471 FNP 1-Neuro & Mental Health

NUR 471 Neuro and Mental Health 1

NUR 471 Family Nurse Practitioner I

Spring 2012
Neurological and Mental Health Problems in Children
Common Problems
A. Cerebral palsy
B. Developmental delays and mental retardation
1. Micro/macroencephalopathy
2. Craniosynotosis
3. Down Syndrome
C. Spina bifida
D. Seizure disorders
E. Febrile seizures
F. Meningitis
G. Brain lesions
H. Reyes syndrome
I. Hypotonia: Muscular Dystrophy
J. Headaches
K. ADD/ADHD
L. Depression/suicide
M. Anxiety (added)
N. Bullying
O. Autism
P. Sleep Disorders
Associated Readings:
Burns et al. (2009). Pediatric Primary Care. Read Chapters 15, 16, 27, 1125-1133.
Chiocca. (2011). Advanced Pediatric Assessment. Read Chapters 22 & 24.
Hay et al. (2011). Current Diagnosis & Treatment Pediatrics. Read Chapters 6 (171-182,
common disorders listed above) & 23 (696-706, common disorders listed above).
Optional resource on neurological exam of newborns with videos!

http://library.med.utah.edu/pedineurologicexam/html/newborn_n.html#01
Cerebral Palsy
Non-progressive disorder of movement
Caused by injury to the CNS
Incidence: 1-3 live birth per 1000
Brain lesion is static but manifestation changes over several years due to developing nervous system
Mental retardation 26% (mild), 27% (severe)

Microcephalic
Definitive diagnosis of cerebral palsy should not be made until 1 year of age (changing findings)
Diagnosis- based on 4 out 6 major motor areas:
Posture
Oral motor functioning
Visual-motor functioning
Tone
Evolution of primitive reflexes
Muscle-stretch reflexes; hyperreflexia

Levine (Poster) Criteria for Diagnosing Cerebral Palsy
P posturing and abnormal movement pattern
O oropharyngeal problems
S strabismus
T tone, increased or decreased in muscles
E evolution response, persistent primitive reflexes/ failure to develop protective response
R reflexes, deep tendon reflex increase, plantar reflexes up-going
Types of Cerebral Palsy
Hemiparesis
Spastic Diplegia/ Quadriplegia; 75%
Dystonic-Athetoid (Extrapyramidal)
Hypotonic
Ataxic; 15%
Mixed
Management Issues in CP
Nutrition (FTT common due to oral motor problems) - assess/educate parents re: eating difficulties/
appropriate techniques
Constipation common (stool softeners/ regular bowel regime)
Drooling skin breakdown/ social issue
Seizures 50%
Orthopedic issues muscle relaxants
Safety issues high risk for injury
Multi-disciplinary management
Micro/Macrocephaly
Average head circumference at birth: 2 cm greater than chest circumference (about 35cm)
Head growth faster in premature infants than term infants
Microcephaly 2 standard deviations below the mean (or 2 nd percentile for age and gender)
Macrocephaly 2 standard deviation above the mean
Refers to brain size
Causes of Micro/Macrocephaly
Infections
Drugs
Anoxia
Heredity
Chromosomal
Malformations
Trauma
Perinatal metabolic/endocrine imbalances
Malnutrition
Perinatal maternal illness
Management:
Microcephaly no treatments or medications are indicated
Counseling for parents
Genetic evaluation and counseling
Routine follow-up with neurologist
Macrocephaly dependent on cause
Monitor for ICP and immediately seek medical attention - teach parents to monitor
o Infants bulging fontanels, vomiting, drowsiness, seizures
o Older child - headache, blurred vision, behavior changes, decreased level of consciousness,
vomiting, seizures)
Monitor head circumference (document parents head circumference) and fontanel size
Chromosomal evaluation
Craniosynotosis
Premature fusion of the cranial sutures, usually beginning in utero
Sagittal suture most common (50%)
More common in boys
Results in skull/craniofacial deformities
Increased intercranial pressure
Cause chromosomal or unknown etiology
Goal is to ensure normal brain growth
Surgery is usually treatment of choice
Down Syndrome
Common chromosomal abnormality; 1/800 to 1/1000 live births
Involves multiple anomalies due to partial or complete (84%) trisomy of chromosome 21
Prenatal diagnosis by amniocentesis offered to women over 35 years
Most born to women under age 35
Genetic counseling and chromosome analysis of parents (especially with translocation of 21)
Interdisciplinary team management is key
Diagnostic Features
Facial; up-slanted palpebral fissures, small nose with low nasal bridge, inner epicanthal folds, flat
facial profile, Brushfield spots (speckling of iris), open mouth, tongue protruding, small ears
Flat occiput
Short neck, excess skin on posterior neck
Hypotonia
Hyper-flexibility of joints
Limbs; wide space between first and second toe, single palmar crease, short wide hands
Small stature, immature gait
Associated Developmental and Medical problems

