infants

• Group discussion