This document provides an overview of Down syndrome including definitions, features in newborns, common abnormalities, and age-specific healthcare guidelines. It summarizes the incidence of Down syndrome as occurring in 1 in 660 newborns. Common physical features in newborns include slanted palpebral fissures, anomalous auricles, and hypotonia. The document outlines numerous potential abnormalities and provides healthcare guidelines for individuals with Down syndrome from the neonatal period through adulthood.
Down syndrome is a genetic disorder caused by the presence of a third copy of chromosome 21. It is characterized by delayed physical and intellectual development. Affected individuals typically have mild to moderate intellectual disabilities and characteristic facial features such as a flat nasal bridge. While signs and symptoms vary, early intervention can help maximize development. Prenatal screening and testing can detect Down syndrome, but the only definitive test is chromosome analysis after birth. Lifelong support is important for managing associated medical issues.
Pediatrics. trisomy 21. Meiotic non-disjunction of chromosome 21. clinical features and associated abnormalities of down syndrome. screening test for down syndrome. counseling for parents in down syndrome.
Down syndrome is caused by trisomy 21, occurring in approximately 1 in 1000 live births. It results from errors in cell division during meiosis. Clinically, it is characterized by facial features like an upward slant of the eyes, a flat facial profile, and intellectual disability. Complications can include heart defects, hearing or vision problems, gastrointestinal issues, and other conditions. Management involves monitoring for associated medical issues and providing therapies to support development. The lifespan for individuals with Down syndrome has increased in recent decades due to improved medical care.
Down syndrome is a genetic disorder caused by the presence of an extra chromosome 21. It is characterized by mild to moderate intellectual disability and distinctive facial features. The document discusses the history, genetics, clinical features, health issues, diagnosis and management of Down syndrome. Key points include that the risk increases with maternal age, common physical signs include a flat facial profile and hypotonia, associated conditions affect the heart, GI tract and thyroid, and treatment involves screening and early intervention.
Patau syndrome, also known as trisomy 13, is a rare genetic disorder caused by the presence of an extra chromosome 13. It affects about 1 in 12,000 live births and causes severe intellectual and physical disabilities. Common signs include microcephaly, eye abnormalities, cleft palate, extra fingers or toes, and heart defects. While there is no cure, surgery can address some physical defects, though over 80% of infants with Patau syndrome do not survive past their first year.
Down syndrome is a genetic disorder caused by the presence of an extra chromosome 21. It causes lifelong intellectual disability and developmental delays. There are three main types of Down syndrome - Trisomy 21, Mosaic Down syndrome, and Translocation Down syndrome. Trisomy 21 accounts for 95% of cases and is caused by abnormal cell division during conception. While Down syndrome cannot be prevented or cured, early intervention programs can help children with Down syndrome develop important skills and abilities. Individuals with Down syndrome also often face increased health risks such as heart defects and dementia. However, with medical advances, the average life expectancy for people with Down syndrome is now over 50 years.
Gestational diabetes can cause complications in infants due to hyperglycemia transferring through the placenta. Infants of diabetic mothers (IDMs) are at risk for birth defects if hyperglycemia occurs early in pregnancy during organ development. Later hyperglycemia increases risks for macrosomia, hypoglycemia, and other issues. IDMs require careful monitoring and treatment of potential complications in the neonatal period such as hypoglycemia, hypocalcemia, respiratory distress, and cardiomyopathy. Long term, IDMs have increased risk of obesity, diabetes, and developmental or cognitive delays.
Down syndrome is a genetic disorder caused by the presence of a third copy of chromosome 21. It is characterized by delayed physical and intellectual development. Affected individuals typically have mild to moderate intellectual disabilities and characteristic facial features such as a flat nasal bridge. While signs and symptoms vary, early intervention can help maximize development. Prenatal screening and testing can detect Down syndrome, but the only definitive test is chromosome analysis after birth. Lifelong support is important for managing associated medical issues.
Pediatrics. trisomy 21. Meiotic non-disjunction of chromosome 21. clinical features and associated abnormalities of down syndrome. screening test for down syndrome. counseling for parents in down syndrome.
Down syndrome is caused by trisomy 21, occurring in approximately 1 in 1000 live births. It results from errors in cell division during meiosis. Clinically, it is characterized by facial features like an upward slant of the eyes, a flat facial profile, and intellectual disability. Complications can include heart defects, hearing or vision problems, gastrointestinal issues, and other conditions. Management involves monitoring for associated medical issues and providing therapies to support development. The lifespan for individuals with Down syndrome has increased in recent decades due to improved medical care.
