Pediatric Assessment and intervention

• Congenital heart disease


  • Three major cardiovascular changes must take place at birth:
  • The hole between the right and left atria must close (foramen ovale)
  • The ductus arteriosus must close to allow blood flow to the lungs
  • The ductus venosus must close to allow blood flow to the liver
• Heart defects that increase pulmonary blood flow

  • Patent ductus arteriosus
  • Atrial septal deficits
  • Ventricular septal deficits
• Patent ductus arteriosus


  The most common condition found in premature newborns; it can lead to heart failure and inadequate oxygenation of the brain
• Atrial septal deficits


  Characterized by an opening in the septum between the right and left atrial chambers; they result in "wet lungs" (too much blood sent to the lungs) and may lead to respiratory infection; cause the right ventricle to work too hard, leading to heart failure; or result in poor exercise tolerance and being small for chronological age
• Ventricular septal deficits


  Characterized by one or more openings in the muscular or membranous portions of the ventricular septum; more than 50% of cases self-correct by age 5; otherwise, surgery is warranted; these deficits could result in Eisenmenger's complex or pulmonary vascular obstruction owing to prolonged exposure to increased blood flow and high pressure; symptoms include feeding difficulties, shortness of breath, increased perspiration, increased respiratory infections, fatigue with increased activity, and delayed growth
• Heart defects that decrease pulmonary blood flow

  • Tetralogy of Fallot
• Tetralogy of Fallot


  Characterized by pulmonary valve or artery stenosis, ventricular septal deficit, right ventricular hypertrophy, and override of the ventricular septum; symptoms include central cyanosis, coagulation defects, clubbing of fingers and toes, feeding difficulties, failure to thrive, and dyspnea
• Heart defects with mixed pulmonary blood flow

  • Transposition of great arteries
• Transposition of great arteries

  Characterized by no communication between the systemic and pulmonary circulations and is the result of coexisting congenital transposition of the ventricles; symptoms may include cyanosis, congestive heart failure, and respiratory distress
• Occupational therapy treatment implications for children with congenital heart defects

  • Children whose conditions have not resolved or been treated surgically are likely to have compromised endurance but may develop typically unless a comorbid condition is present
  • Activities should be appropriately paced
  • Activities should be selected with care
  • The child and the family should be educated in general health maintenance (e.g., diet, exercise, avoidance of smoke inhalation)
• Bradydysrhythmia


  Characterized by an abnormally slow heart rate (<60 beats/min)
• Atrioventricular block


  The most common type of bradydysrhythmia
• Medical intervention for bradydysrhythmia

  May include a pacemaker
• Tachydysrhythmia


  Characterized by an abnormally fast heart rate (>100 beats/min)
• Tachydysrhythmia is common in children
• Tachydysrhythmia


  Can lead to congestive heart failure
• Typical presentation of tachydysrhythmia

  Marked by irritability, poor eating habits, and pallor
• Conduction disturbances are most common after surgery and may be temporary
• Respiratory distress syndrome


  Common in preterm infants; caused by a deficiency of surfactant, which is not produced until the 34th to 36th week of gestation; results in compromised oxygen absorption and carbon dioxide elimination; many infants recover after a few days of medical intervention; however, some develop chronic lung conditions
• Bronchopulmonary dysplasia


  A result of the prolonged use of mechanical ventilation and other traumatic interventions to treat acute respiratory problems; results in thickening of the airway, formation of excess mucus, and restricted alveolar growth; children with bronchopulmonary dysplasia are at a greater risk of respiratory infections and problems
• Asthma


  Characterized by bronchial smooth muscle hyperreactivity that causes airway constriction in the lower respiratory tract, difficulty breathing, and wheezing; the first symptoms typically appear before age 5; asthma attacks may be triggered by allergens, smoke, cold air, exercise, and inhalation of irritants
• Occupational therapy treatment implications for asthma

  • Educate the client regarding the reduction of exposure to irritants
  • Teach the client self-management strategies, including pacing and stress management
  • Encourage structured peer-group activities to reduce the likelihood of social isolation
  • Educate the client regarding breathing exercises, stretching, and controlled breathing to manage attacks
• Cystic fibrosis (CF)


  A degenerative condition caused by an inherited autosomal recessive disorder related to a gene on chromosome 7; affects multiple systems and is characterized by the mucus-producing glands malfunctioning and producing secretions that are thick, viscous, and lacking in water; these secretions block the pancreatic duct, the bronchial tree, and the digestive tract
• Symptoms of cystic fibrosis

