Autism is diagnosed when the patient meets the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision. At least six characteristics from the following three categories must be present, including at least two from the social interaction category and one each from the communication and patterns categories.
Social interaction
Patient displays impairment in social interaction, as shown by at least two of the following:
  • marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
  • failure to develop peer relationships appropriate to developmental level
  • no spontaneous sharing of enjoyment, interests, or achievements with others
  • lack of social or emotional reciprocity
  • gross impairment in ability to make peer friendships.
Communication
Patient displays impairment in communication, as shown by at least one of the following:
  • delay in or total lack of development of spoken language
  • in individuals with adequate speech, marked impairment in initiating or sustaining a conversation with others
  • stereotyped and repetitive use of language or idiosyncratic language
  • lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
Patterns
Patient displays restricted, repetitive, and stereotyped patterns of behavior, interests, and Continue reading »
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Cerebral palsy (CP) is a term used to describe a diverse group of chronic, nonprogressive disorders of movement, posture, and tone resulting from a central nervous system insult during early development. The timing of the insult may be prior to, at the time of, or shortly after birth.

Etiology

Many factors, both genetic and acquired, have been postulated as causes of cerebral palsy. These include hypoxic-ischemic injury, structural malformations, vascular disorders, intraventricular or subarachnoid hemorrhage, infections, hormonal disorders, toxins, trauma, metabolic disease, prematurity, and hemolytic disease of the newborn. In recent years, several studies have sought to determine the relative contribution of these and other factors to the total incidence of cerebral palsy.

Perinatal Asphyxia
Historically, asphyxia during labor and delivery has been implicated as a major cause of cerebral palsy. In the last decade, a number of large population studies have revealed that asphyxia probably accounts for only a relatively small proportion of cases.  The rate is approximately 4 times higher (16.7 versus 4.7) if the Apgar score is 0 to 3 at 10 minutes compared with 5 minutes. It is remarkable that even when the Apgar score was less than or equal to 3 for 15 minutes, the majority of infants did not develop cerebral palsy.When the association of CP with a variety of potentially asphyxiating conditions was examined, only a tight nuchal cord was associated with a statistically significant increase in risk. Thus, these three major studies are all in agreement that birth asphyxia causes fewer than 1 in 5, and probably fewer than 1 in 10, of the cases of cerebral Continue reading »
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Introduction

Suspected bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause so that appropriate antimicrobial therapy can be initiated. The mortality rate of untreated bacterial meningitis approaches 100 percent and, even with optimal therapy, morbidity and mortality may occur. Neurologic sequelae are common among survivors.

Self-Care at Home

Meningitis can be a rapidly progressing, life-threatening disease, so immediate medical care is important if meningitis is suspected in a child.

  • While transporting a child to a hospital’s emergency department, supportive care may include the following:
    • Give the correct amount of acetaminophen for fever.
    • Attempt to keep the child comfortable and prevent the child from choking or inhaling any material vomited.
    • Directly observe the child to notice any deterioration in condition.
  • Sometimes, children are sent home from the emergency room if the doctor is confident that the child has viral meningitis. Frequently, a child with viral meningitis can be treated successfully at home by taking acetaminophen  or other pain medications and by drinking plenty of fluids. If a child has viral meningitis, follow-up care is still important.
    • Have the child reevaluated within 1-2 days to be sure that he or she isimproving.
    • Watch for any worsening signs or symptoms and if necessary, return immediately to a medical facility.
  • Avoidance of delay — Antibiotic therapy should be initiated immediately after lumbar Continue reading »
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