Down syndrome is a genetic disorder caused by the presence of an extra chromosome 21. It is characterized by mild to moderate intellectual disability and distinctive facial features. The document discusses the history, genetics, clinical features, health issues, diagnosis and management of Down syndrome. Key points include that the risk increases with maternal age, common physical signs include a flat facial profile and hypotonia, associated conditions affect the heart, GI tract and thyroid, and treatment involves screening and early intervention.
Patau syndrome, also known as trisomy 13, is a rare genetic disorder caused by the presence of an extra chromosome 13. It affects about 1 in 12,000 live births and causes severe intellectual and physical disabilities. Common signs include microcephaly, eye abnormalities, cleft palate, extra fingers or toes, and heart defects. While there is no cure, surgery can address some physical defects, though over 80% of infants with Patau syndrome do not survive past their first year.
Down syndrome is a genetic disorder caused by the presence of an extra chromosome 21. It causes lifelong intellectual disability and developmental delays. There are three main types of Down syndrome - Trisomy 21, Mosaic Down syndrome, and Translocation Down syndrome. Trisomy 21 accounts for 95% of cases and is caused by abnormal cell division during conception. While Down syndrome cannot be prevented or cured, early intervention programs can help children with Down syndrome develop important skills and abilities. Individuals with Down syndrome also often face increased health risks such as heart defects and dementia. However, with medical advances, the average life expectancy for people with Down syndrome is now over 50 years.
Gestational diabetes can cause complications in infants due to hyperglycemia transferring through the placenta. Infants of diabetic mothers (IDMs) are at risk for birth defects if hyperglycemia occurs early in pregnancy during organ development. Later hyperglycemia increases risks for macrosomia, hypoglycemia, and other issues. IDMs require careful monitoring and treatment of potential complications in the neonatal period such as hypoglycemia, hypocalcemia, respiratory distress, and cardiomyopathy. Long term, IDMs have increased risk of obesity, diabetes, and developmental or cognitive delays.
The document provides information on evaluating and diagnosing short stature in children. It defines short stature as height more than 2 standard deviations below the median for age and gender. It discusses evaluating growth velocity and proportions, considering causes like familial, constitutional, medical conditions affecting the GH-IGF axis, malnutrition, chronic illness, genetic syndromes, and psychosocial factors. The diagnosis involves a detailed history, physical exam including measurements, and laboratory tests to identify potential causes.
Down syndrome is the most common chromosomal abnormality, caused by trisomy of chromosome 21. It is characterized by intellectual disability, distinctive facial features, and often congenital heart disease. The incidence increases with maternal age, ranging from 1 in 700 live births under age 20 to 1 in 35 for mothers age 45. Diagnosis is usually made based on clinical features, and confirmed with karyotyping. Management involves early intervention, education support, screening and treatment for associated medical issues.
Basic approach on short stature in childrenAzad Haleem
This document provides an overview of short stature, including definitions, types, diagnostic principles, causes, and management. It defines short stature as height below the 3rd percentile and discusses types such as familial short stature. Diagnosis involves accurate height measurements, bone age assessment, mid-parental height comparison, and medical investigations. Causes include growth hormone deficiency, Turner syndrome, and small size at birth. Management consists of dietary counseling, growth hormone injections, and limb lengthening procedures depending on the underlying cause.
This document provides information about Edwards syndrome, also known as Trisomy 18. It is a rare chromosomal disorder caused by the presence of an extra copy of chromosome 18. The key symptoms include intellectual disability, heart defects, and abnormalities of the hands and feet. Diagnosis is often made through blood tests to analyze chromosomes or through ultrasound screening. Treatment focuses on managing symptoms, as there is currently no cure. Life expectancy is poor, with over 90% of children passing away within the first year. The document outlines the different types of Edwards syndrome and provides some background on its discovery and causes.
Fetal alcohol spectrum disorders (FASD) are caused by prenatal alcohol exposure and range from mild effects to the most severe, fetal alcohol syndrome (FAS). FAS is characterized by facial abnormalities, growth problems, and central nervous system issues. A study in Croatia found a prevalence of FAS of 16.9 per 1,000 children and a combined FASD prevalence of 66.7 per 1,000 children examined, indicating FASDs are a serious public health problem. The only way to prevent FASDs is to avoid any alcohol during pregnancy. Treatment requires lifelong medical and therapeutic care to address symptoms.
