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Most popular medical Questions
Is physical injury a concern in children with head banging?Head banging, which is a common problem that occurs in 5-15% of normal children, rarely results in physical injury. When injury does occur, it is usually in children with autism or other developmental disabilities. Normal children often show signs of bliss as they bang away, and the activity usually resolves by the time the child is 4 years old. (It may resume spontaneously during national board examinations.)
What is the difference between a "blue" breath-holding spell and a "white" breath-holding spell?
Both of these are syncopal attacks that occur commonly in children between the ages of 6 months and 4 years. A "blue" or cyanotic spell is more common. Vigorous crying provoked by physical or emotional upset leads to apnea at end of expiration. This is followed by cyanosis, opisthotonus, rigidity, and loss of tone. Brief convulsive jerking may occur. The episode lasts from 10-60 seconds. A short period of sleepiness may ensue. A "white" or pallid spell is more commonly precipitated by an unexpected event that frightens the child. On testing, children prone to these spells demonstrate increased responsiveness to vagal maneuvers. This parasympathetic hypersensitivity may cause cardiac slowing, diminished cardiac output, and diminished arterial pressure, which result in a pale appearance.
When does prolonged thumb-sucking warrant intervention?
If frequent thumb-sucking persists in a child who is more than 4-5 years old or in whom permanent teeth have begun to erupt, treatment is usually indicated. Treatment commonly has two components: (1) application of a substance with an unpleasant taste at frequent intervals (such products are commercially available), and (2) behavior modification with positive reinforcement (small rewards) given when a child is observed not sucking his or her thumb. Occlusive dental appliances are generally not needed. Persistent thumb-sucking after the eruption of permanent teeth can lead to malocclusion.
When should "toilet training" be started?
When the child is physically and emotionally ready, training can be begun. The physical prerequisite of the neurologic maturation of bladder and bowel control usually occurs between 18 and 30 months of age. The child's emotional readiness is often influenced by his or her temperament, parental attitudes, and parent-child interactions. The "potty chair" should be introduced when the child is between 2 and 3 years old. Most children will achieve daytime bladder and bowel control by the age of 3? years. A recent study indicates that intensive attempts at training before 27 months were not associated with earlier completion.
Are girls or boys toilet trained earlier?
On average, girls are toilet trained earlier than boys. With regard to most other developmental milestones during the first years of life, however, there do not seem to be significant sex differences (i.e., in walking or running, sleep patterns, or verbal ability). Girls do show more rapid bone development.
When is masturbation in a child considered pathologic?
Masturbation (the rhythmic self-manipulation of the genital area) is considered a normal part of sexual development. However, if masturbation occurs to the exclusion of other activities, if it occurs in public places when the child is >6 years old, or if the child engages in activities that mimic adult sexual behavior, evaluation for sexual abuse, central nervous system abnormalities, or psychological pathology would be appropriate.
Which conditions are most commonly associated with premature or delayed closure of the fontanel?
Premature closure: Microcephaly, high calcium/vitamin D ratio in pregnancy, craniosynostosis, hyperthyroidism, or variation of normal
Delayed closure: Achondroplasia, Down syndrome, increased intracranial pressure, familial macrocephaly, rickets, or variation of normal
When is an anterior fontanel too big?
The size of the fontanel can be calculated using the formula: (length + width)/2, where length equals anterior-posterior dimension and width equals transverse dimension. However, there is wide variability in the normal size range of the anterior fontanel. Mean fontanel size on day 1 of life is 2.1 cm, with an upper limit of normal of 3.6 cm in white infants and 4.7 cm in black infants. These upper limits may be helpful for identifying disorders in which a large fontanel may be a feature (e.g., hypothyroidism, hypophosphatasia, skeletal dysplasias, increased intracranial pressure). Of note is that the posterior fontanel is normally about the size of a fingertip or smaller in 97% of full-term newborns.
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