Variable global delay
Mid-moderate mental retardation (IQ 45-90)
40-60% with cardiac problems ASD, VSD, TOF, PDA
12% with GI problems Hirschsprung Disease, imperforate anus, duodenal atresia
Jaundice when newborn
Orthopedic problems atlantoaxial instability, late hip dislocation
Ophthalmologic problems refractive errors, myopia, congenital cataracts, strabismus
incidence of OM, chronic sinusitis, hearing loss (70-80%), hypothyroidism, leukemia
Management considerations
Medical through physical evaluation
o Consider X-rays if indicated for orthopedic problems, echocardiogram, TSH, vision and
hearing screening
Educational IEP, teachers aide in classroom
Psychological social skills training, behavioral therapy consult
Spina Bifida and Myelomeningocele
Most frequent serious congenital malformation
Multifactorial cause (incidence 1 in 1000 live births)
Folic acid supplementation is protective
Neural tube defect present at birth
Level of lesion in spinal cord determines childs potential for mobility
75% of lesions occur in lumbosacral area
Scoliosis develops with higher level lesions
Foot deformities occur early due to innervation of ankle dorsiflexors and weak plantar flexors
Care Issues with Spina Bifida
Monitor growth & development
Skin breakdown due to decreased sensation
Safety prone to injury due to w/c or braces and decreased mobility
Bowel and bladder management assess bladder program; constipation is common and can cause
shunt malfunction or UTIs
Latex allergy is common in those with spina bifida
Multidisciplinary management
Seizure Disorder
Definition: Abnormal brain functioning caused by abrupt, uncontrolled, repetitive discharges of

cortical neurons with the brain
Incidence: Approximately 3.5 to 5% of children have a seizure by 15 years of age
Only 1% with seizures have epilepsy (recurrent seizures)
50% occur in children under 10 years
Appx. of childhood seizures are idiopathic
Common Etiology
Neonate: hypoxia, CNS bleed, infection
Infants: infection, dehydration, fever, CNS trauma, inborn errors of metabolism
Children and Adolescent: head trauma, fever, tumor, toxin ingestion, non-adherence or inadequate
dose of anticonvulsant med, street drugs esp. cocaine, breath-holding spells
Classification of Seizures:
Generalized Seizures (arise from both cerebral hemispheres)
Nonconvulsive
o Typical absence seizures petit mal
o Atypical absence seizures onset gradual
Convulsive
o Tonic abrupt increase in muscle tone
o Atonic abrupt decrease in muscle tone
o Clonic repetitive muscle jerking

o Tonic-Clonic classic grand mal seizure
o Myoclonic brief, shock-like muscle contractions
Partial Seizures (focal onset)
Simple does not impair consciousness

o Symptoms bases on lobe affected such as temporal (emotional sensations, smell,
taste), frontal (strange movements), parietal (strange sensations), occipital (visual
sensations)
Complex focal onset seizure that does involve the loss or impairment of consciousness
Both types of partial seizures may present with motor signs (clonic jerking), sensory symptoms
(tingling, distortions of smell or vision), autonomic signs (pallor, diaphoresis), or psychic sxs
(fear, hallucinations)
Status epilepticus: Prolonged seizure for > 30 minutes
History
High-risk screening by 5 questions: Born prematurely, family history of seizures, personal history
of seizures, head injury with loss of consciousness for 30 minutes or more, CNS infection
(meningitis, encephalitis)
Characteristics of seizure
Loss of consciousness
Presence of an aura; visual, auditory, sensations
Abnormal eye movements
Precipitating events
Post-ictal state
Head injury
Incontinence
Cyanosis
Hx of seizures, medication, underlying illness
Management
Complete physical/neurologic exam
Blood chemistry (serum glucose, lytes, Ca, BUN, CBC with diff)
Lead screen
Toxicology on blood and urine in teens
Liver function tests
EEG; may need to do serial EEGs (sleep-deprived)
MRI (for focal seizures, adolescent with 1st seizure)
Dont routinely change from Trade to Generic brand drug; increase risk of seizure
Referral/consultation
o May not treat 1st seizure
o Some seizures in children resolve with aging
o Trial off medication if > 5 years seizure free
o No driving until 6 months seizure fee