  • Blockage of the small intestine, resulting in abdominal distension (an early symptom found in infants)
  • Salty-tasting skin, the result of excessive sodium levels
  • Greasy, foul-smelling stools, which indicate pancreatic insufficiency and problems with vitamin malabsorption
• Chronic pulmonary disease in cystic fibrosis


  The most serious complication, characterized by a chronic cough, wheezing, and lower respiratory infections
• Cystic fibrosis may result in an enlarged right side of the heart, which could lead to heart failure
• Occupational therapy treatment implications for cystic fibrosis

  • Educate the client about the disease's progression
  • Instruct the client and his or her family in energy conservation
  • Teach techniques to promote efficient breathing
• Erythrocytosis


  Characterized by too many red blood cells and elevated levels of white blood cells; it is referred to as transient leukemia
• One in every 150 children with Down syndrome will experience transient leukemia
• Hemophilia


  A blood disorder that commonly affects males; 60% of cases are hereditary; characterized by the absence or reduction of one of the clotting blood proteins; results in longer bleeding time or bleeding episodes
• Types of hemophilia


  • Mild hemophilia: Bleeding episodes usually occur after traumatic events or injuries; without a traumatic event or injury, this type is usually not detected
  • Moderate hemophilia: Bleeding episodes occur after minor injuries
  • Severe hemophilia: Bleeding occurs after injuries or without an apparent cause; this type may also affect joints and muscles

  
• Signs of hemophilia


  • Excessive bleeding
  • Excessive bruising
  • Spontaneous bruising or bleeding without a known cause
  • Nosebleeds
• Anemia


  Caused by iron deficiency in the blood; diagnosed through blood tests and usually treated through diet (i.e., iron-rich foods); may be symptomatic of other conditions, such as lead poisoning, vitamin deficiencies, leukemia, or sickle cell disease
• Sickle cell anemia


  A form of anemia caused by abnormally shaped red blood cells; most common among African-Americans; children may demonstrate decreased energy for daily tasks and are at risk for organ damage resulting from blocked blood flow caused by the sickle cells; children may experience pain and thus may require intervention for pain management
• Osteogenesis imperfecta (OI)


  Also known as brittle bones; minor trauma can cause a fracture in children with OI; multiple fractures or repeated fractures of the same bone may cause a limb to become misshapen and eventually muscularly underdeveloped; characterized by decreased bone deposition caused by an inability to form Type I collagen; transmitted by an autosomal dominant gene; ranges from mild to severe (fatal), with most individuals having a mild form
• Types of osteogenesis imperfecta

  • Fetal: most severe; fractures occur in utero and during birth; mortality is high
  • Infantile: moderately severe; many fractures occur in early childhood; severe limb deformities and growth disturbances also occur
  • Juvenile: least severe; fractures begin in late childhood; by puberty, bones often begin to harden and fewer fractures occur
• Occupational therapy treatment implications for osteogenesis imperfecta

  • Children can be expected to develop progressive deformities
  • Activity patterns are affected by caution and time spent in casts
  • Parental education in handling and positioning is essential to prevent fractures
  • Monitored activity that promotes weight bearing should be encouraged
• Marfan's syndrome


  Caused by an autosomal dominant trait; characterized by excessive growth at the ephiphyseal plates; children present with long and slender fingers (arachnodactyly), skull asymmetries, and tall stature; associated with lax and hypermobile joints and with poorly developed, striated muscles; common comorbidities include dislocation of the lenses, scoliosis, coxa vara, depressed sternum, stooped shoulders, and fragility of the blood vessels; walking may be delayed, but the child may otherwise meet developmental milestones
• Achondroplasia (chondrodystrophia or dwarfism)


  Caused by an autosomal dominant trait that results in the stunting of ephiphyseal plate growth and cartilage formation; people usually grow to 4 feet or less in height, with limbs that have typical width but are shorter in length, a prominent forehead, and a small nose and jaw; common comorbidities include lumbar lordosis, coxa vara, and cubitus varas; back and leg pain are common and more pronounced in adulthood
• Arthrogryposis multiplex congenital


  Associated with reduced anterior horn cells in the spinal cord; characterized by an incomplete contracture (fibrous ankylosis) of many or all of the client's joints, which is present at birth; often both the upper and the lower extremities are involved; clients present with stiff and spindly extremities and the appearance of thickened knee and elbow joints; muscles may be underdeveloped, and in some cases there may be paralysis because of spinal cord involvement