Behavioral

Question 1

1. Definition of short stature?

2. Goal?

Answer 1

1. past age 2 years—height below 2.3 %

2. differentiate between benign and pathological etiologies

Question 2

Diagnostic Approach to short stature

4

Answer 2

1. Thorough history and PE (ALWAYS!)
2. Look at growth curve velocity on growth chart
3. Use formula using parents height to determine child’s adult height
4. Bone age determination

Question 3

Calculation of Child’s Ht. by Parents Heights

Answer 3

Add the parents heights together in inches

Divide by 2

For boys add 2 ½ inches

For girls subtract 2 ½ inches

This is a rough approximate!

Question 4

Familial short stature:

1. Bone age is what compared to the childs?
2. History of what?

Constitutional growth delay:

1. Bone age is what compared to the childs age?
2. Describe puberty and growth period?
3. End result?

Answer 4

Familial short stature:

1. Bone age is the same as the child’s age
2. History of one or both parent’s being short

Genetic—will be a short adult

Constitutional growth delay:

1. Bone age is less than child’s age—plot the height at the bone age and is usually more in the normal range
2. Usually have delayed puberty and longer period of growth
3. End result normal adult height

Question 5

The MOST important first step in a newborn’s life:

Answer 5

Physical contact with the mother or father represents protection to the baby

Babies deprived of care are more irritable, more easily startled, and fussier throughout their infancy than babies who have known mothering

You CANNOT spoil an infant!!!

Question 6

Bonding/Attachment Problems

8

Answer 6

1. Mother ill because of complications or chronic problems
2. Single parent—increased stress
3. No outside support for parent(s)
4. Post-partum Blues, depression or psychosis
5. Marital stress
6. Abuse
7. Not having wanted the baby from the beginning
8. Too much “support”

Question 7

Typical behavior in 2-4 YO’s

4

Answer 7

1. Consists of whining, screaming, crying and even throwing one’s self on the floor
2. Usually do to frustration—they are just learning to communicate*
3. Easily overwhelmed—used to schedules
4. May be overtired
   - -They want their own way

Question 8

Temper Tantrums/Misbehavior

Four goals of Misbehavior?

Answer 8

1. Attention
2. Power
3. Revenge
4. Display of inadequacy

Question 9

Temper Tantrums—Management to Give to Parents

6

Answer 9

1. Try to avoid putting the child in situations where they are tired and exposed to a lot of stimulating activity
2. Give them easy choices between two things
3. Ignore the tantrum unless they are hurting themselves (negative attention*)
4. Distract them
5. Warn them of consequences
6. DO NOT hit or spank them

Question 10

TT—When to Seek Help

7

Answer 10

1. The parent is uncomfortable with their response or their feelings (the parent needs to remain CALM)
2. The parent keeps giving in when the tantrum is over something the child wants
3. The tantrums arouse a lot of bad feelings
4. They are increasing in frequency, intensity, or duration
5. The child frequently hurts him/herself or others
6. The child is destructive
7. The child displays mood disorders—negativity, low self-esteem or extreme dependence

Question 11

TT—Potential Underlying Problems

4

Answer 11

1. Hearing or vision problems
2. Chronic illness
3. Language delay
4. Learning disability

Question 12

Abnormal Aggressiveness:
Chronic aggressiveness in 5 year olds and up: Results from this?
3

Answer 12

1. Odds are very high that they will experience repeated failure in school
2. Life will be frustrating and disappointing
3. They may inflict a great deal of emotional and physical pain upon others

Question 13

1. Potentially long-term aggressive behavior can very accurately be identified in children as young as?
2. What kind of behavior can continue into adulthood if intervention has not been stopped by the third grade?
3. What is is key to preventing aggressive toddler/preschoolers from becoming violent teens/adults?

Answer 13

1. age 3 or 4
2. Antisocial behavior
3. Early intervention in homes, schools, and communities

Question 14

Prevention of abnormal aggression?

3

Answer 14

1. LIMIT exposure to television and videos!
2. Intervene as early in the child’s life as possible:
   Intervention begun at an early age shows that success in preventing long-term violent behavior is high
3. Consult with qualified medical and mental health professionals

Question 15

At what age if still chronically aggressive the childs odds of successful intervention are low?