Monitoring/Education
Routine monitoring of lab related to anticonvulsant medications (levels, CBC, LFTs as indicated)
Dental hygiene/gum hyperplasia if on Dilantin
Emphasize need to never abruptly discontinue meds
Educate regarding seizure precautions and safety issues (ie. shower versus bath, no swimming
alone, biking, mowing, pregnancy)
Febrile Seizures
Occurs in approximately 2% of children; most common childhood seizure
Highest incidence between 6-18 months (range 3 months-5 years)
Risk increases with:
o Family hx of seizures
o Maternal smoking during pregnancy
o Prematurity
o Day care > 20 hours per week
o Frequent infections in the 1st year of life
Triggered by rapid rise in temperature to at least 39 degrees during the early course of an illness
A febrile seizure that occurs after the 1st 24 hours of fever is most likely due to significant
infection
Most are generalized seizures (tonic-clonic)
Duration: 50% last < 5 minutes; 75 % last < 20 minutes; 2-3% last longer than 30 minutes
Recurrence risk 30%, < 1year-old 50%

Increased risk of epilepsy

Management
Controlling fever (rectal acetaminophen, sponging)
Monitoring for any sign of meningitis esp in children under 2 yrs
Monitoring for other infections (UTIs, throat) with UA, CBC, strep screen
Lorazepam used for status epilepticus due to less resp. depression
Prophylaxis with anticonvulsant if: family member has hx of nonfebrile seizures; duration > 15
min; > 1 seizure in 24 hrs; prior hx of abnormal neuro exam
Reassure parents/of nature of seizures
Seizure precaution education
Referral if uncertain of diagnosis or cause of recurrence
Meningitis
Most common pathogens: Strep pneumoniae and Neisseria meningitidis (2 mo to 12 yrs)
Aseptic meningitis (acute inflammation of meninges) most often viral
Incidence: increased during winter and spring
More common in males/age 2 mos to 2 years
Risk factors: varicella inf., URI, insect bites, without Hib or MMR vaccinations, head trauma,
day-care
Sxs: irritability, fever, lethargy, nuchal rigidity, confusion, severe headache

Brain Lesions
Most common brain tumors:
o Astrocytoma
o Medullablastoma
o Ependymoma
2nd most common childhood malignancy
Incidence: 3 per 100,000 under 15yrs
Sxs: headaches, neuromuscular changes, behavioral changes, vomiting, seizures, papilledema

cranial neuropathy, VS changes
Care of children with brain tumors
Txs: surgery, chemotherapy, radiation
Monitor nutrition
Immunizations
Sleep
Safety
Vision/hearing/dental screening
Discipline advise parents to use other strategies than spanking
Normal activity as possible
Reyes Syndrome
Encephalopathy and non-inflammatory fatty infiltration of liver and kidney
Associated with epidemics of influenza A & B, and chicken pox and medicating with aspirin for
viral illness (predisposes to developing Reyes syndrome)
Sxs: protracted vomiting; confusion; combative behavior; agitation; stupor; coma
Management: supportive care, monitoring ICP, vit K or fresh frozen plasma, educate parents
regarding no aspirin products
Muscular Dystrophy
Duchenne and Becker Muscular dystrophy (most common types) - genetically determined
Progressive disorder affecting muscles of upper extremities, chest wall and heart
Clinical onset: appx 3 yrs old, with rapid progression
Sxs: hx of clumsiness; trips and falls easily; muscular looking calves; delayed motor
development; inability to keep up with peers when running, mental impairment (30%), scoliosis
-Gower maneuver - pushes off ones own upper legs to get up from seated position
Headaches
Optional resource Migraine headache article http://www.aafp.org/afp/2009/1215/p1445.html
Majority of HAs due to nonorganic causes (Tension, allergies, sinus infections, migraines 5-15%)
Frequent complaint; 37% by age 7, 69% by age 14
More common in girls
Young children (less than 5 years of age) esp with specific complaints are likely to have organic
etiology
Increased risk: stressful home/school environments; family hx of HA; parent with mental health
problem; recent major life crisis; use of drugs or ETOH
Hx/Exam:
o Ask about associated sxs
o Vital signs (esp temp and B/P)
o Complete Neurologic exam
o Assessment of TMJ/dental exam
o Visual acuity/last vision exam by optometrist
o Thorough HEENT exam
o Skin inspection for rashes and/or lesions
Headache Warning Signs Indicators of Organic Etiology
New onset (less than 3 months)
Child less than 3 years old

