HIGH RISK PRESCHOOL

• Leukemia is a hematological malignancy or a cancer of the blood, which develops in the bone marrow
• Childhood Leukemia is the most common childhood cancer
• Types of Leukemia


  • Acute Leukemia
  • Chronic Leukemia
• Acute Leukemia


  Typically develops and worsens quickly (over periods of days to weeks)
• Chronic Leukemia


  Develops over a slower period of time (months), but is more difficult to treat than acute leukemia, and is more common in adults than in children
• Main types of leukemia in children

  • Acute Lymphoblastic Leukemia (ALL)
  • Acute Myelogenous Leukemia (AML)
  • Acute Promyelocytic Leukemia (APL)
  • Chronic Myelogenous Leukemia (CML)
  • Chronic Lymphocytic Leukemia (CLL)
  • Juvenile Myelomonocytic Leukemia (JMML)
• Acute Lymphoblastic Leukemia (ALL)


  The most common form of childhood leukemia, which makes up 75-80% of childhood leukemia diagnoses. A form of leukemia that affects the lymphocytes, a type of White Blood Cells (WBC) which fights infection. When a patient has ALL, the bone marrow makes too many immature WBC and they do not mature correctly. These WBC also do not work correctly to fight infection. The WBC over-produce, crowding the other blood cells in the bone marrow
• Acute Myelogenous Leukemia (AML)


  Accounts for most of the remaining cases of leukemia in children, comprising about 20% of childhood leukemia. A cancer of the blood in which too many myeloblasts (immature WBC) are produced in the bone marrow. The marrow continues to produce abnormal cells that crowd the other blood cells and do not work properly to fight infection
• Acute Promyelocytic Leukemia (APL)


  A specific type of AML. In this leukemia, promyelocyts are produced and build up in the bone marrow. A specific chromosome translocation (a type of genetic change) is found in patients with APL. Genes on chromosome 15 change places with genes on chromosome 17. This genetic change prevents the promyelocytes from maturing properly
• Chronic Myelogenous Leukemia (CML)

  A chronic leukemia that develops slowly, over months to years. CML is rare in children, but does occur. CML patients have too many immature WBC being produced, and the cells crowd the other healthy blood cells. A chromosome translocation occurs in patients with CML. Part of chromosome 9 breaks off and attaches itself to chromosome 22, facilitating exchange of genetic material between chromosomes 9 and 22. The rearrangement of the chromosomes changes the positions and functions of certain genes, which causes uncontrolled cell growth
• Chronic Lymphocytic Leukemia (CLL)


  Another form of chronic leukemia, but is extremely rare in children
• Juvenile Myelomonocytic Leukemia (JMML)


  A form of leukemia in which myelomonocytic cells are overproduced. It is sometimes considered a myeloproliferative neoplasm. It is rare and most commonly occurs in children under the age of four. In JMML, the myelomonocytic cells produced by the bone marrow and invade the spleen, lungs, and intestines
• Signs and Symptoms of Leukemia

  • Continuous weight loss
  • Headache, persistent nausea and vomiting with or without seizure
  • Increased swelling or persistent pain in bones, joints, back or legs
  • Lump or mass (swollen lymph nodes) – abdomen, neck, chest, armpits
  • Development of rash, bleeding, bruises (including petechiae)
  • Constant / recurrent infections
  • Abdominal pain or fullness, which may cause shortness of breath or loss of appetite
  • Noticeable paleness of skin
  • Constant tiredness
  • Eye or vision changes
  • Recurrent or persistent fever
• The exact cause of most cases of childhood leukemia is not known. Most children with leukemia do not have any known risk factors
• Diagnosis of Leukemia


  • Bone Marrow Aspiration and Biopsy
  • Immunophenotyping and Cytognetic Analysis
  • Complete Blood Count (CBC)
  • Blood Tests
  • Spinal Tap
• Standard Treatments for Leukemia

  • Chemotherapy
  • Stem Cell Transplant
  • Radiation Therapy
  • Targeted Therapy
  • Immunotherapy
• Wilm's Tumor (Nephroblastoma) is a cancerous tumor in the cells of the kidney
• Fortunately, with the right treatment, Wilms tumor is highly treatable
• Signs and Symptoms of Wilm's Tumor

