ELS 2010...PEDS !

1. ELS 2010...PEDS ! MCH protocols and peds exam for adult trainees

2. Headaches and Migraines

3. Migraines in childhood • Prevalence • 3 to 7 years • 1 to 3 % • ♂ > ♀ • 7 to 11 years • 4 to 11% • ♂ = ♀ • Above 15 years • 8 to 24% • ♀ > ♂

4. Migraines in childhood • 2003 IHS Diagnostic Criteria for Pediatric Migraine without aura A) At least 5 attacks fulfilling criteria B through D B) Lasting 1 to 72 hours C) At least 2 of the following • Unilateral or bilateral frontotemporal (not occipital) • Pulsing quality • Moderate or severe pain • Aggravation by or causing avoidance of routine physical activity D) During the headache, at least 1 of the following • Nausea and/or vomiting • Photophobia and phonophobia with may be inferred from behavior E) Not attributed to another disorder

5. Migraines in childhood • Migraine equivalents • Benign paroxysmal torticollis • Attacks of head tilt lasting hours to days • Onset between 2 and 8 months of age • Benign paroxysmal vertigo of childhood • Abrupt and brief episodes of unexplained unsteadiness • Onset usually in toddlers • Abdominal migraine • Recurrent episodes of moderate-to-severe intensity midline epigastric pain lasting 1 to 72 hours associated with vasomotor symptoms (flushing, pallor) and N/V • Onset during childhood • Cyclic vomiting • Recurrent episodes of intense vomiting recognizable by their stereotypical time of onset, duration and symptomatology • Onset during childhood

10. Febrile seizures

11. Febrile seizures • 2 to 5% of children • Most common form of childhood seizures • Definition: (International League Against Epilepsy) • “Seizure occurring in association with a febrile illness in the absence of a central nervous system infection or acute electrolyte imbalance in children older than 6 month of age without prior afebrile seizures.” • Peak incidence: 18 months

12. Febrile seizures • Simple vs complex

13. Febrile seizures • Recurrence of Febrile Seizures: • 1/3 will experience recurrence • 10% will have ≥3 episodes

15. First seizure, status epilepticus and breakthrough seizure in a known epileptic

19. Tics and Tourette syndrome

21. Peds Neuro Exam

22. Primitive Reflexes

23. Questions ?