This document provides information on diabetes including definitions, epidemiology, diagnosis, etiologic classifications, physiology, presentation, investigations, management, treatment, insulin types, and special considerations for pediatric diabetes. It defines diabetes as a metabolic disorder characterized by hyperglycemia caused by insulin deficiency or resistance. Key points include that type 1 diabetes is an autoimmune condition resulting in absolute insulin deficiency, while type 2 involves insulin resistance with relative deficiency. Diagnosis requires hyperglycemic symptoms and blood glucose criteria. Management involves a multidisciplinary team, medical treatment including insulin administration and nutrition management, and screening for acute and long-term complications.
Patau syndrome, also known as trisomy 13, is a rare genetic disorder caused by the presence of an extra copy of chromosome 13. It often results in miscarriage, stillbirth, or death in the first year of life. Babies born with Patau syndrome experience slow growth and development with low birth weight. They typically have several serious medical problems affecting the brain, heart, kidneys and other organs. While there is no cure, treatment aims to address symptoms through surgery, feeding tubes, and therapies. Most children with Patau syndrome do not survive past one year of age.
Microcephaly is a head circumference more than 3 standard deviations below the mean. It can be primary/genetic due to defects in cellular migration, neurulation or prosencephalization. Secondary microcephaly has prenatal causes like infections, drugs or postnatal causes like birth injuries or infections. Primary microcephaly is usually autosomal recessive and presents with distinctive facial features and severe intellectual disability. Secondary microcephaly has a varied presentation depending on the cause. Evaluation involves examining for dysmorphism, neurological problems and investigating for possible causes. Treatment focuses on managing symptoms while prevention centers around screening for infections and nutritional supplementation.
Turner syndrome is a genetic condition where females are missing an entire or partial X chromosome. It affects about 1 in 2,500 baby girls. Common characteristics include short stature and lack of ovarian development leading to infertility. While it cannot be passed down from parent to child, it is typically caused during egg formation when chromosomes fail to separate properly. Diagnosis involves a karyotype blood test and treatment focuses on hormone replacement therapy to promote normal development and replace missing hormones.
Down syndrome is a genetic disorder caused by the presence of an extra chromosome 21. It can be caused by trisomy 21, translocation, or mosaicism. Common symptoms include distinctive facial features, poor muscle tone, cognitive delays, and heart defects. While there is no cure, early intervention including speech, physical, and occupational therapy can help children with Down syndrome reach their full potential. Lifespan and quality of life have improved significantly in recent decades for those living with Down syndrome.
Down syndrome is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It causes delays in physical and intellectual development and is the most common chromosome abnormality in humans, affecting approximately 1 in 800 live births. The signs and symptoms include cognitive impairment and characteristic facial features. While individuals with Down syndrome may have health issues, proper care and education can significantly improve quality of life.
This document discusses an approach to evaluating children with dysmorphic features or congenital anomalies. It begins by outlining common birth defects, their estimated incidences, and potential causes. It then describes the goals and purposes of a dysmorphology evaluation, including establishing diagnoses, determining recurrence risks, and providing management and counseling. The rest of the document discusses specific aspects of evaluating congenital anomalies, such as recognizing normal and abnormal phenotypic variation, determining whether features are isolated or represent a genetic syndrome, and managing patient care.
This document discusses diabetes mellitus (DM), specifically in children. It defines DM as a chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion or action. Type 1 DM is described as an autoimmune disease resulting in absolute insulin deficiency, while Type 2 DM is associated with insulin resistance. Signs and symptoms, classification, incidence rates, diagnosis, treatment involving insulin therapy, nutrition management, and exercise are covered. Nursing care focuses on education, emotional support, and ensuring safety.
A 15-year-old male presents with concerns of short stature and delayed puberty. Differential diagnoses include gonadotrophin deficiency, gonadal failure, and constitutional delay of growth and puberty. Physical exam and bone age assessment support a diagnosis of constitutional delay of growth and puberty, which is a condition of temporary short stature and delayed puberty but normal expected progression and attainment of full adult height. Reassurance and monitoring are the typical management approach.
Edwards syndrome, also known as Trisomy 18, is a genetic disorder caused by the presence of an extra 18th chromosome. It results in physical abnormalities and intellectual disabilities. Individuals with Edwards syndrome often have heart defects, respiratory issues, and feeding difficulties. Prognosis is generally poor, with 50% surviving the first week and only 5-10% living beyond one year. Treatment focuses on management of symptoms and organ dysfunction. The condition is not inherited but rather caused by a random chromosomal error and cannot be passed to future generations.
This document discusses precocious puberty in a 3 year old girl. On examination, she had breast enlargement and pubic hair development consistent with Tanner stages B3 and Ph2. Lab tests found elevated LH and FSH. Ultrasound showed enlarged uterus and ovaries. The document then reviews physiology of puberty, Tanner staging of breast and pubic hair development, defines precocious puberty, and discusses causes and treatment options like GnRH agonists or surgery.