  • An abdominal mass you can feel
  • Abdominal swelling
  • Abdominal pain
  • Fever
  • Blood in the urine
  • Nausea or vomiting or both
  • Constipation
  • Loss of appetite
  • Shortness of breath
  • High blood pressure
• Risk Factors for Wilm's Tumor

  • African-American race
  • Family history
  • Aniridia
  • Hemihypertrophy
  • WAGR syndrome
  • Denys-Drash syndrome
  • Beckwith-Wiedemann syndrome
• Asthma is a chronic disease involving the airways in the lungs
• Childhood Asthma


  The lungs and airways become easily inflamed when exposed to certain triggers, such as inhaling airborne pollen or catching a cold or another respiratory infection
• Risk Factors for Asthma


  • Exposure to tobacco smoke
  • Previous allergic reactions, including skin reactions, food allergies or hay fever (allergic rhinitis)
  • A family history of asthma, allergic rhinitis, hives or eczema
  • Living in an urban area with increased exposure to air pollution
  • Obesity
  • Respiratory conditions, such as a chronic runny or stuffy nose (rhinitis), inflamed sinuses (sinusitis) or pneumonia
  • Heartburn (gastroesophageal reflux disease, or GERD)
  • Being male
  • Being black
• Signs and Symptoms of Childhood Asthma

  • Frequent, intermittent coughing
  • A whistling or wheezing sound when exhaling
  • Shortness of breath
  • Chest congestion or tightness
  • Chest pain, particularly in younger children
  • Trouble sleeping caused by shortness of breath, coughing or wheezing
  • Bouts of coughing or wheezing that get worse with a respiratory infection, such as a cold or the flu
  • Delayed recovery or bronchitis after a respiratory infection
  • Trouble breathing that may limit play or exercise
  • Fatigue, which can be caused by poor sleep
• Diagnosis of Asthma


  • History of recurrent or persistent wheeze
  • Presence of allergies or family history of asthma and allergies
  • Absence of physical findings that suggest an alternative diagnosis
  • Tests that support the diagnosis (e.g. Spirometry in children able to perform the test)
  • A consistent clinical response to an inhaled bronchodilator or preventer
• It can be difficult to diagnose asthma with certainty in children aged 0–5 years, because episodic respiratory symptoms such as wheezing and cough are very common in children, particularly in children under 3 years, and objective lung function testing by spirometry is usually not feasible in this age group
• Types of Asthma


  • Allergic Asthma
  • Nocturnal Asthma
• Allergic Asthma


  Triggered by exposure to allergens such as animal, dust mite, food, latex, mold, or pollen
• Nocturnal Asthma


  Worsening of asthma at night, which may be due to exposure to allergens in the bedroom, delayed allergic response, chronic sinus problems and/or post-nasal drip, gastroesophageal reflux, airway cooling from a drop in body temperature, decreased effect of medications during early morning hours, or sleep apnea
• Urinary Tract Infection (UTI) is an infection in any part of the urinary system – kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract – the bladder and the urethra
• Women are at greater risk of developing a UTI than are men
• Signs and Symptoms of UTI

  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Strong-smelling urine
• Signs and Symptoms of Specific UTI Types

  • Kidneys / Acute Pyelonephritis: Upper back and side (flank) pain, High fever, Shaking and chills, Nausea, Vomiting
  • Bladder / Cystitis: Pelvic pressure, Lower abdomen discomfort, Frequent painful urination, Blood in urine
  • Urethra / Urethritis: Burning sensation with urine discharge
• Risk Factors for UTI

  • Female anatomy, Sexual activity, Certain types of birth control (diaphragm), Menopause
  • Urinary tract abnormalities
  • Blockages in the urinary tract
  • Suppressed immune system
  • Catheter use
  • Recent urinary procedure
• Diagnosis of UTI


  • Urinalysis
  • Utrasound
  • Voiding Cystourethrogram (VCUG)
  • Nuclear scan
  • Computed Tomography
  • Magnetic Resonance Imaging