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Cerebral palsy in children

Background
Definition
Non-progressive lesion of motor pathways in brain, presenting in infancy (<2 years).
Causes a disorder of movement and posture – a motor developmental delay – and may affect other developmental domains – a global developmental delay.
Causes and risk factors
In-utero (80%): vascular occlusion, cortical malformation, maternal infection, prematurity, low birth weight.
Birth (10%): hypoxic injury.
Neonatal (10%): infection, kernicterus.
Sub-types
3 sub-types, though can be mixed:

Spastic CP (80%): may have initial hypotonia, then spastic hemiplegia, quadriplegia, or diplegia (usually in legs).
Ataxic hypotonic CP: initial hypotonia, then incoordination, intention tremor, and ataxic gait.
Dyskinetic CP: chorea, athetosis.
Signs and symptoms
General:

Neonate with abnormal tone or posture.
Persistent primitive reflexes.
Missed motor milestones.
Hyper-reflexia.
Legs:

Abnormal gait.
Tiptoe walking.
Leg scissoring.
Hands:

Asymmetric hand function under 12 months.
Hand fisting.
Later signs:

Joint contractures.
Hip subluxation.
Scoliosis
Other problems:

Intellectual disability (50%).
Epilepsy (40%).
Strabismus (30%) and visual impairment.
ENT: speech problems (30%), hearing impairment (10%), drooling.
GI and GU: feeding difficulty (slow eating, gagging), GORD, vomiting, bowel and bladder dysfunction.
Psychological: sleep problems, mental health problems.
Investigations
Diagnosis is clinical, but MRI may be used if cause is unclear.

Management
Supportive:

Child development MDT inc. physio, OT, and speech and language.
Aids and adaptations e.g. wheelchairs, hoists, orthoses, feeding tubes.
Medical:

Manage most problems (e.g. epilepsy, GI and GU dysfunction, visual problems) as in any child.
Spasticity: baclofen (PO or intrathecal), diazepam PO, or botulinum toxin type A IM.
Drooling: anti-cholinergics e.g. glycopyrronium bromide PO.
Surgical:

Release of fixed contractures.
Selective dorsal rhizotomy – division of sensory nerve roots – for lower limb spasticity.
Labels: health tips, disease condition

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DISEASE CONDITIONS LIST THAT IMPROVED KNOWLEDGE.

Newborn Baby Assessment

Baby check at birth and 6 weeks  Check notes and get equipment ready:   Measuring tape. Ophthalmoscope Sats probe. In notes, look at full details of pregnancy and birth, including Apgar scores at 1 and 5 minutes. Observation: Colour: pink/red, pale, jaundiced. Any rash? Erythema toxicum is a self-limiting rash of red papules and vesicles, surrounded by red blotches which sometimes give a halo appearance. Usually occurs between 2 days and 2 weeks. Behaviour and mood. Movements. Face: dysmorphism? Head: Feel fontanelle (bulging? sunken?) and sutures. Note that posterior fontanelle closes at 1-2 months, and anterior at 7-19 months. Measure circumference at widest point; take the highest of 3 measurements. Looking for hydrocephalus and microcephaly. Eyes: check red reflex with ophthalmoscope. Feel inside top of mouth with little finger for cleft palate. Also gives you the sucking reflex. Inspect ears to see if they are low-set (below eye level), have any tags or lumps, and check behind the
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immunization schedule

Infant immunisations  2 months 5-in-1 DTaP/IPV/Hib – diptheria, tetanus, pertussis, polio, Hib – dose 1. Pneumococcal conjugate vaccine (PCV) dose 1. Rotavirus dose 1. Live, oral virus. MenB dose 1. 3 months 5-in-1 dose 2. MenC dose 1. Rotavirus dose 2. 4 months 5-in-1 dose 3. PCV dose 2. MenB dose 2. 12 months MMR dose 1. MenC dose 2 + Hib dose 4 (combined). MenB dose 3. PCV dose 3. Hepatitis B if they have risk factors. Toddler immunisations Flu vaccine Annual, live attenuated nasal spray flu vaccine in September/October at age 2-7. Kids with asthma and other chronic diseases like CF will continue to get this through childhood and beyond. Contraindicated in severe egg allergy, immunosuppression (inc. steroids in past 2 weeks), and severe asthma or active wheeze. Alternative form can be given. Postpone in those with heavy nasal congestion. 3.5 years 4-in-1 DTaP/IPV: dip, tet, pertussis, polio pre-school boost. MMR dose 2. Teenager immunisations 12 years HPV: Girls only. Parental conse
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Hypertension (HTN)

Background     Causes Primary causes: Essential HTN (i.e. idiopathic). Commonest cause. Non-pathologically raised during pain or anxiety (including white coat HTN). However, this may suggest underlying problem so consider following up. Kidney diseases (80% of secondary HTN): Chronic kidney disease. Renal artery stenosis: due to atherosclerosis or fibromuscular dysplasia. Latter most commonly occurs in young women, but even then essential HTN is still commoner. Endocrine: Conn's Cushing's Pheochromocytoma Acromegaly Hyperparathyroidism Other: Obstructive sleep apnoea Pregnancy or pre-eclampsia. Coarctation of the aorta. Medication: CE-LESS ('see less'): C yclosporin E strogen (OCP) L iquorice E PO S teroids S ympathomimetics: α-agonists, dopamine agonists, cocaine, amphetamines, and nasal decongestants such as ephedrine. Signs and symptoms Symptoms of HTN itself are rare, and occur only in severe disease. They include heada
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