Headaches associated with diplopia/papilledema
Awakens child in middle of night, worse when lying down
Pain present upon arising but improves as day progresses, or occipital pain (common with
tumors)
Bruit in temporal areas
Positive neurologic finding/seizures/N/V
Increase in frequency/severity over a few weeks
Exacerbated by position changes, straining, coughing
Petechiae/ecchymosis
Post trauma
Headache Differential Dx:
Acute generalized: fever, infection; trauma
Acute localized: sinusitis, otitis, dental, TMJ, cocaine use
Acute recurrent: migraine, cluster, post seizure
Chronic progressive: tumor, brain abscess, subdural, hematoma, hemorrhage, vasculitis
Chronic nonprogressive (tension headache): muscle contraction, malingering, post concussion,

depression, anxiety, adjustment reaction
Management
Medicate at onset of headache. Reassurance is important.
Headache diary if frequent, including diet.

Acetaminophen: if sxs infrequent or not severe (15mg/kg/dose) for non-migraine
Acute migraine attacks
o Ibuprofen: when acetaminophen not providing good relief or if migraine or menses

related HA (5-10mg/kg/dose) q 6-8 hrs
o Abortive for migraines (if has aura): sumatriptan po 50 mg children 6-12 yrs; 100mg if
over 12 yrs
Migraine Prophylaxis
o Beta-blockers, propranolol 40-80 mg BID initially
o Sleep
o Stress reduction
o Dietary management
With comorbid depression - Zoloft 50 mg per day
Also used but not recommended in migraine clinical guideline;
o Fiorinal (butalbital, aspirin, caffeine) 1-2 caps q 4 hrs if ibuprofen not effective, use
sparingly (for adolescents)
o Amitriptyline (for adolescents) 25-50mg q HS
ADHD - Attention Deficit Hyperactivity Disorder (ADHD and ADD )
Most commonly diagnosed behavioral problem
o Is it under-diagnosed or over-diagnosed?
o Does every inattentive child have ADD or ADHD?

One of five most common chronic disorders of childhood
Prevalence for school age children 3-5%; 4.5 million 5 to 17 year-olds
3 Basic Symptoms of ADHD
o Inattention (pays attention too many things),
o Impulsivity,
o Hyperactivity
M>F
o Teachers expect more of boys
o Boys more hyperactive/impulsive so diagnosed earlier

o Girls more inattention so often diagnosed in Middle school
Clear genetic influences (twin studies), believed to be due to;
o Low norepinephrine (inattention, distractability) and,
o Low dopamine (impulsivity, behavior problems).
Clear environmental influences; maternal tobacco&/or alcohol use, fetal distress, low birth weight
Big controversy due to increased use of stimulants in 1990s
80% have comorbid conditions; ODD (35%), OCD CD (30-50%), mood disorders (15-70%), anxiety
disorders (25%), substance abuse, and may precede development of Tourettes
2011 AAP guidelines cover age 4-18
http://pediatrics.aappublications.org/content/128/5/1007.full.pdf+html
ADHD Hyperactive/Impulsive Criteria
Fidgets hands or feet or squirms in seat
Leaves seat in classroom
Runs about or climbs excessively
Difficulty playing quietly
On the go or driven by a motor
Talks excessively
Blurts out answers
Difficulty waiting turn
Interrupts or intrudes on others
ADHD Inattentive Criteria
Makes careless mistakes
Difficulty sustaining attention
Does not seem to listen
Does not follow through
Difficulty organizing tasks
Avoids tasks that require mental effort
Loses necessary items

Easily distracted
Forgetful
ADHD evaluation
Symptoms before age 7; difficult to diagnose before age 4
DSM IV criteria
o Symptoms present for at least 6 months
o 2 settings (home, daycare, school, work)

o Evidence of social, academic &/or occupational impairment
o At least 6 inattention symptoms and/or hyperactivity/impulsivity symptoms
o Some hyperactivity/impulsivity symptoms must have been present before 7 years-old
Symptoms are not better accounted for by another mental illness
Information must be obtained directly from parent and teachers (Conners)
History; DSM-IV criteria, family history