1. Marfan syndrome is an inherited disorder of connective tissue that affects many parts of the body, including the skeletal, ocular, cardiovascular and pulmonary systems.
2. It is caused by mutations in the FBN1 gene which results in abnormal fibrillin protein and connective tissue abnormalities.
3. Diagnosis is based on assessments of the skeletal, ocular, cardiovascular and other body systems compared to established diagnostic criteria such as the Ghent nosology, with a focus on assessments of the aorta and lenses.
This document discusses neuroregression in children. It begins by outlining key points about neurometabolic disorders, including that they cause diverse neurological manifestations and require a systematic clinical, biochemical and imaging approach for diagnosis. It then discusses various inborn errors of metabolism classified by pathway and organelle. Clinical features of different conditions are provided, along with details about common neonatal and childhood presentations of neuroregression. The challenges in diagnosis and important clues are reviewed. Investigations and the objectives of evaluation are described. Broad management approaches and considerations for specific conditions like Hurler disease and Niemann-Pick disease type A are highlighted.
Down syndrome is a genetic condition caused by trisomy of chromosome 21. It occurs in about 1 in 660 births. Key features in newborns include slanted eyes, small ears, loose skin on the back of the neck, and poor muscle tone. Individuals with Down syndrome often have health issues such as heart defects, hearing or vision problems, gastrointestinal abnormalities, thyroid disorders, and psychiatric conditions. Lifelong healthcare involves screening and management of associated medical problems with a focus on development, education, independence, and quality of life.
Microcephaly is a congenital condition defined as a head circumference more than 3 standard deviations below the mean for age and sex. It can be primary/genetic due to defects in cellular migration, neurulation or prosencephalization. Secondary microcephaly has non-genetic causes like infections, metabolic disorders, trauma or prenatal/perinatal insults. Diagnosis involves examining family history, growth parameters, neurological features and imaging studies. Treatment focuses on managing specific treatable causes, seizures and developmental delays. Recurrence risks vary based on identified genetic or environmental factors.
The document provides information on evaluating and diagnosing short stature in children. It defines short stature as height more than 2 standard deviations below the median for age and gender. It discusses evaluating growth velocity and proportions, considering causes like familial, constitutional, medical conditions affecting the GH-IGF axis, malnutrition, chronic illness, genetic syndromes, and psychosocial factors. The diagnosis involves a detailed history, physical exam including measurements, and laboratory tests to identify potential causes.
Down syndrome is the most common chromosomal abnormality, caused by trisomy of chromosome 21. It is characterized by intellectual disability, distinctive facial features, and often congenital heart disease. The incidence increases with maternal age, ranging from 1 in 700 live births under age 20 to 1 in 35 for mothers age 45. Diagnosis is usually made based on clinical features, and confirmed with karyotyping. Management involves early intervention, education support, screening and treatment for associated medical issues.
Basic approach on short stature in childrenAzad Haleem
This document provides an overview of short stature, including definitions, types, diagnostic principles, causes, and management. It defines short stature as height below the 3rd percentile and discusses types such as familial short stature. Diagnosis involves accurate height measurements, bone age assessment, mid-parental height comparison, and medical investigations. Causes include growth hormone deficiency, Turner syndrome, and small size at birth. Management consists of dietary counseling, growth hormone injections, and limb lengthening procedures depending on the underlying cause.
This document provides information about Edwards syndrome, also known as Trisomy 18. It is a rare chromosomal disorder caused by the presence of an extra copy of chromosome 18. The key symptoms include intellectual disability, heart defects, and abnormalities of the hands and feet. Diagnosis is often made through blood tests to analyze chromosomes or through ultrasound screening. Treatment focuses on managing symptoms, as there is currently no cure. Life expectancy is poor, with over 90% of children passing away within the first year. The document outlines the different types of Edwards syndrome and provides some background on its discovery and causes.
Fetal alcohol spectrum disorders (FASD) are caused by prenatal alcohol exposure and range from mild effects to the most severe, fetal alcohol syndrome (FAS). FAS is characterized by facial abnormalities, growth problems, and central nervous system issues. A study in Croatia found a prevalence of FAS of 16.9 per 1,000 children and a combined FASD prevalence of 66.7 per 1,000 children examined, indicating FASDs are a serious public health problem. The only way to prevent FASDs is to avoid any alcohol during pregnancy. Treatment requires lifelong medical and therapeutic care to address symptoms.