Answer 15

If a child of 9-10

Question 16

Possible Causes of Aggressive Behavior

7

Answer 16

1. Poor parenting
2. Trauma in the form of abuse or neglect
3. Brain damage: closed head injury, lack or oxygen during birth or prenatal exposure to drugs or toxins
4. Genetic abnormalities
5. Other health problems
6. Marital problems resulting in family instability
7. Observation of aggressive peers or aggression at home

Question 17

Strong Warning Signs of abnormal aggression

9

Answer 17

1. Cruelty to animals
2. Fire starting
3. Sexualized behavior
4. Aggressive behavior outside the norm—threats, breaking things, throwing things or hurting others
5. Self-injury—head banging, cutting, substance abuse
6. Extreme non-compliance
7. Lack of behavior change despite consistent consequences
8. Evidence of psychosis—hearing or seeing things (hallucinations)
9. Lack of remorse or empathy for other people’s feelings

Question 18

Possible reasons for biting?

8

Answer 18

1. Relieve pain from teething
2. Experience the sensation of biting
3. Satisfy a need for oral-motor stimulation
4. Imitate other children or adults
5. Get attention
6. Act in self-defense
7. Communicate needs & desires—hunger or fatigue
8. Communicate feelings—frustration, anger, confusion or fear

Question 19

Biting–Management

3

Answer 19

1. Go to the child and make a serious statement to the child who did the biting: “ No biting, biting hurts. I can’t let you hurt Sue or anyone else.”
2. Offer to let the child to help Sue feel better or sit quietly until the adult can talk to the child
3. Comfort the hurt child and do first aid if necessary

Question 20

Biting management:
Talk to the child who did the biting (calmly!)?
3

Answer 20

1. Try to find out what happened
2. Restate rule: “Biting is not allowed.”
3. Model words: “Sue took your ball, you felt angry, you bit Sue. I can’t let you hurt Sue. No biting.”

Question 21

Sleep Disturbances 4

Answer 21

1. Bedtime refusal or resistance
2. Delayed sleep onset
3. Prolonged night awakenings
4. Night terrors

Question 22

1. Nighttime sleep DURATION largely influenced by what?
2. Intrinsic factors?
   5

Answer 22

1. genetics
2. • Child’s temperament
   • Medical issues
   • Circadian preference— “night owl” vs. “morning lark”
   • Neurodevelopmental disabilities
   • Anxiety disorders

Question 23

Night time sleep disturbances

Screening tool—BEARS

Answer 23

B=Bedtime issues
E=Excessive daytime sleepiness
A=Night Awakenings
R=Regularity and duration of sleep
S=Snoring

Question 24

Sleep Disturbances: Interventions

4

Answer 24

1. Bedtime routine:
   Pattern
   Same time
   NO TV or electronics prior
2. Systemic ignoring: “extinction”
3. Positive reinforcement**
4. Parent education!!!

Question 25

1. Night (sleep) terrors occur in what half of the night? 2. During a Sleep terror episode the child may do/experience any of the following? 8 3. Do they recall the episode?

Answer 25

1. Occur in the first half of the night (nightmares occur second half) 2. - Sit up in bed - Scream or shout - Kick and thrash - Sweat, breathe heavily, have a racing pulse - Hard to awaken, but if awakened be confused - Inconsolable - Stare wide-eyed - Get out of bed and run around the house 3. Generally in the morning the child cannot remember the sleep terror episode although a nightmare may be partially remembered

Question 26

Factors that Contribute to Sleep Terrors | 6

Answer 26

1. Sleep deprivation or extreme tiredness 2. Stress 3. Fever 4. Sleeping in unfamiliar surroundings 5. Light or noise 6. A overfull bladder

Question 27

Things that can be associated with sleep terrors? | 6

Answer 27

1. OSA, 2. RLS, 3. migraines, 4. head injuries, 5. medications, 6. genetics

Question 28

Reasons to Evaluate sleep terrors? | 6

Answer 28

1. Happening excessively 2. Leading to daytime somnolence 3. Hurting self or others 4. Lead to the child being afraid to go to sleep 5. Last beyond the teen years 6. Appear to follow the same pattern

Question 29

Evaluation of sleep terrors? | 3

Answer 29

1. Sleep log 2. Sleep study 3. Rare use of benzodiazepans

Question 30

Toilet Training: If you only learn one thing about this, learn that this orifice is entirely under the control of the child!!! What must the child accomplish to start/succeed in potty training? 5