Physical exam; complete history, growth, neurological, auditory/visual screening
Consider testing; CBC, lead, TSH, neurodevelopmental, psychoeducational
Differential diagnosis: see Burns pg. 328
Treatment for ADHD
Behavioral (positive reinforcement, time-out, token economy, response cost) 1 st line
Medication, 2nd line starting at age 4
o Stimulants: methylphenidate (Ritalin), methylphenidate extended release (Concerta,

Ritalin SR, Metadate ER, Methylin), amphetamine/dextroamphetamine (Adderall)
o Non-stimulant: atomoxetine (Strattera), Pemoline, Guanfecine, clonidine (for aggression,

tics, controversial for sleep problems- off label, need baseline ECG, important SEs &
Contraindications).
o If one stimulant does not work at the highest feasible dose, try another
o Parent education on side effects crucial
Dietary considerations; monitor weight
Close follow-up is important for successful management including input of school (family
support, nutrition, sleep, academic performance, psychological functioning)
Depression and Suicide
Rate of depression increases with age; 1-3% before puberty, 8% adolescent, nearly adult rate by at 15
(lifetime risk 10-25% women; 5-12% men)
Depression rate higher for females starting at puberty 5:1, equal rate before puberty
50% do not seek treatment
Most treated in primary care
Often comorbid with ADHD, conduct disorders, anxiety disorders, eating disorders, substance abuse
Suicide is the 2nd leading cause of death for 15-19 year olds
o For each suicide, approximately 100-200 attempts
o Medical examiners under report 25-50%
o 1 in 5 (19%) high school students consider attempting suicide
Behavioral Warning Signs
Changes in appetite or weight
Changes in behavior
Changes in school performance
Helplessness/Hopelessness
Loss of energy
Loss of interest in activities/withdrawal
Morbid ideation
Substance abuse
Myths of Youth Suicide
Most youth suicides occur unexpectedly without warning signs
Youth who talk about suicide do not attempt or commit suicide
Most youth who try suicide fully intend to die
Educating youth about suicide leads to increased suicide attempts

Many suicide threats or attempts should not be taken seriously
Youth suicide occurs only among poor individuals
Only a counselor can help a suicidal youth
How can primary providers help prevent suicide?
General screening includes:
o Pt/Fam hx of psychiatric disorders
o Pt/Fam hx of previous suicide attempts
o Hx of substance abuse
o Brief mental status exam
Ask directly about suicidal ideation, physical and sexual abuse
Actively listen to patient
Know your referral options!

o Treatment usually psychotherapy and in moderate to severe depression medication
Anxiety Disorders
Prevalence Social Anxiety Disorder (3-13%), Generalized Anxiety Disorder (3-8&), Panic Disorder
(6%), Obsessive Compulsive Disorder (2-4%), Phobias (2-9%); others with unknown prevalence
include Separation Anxiety Disorder, PTSD, Selective Mutism
Illness of secrecy need to ask about especially in quiet patient
Course - onset frequently in childhood, recover, chronic & untreated anxiety in childhood increases
adult risk 2-3X, leads to depression and alcoholism in adulthood
Differential diagnosis endocrine, infectious, neurological, drug/toxim, psychosis, affective,
ADHD/ADD
Often co-morbid with depression, ADHD, other anxiety disorders
SSRIs best studied, TCAs and BZ also used
CBT works
Clinical practice guidelines -

http://www.aacap.org/cs/root/member_information/practice_information/practice_parameters/practice
_parameters
Resources www.childanxiety.net/, www.adaa.org/, www.aacap.org/.
Bullying
Physical, verbal, relational, electronic (triad of bully, bullied, bystander)
Autism Spectrum Disorders (ASD)
Optional resources Autism Training Program http://www.cdc.gov/ncbddd/actearly/act/class.html

Epidemiology Prevalence is 1 in 110 in U.S. (CDC, 2009), M>F 4-5:1, 10-25% with
identified etiology
Developmental screening at 9, 18 & 30 months important early warning signs!
ASD includes Autistic Disorder (AD), Rett Disorder, Childhood Disintegrative Disorder,
Aspergers Disorder, Pervasive Developmental Disorder Not Otherwise Specified (PDD-
NOS)
ASD Core Deficits (deviant relative to developmental level)
o Socialization giving, showing, social smiles, gestures, eye contact
o Communication absent spoken language and/or imaginative play
o Repetitive/stereotypic behavior rigidity, routines, perseverations
Sensory integration dysfunction (visual, auditory, tactile, gustatory, olfactory)
Average age of diagnosis > 3 years for AD, > 4 years with PDD, > 5 years for Aspergers
disorder
Medical evaluation should include dysmorphology exam, TSH, lead level, CMP (AA,
hypoglycemia), EEG, MRI
Clinical evaluations and therapy (if indicated) should include hearing, speech/language,
occupational, sensory, psychological
Earlier behavioral intervention beneficial with low risk of harm
o Address specific difficulties such as speech with best evidence therapy

