#developmental pediatrics

[adventuresinfostercare]

Ray had an appointment with his developmental pediatrician this afternoon. It was good news: He’s within the normal range in all of his developmental areas, and he’s even a little ahead of the curve on his social and learning indicators. 

Everyone in the doctors’ office -- including the evaluator -- kept gushing about how cute he is. The receptionist even said, “That is the cutest baby I’ve seen in a long time!” And I assume they see a lot of babies... Obviously I think he’s really cute, too, but then again I’m very biased.

[adventuresinfostercare]

Ray had his first appointment with the developmental pediatrician today. Same one James saw. We even saw James' neurologist, who is in the same office. There were a few tears, but I survived. So far, Ray is on target developmentally. No concerns. But because of his family history, they want to monitor him. We go back in May. Oh, and my chunk-a-monk (as the doctor called him) is 18 pounds, 6 ounces. He'll be 5 months and 1 week tomorrow.

[teachingrounds]

Musculoskeletal function is tightly linked to quality and quantity of life in cerebral palsy. For instance, someone with spastic diplegia or hemiplegia usually has normal intelligence and can often ambulate independently; 98% survive to age 20. However, someone with spastic quadriplegia is likely to have intellectual disability but only 85% reach age 20. A significant percentage survive to 50, but loss of ambulation can herald general decline. There are about 500,000 adults living with cerebral palsy in the United States. By age 30, 60% live independently from their parents, 25% are partnered, and employment ranges from 10-50%.

Image: Maysoon Zayid, "I got 99 problems...palsy is just one," TED Talk (2013), https://www.ted.com/talks/maysoon_zayid_i_got_99_problems_palsy_is_just_one

[teachingrounds]

Conditions associated with cerebral palsy include - intellectual disability 50% - seizures 50% - communication difficulties 40% - dysphagia and sialorrhea - gastric reflux and constipation - urinary dysfunction and UTIs - scoliosis and chronic MSK pain - low bone mineral density - vision and hearing disabilities 50% and 10%

Image: Boy in a stander, Anika Meyer, WikiMedia

[teachingrounds]

In addition to the number of limbs affected (see Monday's post), cerebral palsy can be defined by the individual's muscle tone and movement. Most infants with congenital cerebral palsy go through an early stage of hypotonia. Hypertonicity then develops at 6-18 months, except for those with dyskinetic or dystonic CP*, who have fluctuating tone. *Injury to extra-pyrimidal, subcortical areas of the brain such as the basal ganglia and thalamus, causes dyskinesia (aka choreoathetosis), with excess movement (either slow writing or quick jerks), whereas dystonia consists of involuntary muscular spasms. Individuals with ataxic CP have low tone and trouble balancing due to an insult to the developing cerebellum.

Source: Cerebral Palsy, StatPearls, https://www.ncbi.nlm.nih.gov/books/NBK538147/

Image: Mother and son with CP, Anika Meyer, WikiMedia

[teachingrounds]

This week's topic is cerebral palsy, a life-long neurological condition that occurs in 2-3 of every 1,000 live births. It's an umbrella concept that includes diplegia (primarily legs), hemiplegia (one side or the other), and quadriplegia (all four limbs) as long as the insult occurred during development (in utero up to age 2). For a long time hypoxic injury was assumed to be the major cause, but now we now that it's responsible for a minority of cases, which are more likely to be due to genetic condition, infection, neonatal stroke, or environmental factors (such as prematurity) that disrupt brain development. Although considered a "static encephalopathy" in that the neurological injury doesn't progress, the downstream effects of CP such as spasticity, neurogenic bowel or bowel, and dysphagia leading to failure to thrive may worsen due to age, lack of therapy, or intercurrent illness.

Image credit: cerebral palsy awareness ribbon by AdaleighFaith on Deviant Art

[drpedi07]

Learning Disabilities (ld)

Learning disabilities are a group of disorders that affect a person's ability to either interpret what they see and hear or to link information from different parts of the brain.

[drpedi07]

Autism

Autism is a complex neurobehavioral disorder that includes impairments in social interaction and developmental language and communication skills combined with rigid, repetitive behaviors.