This document provides information on diabetes including definitions, epidemiology, diagnosis, etiologic classifications, physiology, presentation, investigations, management, treatment, insulin types, and special considerations for pediatric diabetes. It defines diabetes as a metabolic disorder characterized by hyperglycemia caused by insulin deficiency or resistance. Key points include that type 1 diabetes is an autoimmune condition resulting in absolute insulin deficiency, while type 2 involves insulin resistance with relative deficiency. Diagnosis requires hyperglycemic symptoms and blood glucose criteria. Management involves a multidisciplinary team, medical treatment including insulin administration and nutrition management, and screening for acute and long-term complications.
Patau syndrome, also known as trisomy 13, is a rare genetic disorder caused by the presence of an extra copy of chromosome 13. It often results in miscarriage, stillbirth, or death in the first year of life. Babies born with Patau syndrome experience slow growth and development with low birth weight. They typically have several serious medical problems affecting the brain, heart, kidneys and other organs. While there is no cure, treatment aims to address symptoms through surgery, feeding tubes, and therapies. Most children with Patau syndrome do not survive past one year of age.
Microcephaly is a head circumference more than 3 standard deviations below the mean. It can be primary/genetic due to defects in cellular migration, neurulation or prosencephalization. Secondary microcephaly has prenatal causes like infections, drugs or postnatal causes like birth injuries or infections. Primary microcephaly is usually autosomal recessive and presents with distinctive facial features and severe intellectual disability. Secondary microcephaly has a varied presentation depending on the cause. Evaluation involves examining for dysmorphism, neurological problems and investigating for possible causes. Treatment focuses on managing symptoms while prevention centers around screening for infections and nutritional supplementation.
Turner syndrome is a genetic condition where females are missing an entire or partial X chromosome. It affects about 1 in 2,500 baby girls. Common characteristics include short stature and lack of ovarian development leading to infertility. While it cannot be passed down from parent to child, it is typically caused during egg formation when chromosomes fail to separate properly. Diagnosis involves a karyotype blood test and treatment focuses on hormone replacement therapy to promote normal development and replace missing hormones.
Down syndrome is a genetic disorder caused by the presence of an extra chromosome 21. It can be caused by trisomy 21, translocation, or mosaicism. Common symptoms include distinctive facial features, poor muscle tone, cognitive delays, and heart defects. While there is no cure, early intervention including speech, physical, and occupational therapy can help children with Down syndrome reach their full potential. Lifespan and quality of life have improved significantly in recent decades for those living with Down syndrome.
Down syndrome is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It causes delays in physical and intellectual development and is the most common chromosome abnormality in humans, affecting approximately 1 in 800 live births. The signs and symptoms include cognitive impairment and characteristic facial features. While individuals with Down syndrome may have health issues, proper care and education can significantly improve quality of life.
This document discusses an approach to evaluating children with dysmorphic features or congenital anomalies. It begins by outlining common birth defects, their estimated incidences, and potential causes. It then describes the goals and purposes of a dysmorphology evaluation, including establishing diagnoses, determining recurrence risks, and providing management and counseling. The rest of the document discusses specific aspects of evaluating congenital anomalies, such as recognizing normal and abnormal phenotypic variation, determining whether features are isolated or represent a genetic syndrome, and managing patient care.
This document discusses diabetes mellitus (DM), specifically in children. It defines DM as a chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion or action. Type 1 DM is described as an autoimmune disease resulting in absolute insulin deficiency, while Type 2 DM is associated with insulin resistance. Signs and symptoms, classification, incidence rates, diagnosis, treatment involving insulin therapy, nutrition management, and exercise are covered. Nursing care focuses on education, emotional support, and ensuring safety.
A 15-year-old male presents with concerns of short stature and delayed puberty. Differential diagnoses include gonadotrophin deficiency, gonadal failure, and constitutional delay of growth and puberty. Physical exam and bone age assessment support a diagnosis of constitutional delay of growth and puberty, which is a condition of temporary short stature and delayed puberty but normal expected progression and attainment of full adult height. Reassurance and monitoring are the typical management approach.
Edwards syndrome, also known as Trisomy 18, is a genetic disorder caused by the presence of an extra 18th chromosome. It results in physical abnormalities and intellectual disabilities. Individuals with Edwards syndrome often have heart defects, respiratory issues, and feeding difficulties. Prognosis is generally poor, with 50% surviving the first week and only 5-10% living beyond one year. Treatment focuses on management of symptoms and organ dysfunction. The condition is not inherited but rather caused by a random chromosomal error and cannot be passed to future generations.
