Common Anomalies in Infants: Colic, Failure to Thrive, and Hydrocephalus, Summaries of Pediatrics

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COMMON ACQUIRED

AND CONGENITAL

ANOMALIES

Elsie P. Miguel, RN MN

COLIC (PAROXYSMAL ABDOMINAL PAIN)

• Characterized by paroxysmal abdominal pain or cramping that is manifested by: o Loud crying and o Pulling/drawing legs up to the abdomen o Abdomen becomes tense o When offered a bottle – will suck vigorously, as if starved, then stops as another wave of intestinal pain occurs
• Infants under 3 months

ASSESSMENT

• Thorough history o Same with intestinal obstruction or infection
• Investigation of possible organic causes: o Cow’s milk protein allergy
• Ask about duration and frequency o Usually lasts up to 3 hours a day, @ least 3 days a week - Document frequency and type of BM o Constipation; narrow, ribbon-like stools; blood or mucus in the stool = suggest other problems - Determine feeding pattern o Bottle fed: type of formula; position o Breast fed: maternal diet – avoiding “gassy” foods

THERAPEUTIC MANAGEMENT

• If sensitivity to cow’s milk is strongly suspected: o Trial substitution of another formula: casein hydrolysate or amino acid
• Drugs: o Sedatives, antispasmodics, antihistamines, antiflatulents
• Help parents understand infant’s crying behavior and modifying parent interventions to promptly attend to infant’s needs ↓
• “Colic Carry”

FAILURE TO THRIVE (FTT)

• A sign of inadequate growth resulting from

inability to obtain or use calories required for

growth

• Weight (and sometimes height) that falls

below the 5th percentile for the child’s age

• Persistent deviation from an established

growth curve – cause for concern

Weight (and sometimes height) that falls below the

5th percentile for the child’s age

OFTT

• A newborn was admitted with features of desquamating skin lesions, loss of weight gain and failure to thrive.
• The clinical photograph shows extensive weepy lesions throughout the body diagnostic of lamellar icthyosis. it is an autosomal recessive disorder.

FACTORS LEADING TO INADEQUATE FEEDING

• Poverty
• Health and childrearing beliefs
• Inadequate nutritional knowledge
• Family stress
• Feeding resistance
• Insufficient breast milk

THERAPEUTIC MANAGEMENT

• Treatment directed @reversing malnutrition (regardless of the cause)
• Goal: to provide sufficient calories to support “catch-up” growth o A rate of growth greater than the expected rate for age
• NFTT = Multidisciplinary team o Physician, nurse, dietician, child-life specialist, and social worker or mental health professional

FEEDING THERAPY First Day of Feeding Therapy After 4 Weeks of Feeding Therapy

NURSING DIAGNOSIS (NFTT)

• Altered nutrition: less than body requirements r/t: o Deprivation of necessities o Emotional deprivation
• Altered growth and development r/t: o Socially restricted environment (infant deprivation) o Physical neglect
• Altered parenting r/t: o Knowledge deficit, poverty

PHYSICAL AND

DEVELOPMENTAL

DISORDERS OF THE

NERVOUS SYSTEM

Elsie P. Miguel, RN MN

CLASSIFICATION OF HYDROCEPHALUS

• If fluid can reach the spinal cord, the disorder is called o COMMUNICATING OR EXTRAVENTRICULAR H.
• If there is block to such passage of fluid, the disorder is called o OBSTRUCTIVE OR INTRAVENTRICULAR
• According to whether it occurs: o @ birth = CONGENITAL (cause unknown) o from an incident later in life = ACQUIRED

EXCESS IN CSF IN NB OCCURS FOR 1 IN 3 REASONS

1. Choroid plexus’ ↑ed production of CSF
   • Occurs in the 1st or 2nd ventricle – from a growing tumor (rare)
2. Obstruction of CSF in the narrow aqueduct of Sylvius (most common cause) - Other common sites of obstruction: - Foramina of Magendie and Luschka - Occurs because of infection (meningitis, encephalitis) may leave adhesions that may block fluid flow - Hemorrhage from trauma or growing tumor