Pharmacology may be useful in management of selected symptoms, significant adverse
effects-should be prescribed by providers with high volume of ASDs.
o Atypical psychotics may be useful with aberrant behaviors (reserve aggression or risk of
self-injury), SEs
o SSRIs no benefit with repetitive behaviors

o Secretin not useful
Disturbed sleep may be due to serotonin (high anxiety, fear and arousal) & dopamine
abnormalities (muscle twitching ), late and low Melatonin release, circadian rhythm
dysynchrony
Educational plan and family support key
Common Sleep Disorders

Significant impact on physical, emotional and educational development
Common sleep disorders by age

Infant confusional arousals, insomnia, sleep-disordered breathing (SDB-sleep apnea
and others).
Preschool sleep terrors, nightmares, sleep enuresis, insomnia, restless legs syndrome
(RLS), periodic limb movement disorder (PLMD), SDB.
Grade school sleep walking, nightmares, sleep enuresis, insomnia, RLS, PLMD, SDB.
Adolescent insomnia, RLS, PLMD, SDB , delayed sleep phase syndrome, narcolepsy.
As part of a well visit screen use BEARS:
Bedtime problems,
Excessive daytime sleepiness,
Awakenings during the night,
Regularity and duration of sleep,
Sleep disordered breathing.
Optional resource PowerPoint presentation on children and sleep.

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NUR 471 Neuro and Mental Health 1

NUR 471 Neuro and Mental Health 1

NUR 471 Family Nurse Practitioner I

Neurological and Mental Health Problems in Children

Optional resource on neurological exam of newborns with videos!

Non-progressive disorder of movement

Caused by injury to the CNS

Incidence: 1-3 live birth per 1000

Mental retardation 26% (mild), 27% (severe)

Diagnosis- based on 4 out 6 major motor areas:

Oral motor functioning

Evolution of primitive reflexes

Muscle-stretch reflexes; hyperreflexia

Levine (Poster) Criteria for Diagnosing Cerebral Palsy

P posturing and abnormal movement pattern

T tone, increased or decreased in muscles

E evolution response, persistent primitive reflexes/ failure to develop protective response

R reflexes, deep tendon reflex increase, plantar reflexes up-going

Types of Cerebral Palsy

Spastic Diplegia/ Quadriplegia; 75%

Constipation common (stool softeners/ regular bowel regime)

Drooling skin breakdown/ social issue

Orthopedic issues muscle relaxants

Safety issues high risk for injury

Head growth faster in premature infants than term infants

Macrocephaly 2 standard deviation above the mean

Refers to brain size

Perinatal metabolic/endocrine imbalances

Perinatal maternal illness

Microcephaly no treatments or medications are indicated

Counseling for parents

Genetic evaluation and counseling

Routine follow-up with neurologist

Macrocephaly dependent on cause

o Infants bulging fontanels, vomiting, drowsiness, seizures

Premature fusion of the cranial sutures, usually beginning in utero

Sagittal suture most common (50%)

More common in boys

Results in skull/craniofacial deformities

Increased intercranial pressure

Cause chromosomal or unknown etiology

Goal is to ensure normal brain growth

Surgery is usually treatment of choice

Small stature, immature gait

Associated Developmental and Medical problems

Spina Bifida and Myelomeningocele

Most frequent serious congenital malformation

Multifactorial cause (incidence 1 in 1000 live births)

Folic acid supplementation is protective

Neural tube defect present at birth

Level of lesion in spinal cord determines childs potential for mobility

75% of lesions occur in lumbosacral area

Scoliosis develops with higher level lesions

Care Issues with Spina Bifida

Monitor growth & development

Skin breakdown due to decreased sensation

Safety prone to injury due to w/c or braces and decreased mobility

Latex allergy is common in those with spina bifida

Definition: Abnormal brain functioning caused by abrupt, uncontrolled, repetitive discharges of

Incidence: Approximately 3.5 to 5% of children have a seizure by 15 years of age

Only 1% with seizures have epilepsy (recurrent seizures)

50% occur in children under 10 years

Appx. of childhood seizures are idiopathic