This document discusses precocious puberty in a 3 year old girl. On examination, she had breast enlargement and pubic hair development consistent with Tanner stages B3 and Ph2. Lab tests found elevated LH and FSH. Ultrasound showed enlarged uterus and ovaries. The document then reviews physiology of puberty, Tanner staging of breast and pubic hair development, defines precocious puberty, and discusses causes and treatment options like GnRH agonists or surgery.
1. Marfan syndrome is an inherited disorder of connective tissue that affects many parts of the body, including the skeletal, ocular, cardiovascular and pulmonary systems.
2. It is caused by mutations in the FBN1 gene which results in abnormal fibrillin protein and connective tissue abnormalities.
3. Diagnosis is based on assessments of the skeletal, ocular, cardiovascular and other body systems compared to established diagnostic criteria such as the Ghent nosology, with a focus on assessments of the aorta and lenses.
This document discusses neuroregression in children. It begins by outlining key points about neurometabolic disorders, including that they cause diverse neurological manifestations and require a systematic clinical, biochemical and imaging approach for diagnosis. It then discusses various inborn errors of metabolism classified by pathway and organelle. Clinical features of different conditions are provided, along with details about common neonatal and childhood presentations of neuroregression. The challenges in diagnosis and important clues are reviewed. Investigations and the objectives of evaluation are described. Broad management approaches and considerations for specific conditions like Hurler disease and Niemann-Pick disease type A are highlighted.
Down syndrome is a genetic condition caused by trisomy of chromosome 21. It occurs in about 1 in 660 births. Key features in newborns include slanted eyes, small ears, loose skin on the back of the neck, and poor muscle tone. Individuals with Down syndrome often have health issues such as heart defects, hearing or vision problems, gastrointestinal abnormalities, thyroid disorders, and psychiatric conditions. Lifelong healthcare involves screening and management of associated medical problems with a focus on development, education, independence, and quality of life.
Microcephaly is a congenital condition defined as a head circumference more than 3 standard deviations below the mean for age and sex. It can be primary/genetic due to defects in cellular migration, neurulation or prosencephalization. Secondary microcephaly has non-genetic causes like infections, metabolic disorders, trauma or prenatal/perinatal insults. Diagnosis involves examining family history, growth parameters, neurological features and imaging studies. Treatment focuses on managing specific treatable causes, seizures and developmental delays. Recurrence risks vary based on identified genetic or environmental factors.
This document provides an overview of Prader-Willi Syndrome (PWS), including:
1. PWS is caused by abnormalities on chromosome 15 that result in problems with feeding, motor skills, cognition and behavior as well as obesity.
2. Clinical features include neonatal hypotonia, poor feeding, developmental delays, hyperphagia leading to obesity, and characteristic facial features.
3. Diagnosis involves genetic testing to identify deletions, disomy or mutations on chromosome 15; treatment aims to manage feeding, obesity, endocrine issues, and behavioral challenges through a multidisciplinary approach.
Hypothyroidism in children can be either congenital or acquired. The document discusses the various causes, signs, symptoms, diagnosis, and management of hypothyroidism in newborns, infants, and older children. A key point is that early diagnosis and treatment of congenital hypothyroidism is important to prevent mental handicap. Treatment involves thyroid hormone replacement therapy with levothyroxine. Monitoring of treatment includes clinical exams and testing of thyroid hormone levels every 3-6 months. Prevention strategies focus on iodine supplementation, newborn screening programs, and increasing awareness of acquired causes.
This document discusses the approach to evaluating a hypotonic infant. It begins by defining muscle tone and how it is assessed. The causes of hypotonia are then classified based on anatomical location of the underlying pathology as paralytic or non-paralytic. A thorough history and physical exam can help differentiate between potential causes. Key diagnostic tests include bloodwork, imaging, nerve conduction studies, muscle biopsy and genetic testing to identify the specific condition causing hypotonia. The goal is to determine the anatomical location and underlying etiology to guide management.
This document discusses several chromosomal abnormalities including Down syndrome, Turner syndrome, Patau syndrome, and Edwards syndrome. It provides details on the characteristics, causes, diagnosis and management of each condition. Down syndrome results from trisomy 21 and is associated with developmental delays, congenital heart defects, increased risk of leukemia and thyroid disorders. Turner syndrome occurs when one X chromosome is missing and affects growth and fertility in girls. Patau and Edwards syndromes are trisomies of chromosomes 13 and 18 respectively, often causing multiple physical abnormalities and intellectual disability. Prenatal screening and testing can help identify these conditions.