Answer 30

1. Child must be ready and be neurologically mature 2. Must establish regular bowel frequency 3. Avoid pressuring and punishment for accidents 4. Reiterate positive reinforcement 5. Expect periods of regression with stressors

Question 31

Toilet Training--Resistance Factors? 6

Answer 31

1. Attempting training at too early an age 2. Excessive parent-child conflict 3. Irrational fear or anxieties about toilet 4. Difficult temperament, such as negative persistence or poor adaptability 5. Hard, painful stools from chronic constipation 6. These children may be trying to exert their independence or control in a power struggle w/ their parents**

Question 32

Recommended toddler should have 1st dental visit when what happens?

Answer 32

first teeth erupt*:

Question 33

1st dental visit: What are we evaluating? | 3

Answer 33

1. Evaluate for abnormalities of teeth and oral mucosa 2. Assess for dental plaque 3. Assess for white spots and cavities

Question 34

Early visits can help identify children at risk for development of dental disease: Risk factors? 11

Answer 34

1. Parent/caregiver low socioeconomic status 2. Prolonged breast or bottle feeding (>12 months) 3. Frequent consumption of sugary beverages of snacks 4. Prolonged use of sippy cup throughout the day 5. Use of bottles at bed time, especially with sweetened beverages 6. Exposure to passive smoke 7. Children with special health care needs 8. Insufficient fluoride exposure 9. Visible plaque on upper front teeth 10. Enamel pits and defects 11. Nonnutritive sucking

Question 35

Dental Caries Prevention | 4

Answer 35

1. Early brushing with a “smear” of fluorinated toothpaste 2. Fluoride** 3. Flossing 4. Regular dental check ups

Question 36

Visual Screening in Infants Infant visual development: 4 steps up to 3-5 yrs

Answer 36

1. Visual fixation is seen shortly after birth—20/400 2. By 3 months of age most infants can follow an object 3. By 6 months of age infants have developed stereopsis and binocular vision 4. By 3-5 years vision reaches 20/20

Question 37

Visual Assessment | 7

Answer 37

1. Cataracts 2. Strabismus 3. Amblyopia 4. Retinoblastoma 5. Glaucoma 6. Asymmetric Pupil

Question 38

Significant hearing loss the most common disorder at birth: -How do we manage/identify this? 2

Answer 38

1. Mandated screening of all infants prior to discharge from hospital 2. Early identification improves outcome Screening for older children when there is a concern**

Question 39

Intellectual Disability. Neurodevelopmental disorder characterized by? 2

Answer 39

1. Deficits in intellectual and adaptive functioning | 2. Before the age of 18

Question 40

Intellectual Disability- Cognitive Functions | IQ is what?

Answer 40

statistically derived number reflecting the ratio of age-appropriate cognitive function and the child’s level of cognitive function

Question 41

Intellectual Disability- Cognitive Functions: Categories of IQ? 4

Answer 41

``` Categories: Mild IQ 50-69 Moderate IQ 35-49 Severe IQ 20-34 Profound IQ less than 20 ```

Question 42

Intellectual Disability- Adaptive Behaviors. Deficits (>2) in the development of: 7

Answer 42

1. language 2. motor skills 3. attention 4. abstract reasoning 5. visual-spatial skills 6. academic or vocational 7. achievement

Question 43

Intellectual Disability- Multiple causes 9

Answer 43

1. Chromosomal abnormalities (4-28%) 2. Fragile X syndrome (2-5%) 3. Monogenetic conditions (4-14%) 4. Structural CNS abnormalities (7-17%) 5. Complications of prematurity (2-10%) 6. Environmental or teratogenic causes (5-13%) 7. “Cultural-familial” mental retardation (3-12%) 8. Metabolic or endocrine causes (1-5%) 9. Unknown (30-50%)

Question 44

INtellectual Disability: Usually a combination of treatments including? 4

Answer 44

1. Speech and language therapy 2. Special education support 3. Occupational or physical therapy 4. Behavioral therapy or counseling

Question 45

Changes in performance usually worsening performance is a signal of a stressor in younger children: 4

Answer 45

1. New sibling 2. Divorce 3. Move to new location 4. Abuse

Question 46

Children begin to learn to play together and share around what ages?

Answer 46

Ages 3-4