The document discusses various birth defects including:
1. Atavism, polydactyly, syndactyly, gigantism, and cleft lip which are abnormalities in development.
2. Terms used to describe diseases such as signs, symptoms, and etiology.
3. Types of anomalies including malformations, disruptions, deformations, and syndromes.
4. Various congenital defects and birth defects are discussed such as clubfoot, torticollis, Down syndrome, fetal alcohol syndrome, muscular dystrophy, spina bifida, and cerebral palsy. Environmental factors that can influence birth defects are also summarized.
Newborn screening involves a head-to-toe examination of a newborn to check for any abnormalities and includes biochemical screening tests and special screenings like screening for retinopathy of prematurity, hearing, and echocardiograms. The examination involves measurements, vital signs checks, examination of skin, head, face, chest, heart, abdomen, genitals, extremities, spine, and hips as well as assessment of muscle tone, reflexes, and any other abnormalities. Biochemical screening checks for conditions like G6PD deficiency and congenital hypothyroidism to identify issues early to prevent intellectual disabilities or death. Special screenings include screening preterm infants for retinopathy of prematurity, hearing screening for those
1. Short stature is defined as a height less than the 3rd percentile for age, sex and population or more than 2 standard deviations below the mean height.
2. Physiological short stature includes familial short stature and constitutional delay of growth and puberty. Pathological short stature can be due to disproportionate short stature from skeletal dysplasias, acquired conditions like malnutrition or genetic syndromes.
3. Evaluation of short stature involves detailed history, physical exam, bone age assessment and screening for endocrine or systemic illnesses based on three levels of investigation. Management depends on identifying and treating the underlying cause.
approach to a child with altered sensorium.pptxdrgsvt
The document provides guidance on assessing and managing an altered sensorium in a child. It describes stabilizing the child's airway, breathing, and circulation. It also recommends treating potential causes like hypoglycemia, infections, seizures and raised intracranial pressure. The primary goals are saving the child's life and achieving intact neurological recovery through a multidisciplinary approach.
A toddler boy is lying on the bed, conscious and comfortable. He is in respiratory distress and on oxygen support. A physical examination will assess vital signs, growth parameters, general appearance, and specifically examine the head, eyes, mouth, nose and ears for any abnormalities. Examinations of young children require developmentally appropriate techniques to establish rapport and avoid distress.
1. Down syndrome is caused by trisomy 21 and is characterized by intellectual disability and distinctive physical features. It is the most common genetic chromosomal disorder.
2. Turner syndrome is caused by a missing or partial X chromosome and affects growth and sexual development in females, causing short stature and infertility.
3. Klinefelter syndrome is the most common sex chromosome disorder in males, caused by at least one extra X chromosome, and is associated with infertility and less developed secondary sex characteristics.
Unit 1_ Genetic Disorders, Part 2, Educational Platform.pptuk581147
Down syndrome is a chromosomal disorder caused by an extra 21st chromosome. It leads to cognitive and physical impairments ranging from mild to moderate. The document discusses Down syndrome, including its definition, background, etiology, pathophysiology, potential problems, signs and symptoms, screening tests, nursing diagnoses, interventions, and management. It is intended to educate nursing students on Down syndrome.
This document provides information on common behavioral problems in children. It discusses causes of behavioral disorders like faulty parental attitudes, inadequate family environment, and influence of social relationships. It describes types of behavioral problems stemming from emotional, physical, and social deprivation including temper tantrums, bedwetting, thumb sucking, and more. Assessment and management strategies are outlined for each condition. The document emphasizes the importance of parental support, clear communication, and developing a child's independence and social skills to address behavioral issues.
This document provides an overview of key considerations for pediatric anesthesia. It discusses how children's physiology differs from adults, especially regarding airways, drug dosing, development milestones. It covers age group classifications and specific organ system considerations for the cardiovascular, respiratory, renal and hepatic systems. Factors like preoperative evaluation, NPO guidelines and potential developmental impacts of anesthesia like apoptosis are also reviewed at a high level. The document emphasizes that pediatric anesthesia requires accounting for normal developmental changes as children grow.
Down syndrome is a genetic condition caused by trisomy of chromosome 21. It occurs in about 1 in 700 live births. Clinical features include intellectual disability, characteristic facial features such as a flat face, upward slanted eyes, and a protruding tongue. Individuals with Down syndrome also have an increased risk of certain medical conditions such as congenital heart defects and thyroid problems. Prenatal screening and diagnostic tests can identify Down syndrome in utero. Lifelong medical care is important to monitor development, screen for associated conditions, and support quality of life.
A group of motor impairment syndromes resulting from disorders of early brain development and often associated with epilepsy and abnormalities of speech, vision and intellect
This document discusses global developmental delay and related disorders. It begins with defining developmental milestones and types of developmental abnormalities like delay, dissociation, and deviancy. It then covers the definition, causes, risk factors, signs, and differential diagnosis of global developmental delay. The document emphasizes taking a thorough history and examination. It provides an overview of evaluating developmentally delayed children and investigating etiologies. Common genetic and metabolic causes are reviewed along with their management. The importance of a multidisciplinary approach and early intervention is stressed.
This document provides guidance on approaches to pediatric emergencies and assessments. It emphasizes gaining the child's trust and cooperation through gentle, honest communication. Exams should involve the parent and avoid causing pain until the child is comfortable. Injuries are often due to accidents, but abuse requires a careful exam and history that is inconsistent with the reported events.
Examination in paediatric Medicine for medical students.pptxVarsha Shah
This document provides guidance on examining pediatric patients. It emphasizes establishing rapport, keeping exams non-threatening, and tailoring the approach based on a child's age and development. Key points include observing the child first before interacting, explaining procedures, using distraction, and examining painful areas last. Practice is emphasized to improve skills in communication, examination techniques, and handling different age groups in a developmentally-appropriate manner. The goal is to make exams as comfortable as possible for children.
Neonatal presentations to Emergency department.pptxVarsha Shah
1. Neonatal presentations to emergency departments are rising, partly due to shorter postpartum stays. Common non-emergency presentations include jaundice, feeding issues, breathing difficulties, and excessive crying.
2. Factors associated with increased ED attendance among neonates include parental anxiety, perceived convenience of EDs, lack of continuity with primary care, and neonates exhibiting non-specific symptoms.
3. The most common neonatal emergencies can be summarized by the acronym "THE MISFITS" and include conditions like trauma, heart disease, endocrine emergencies, and sepsis. Timely diagnosis and treatment of these conditions in the ED is important for neonatal health outcomes.
Approach to thalassemia with abdominal distension in childrenVarsha Shah
1. Siti, a 7-year-old girl from Indonesia, has been diagnosed with beta-thalassemia major requiring regular blood transfusions over the past 4 years.
2. During a recent clinic visit, her hemoglobin level was 10 g/dL but her serum iron level was elevated at 150 microg/L, indicating potential iron toxicity from chronic transfusions.
3. Common complications of beta-thalassemia major and lifelong transfusions include organ damage from iron overload, as well as infectious risks from transfused blood. Treatment focuses on maintaining hemoglobin levels while preventing iron toxicity.
This document discusses jaundice in infants and neonatal cholestasis. Neonatal cholestasis is defined as conjugated hyperbilirubinemia occurring in newborns due to diminished bile flow. Clinical presentations include prolonged jaundice, acholic stool, dark urine, hepatomegaly, and bronze discoloration of the body after phototherapy. Treatment involves continuing breastfeeding with MCT supplement if needed, vitamin supplements, surgical procedures like Kasai surgery or liver transplantation depending on the severity and cause of cholestasis. The key points are to promptly refer newborns with prolonged jaundice and dark urine for investigation and to perform surgery for conditions like biliary atresia before
Approach to Cafe au lait spots in childrenVarsha Shah
This document provides guidance on evaluating and monitoring children with neurocutaneous syndromes and café au lait spots. It discusses several neurocutaneous disorders including neurofibromatosis types 1 and 2, tuberous sclerosis, ataxia telangiectasia, and others. For children presenting with café au lait spots, the provider should consider neurofibromatosis type 1 and monitor for diagnostic criteria such as additional café au lait spots, skinfold freckling, neurofibromas, Lisch nodules, and skeletal or ocular abnormalities. Regular examinations are recommended to monitor for signs of NF1 and potential complications.
Mcq in neonatology for medical studentsVarsha Shah
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1. True
2. True
3. False
4. True
5. False
6. e. Tonsillitis
7. e. Infertility
8. c. Higher cost to feed a lactating mother
9. f. No free sponsorship from pharma, samples of formula and less earnings for hospital
10. d. Mother can do house works, can take care of sibling and save money
11. c. Causes high incidence of jaundice
12. e. All of the above
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This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
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Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
2. DOWN SYNDROME
• I. “Definitions”
• II. Principle Features in Newborns
• III. Abnormalities
• IV. Age Specific Healthcare Guidelines
3. DOWN SYNDROME; “Definitions”
• Incidence: 1:660 • Etiology: Trisomy for
newborns all or a large part of
• “The most common Chromosome 21
pattern of • Full 21 = 94%
malformation in man” • Mosaicism = 2.4%
• Translocation = 3.3%
(D/G or G/G)
4. DOWN SYNDROME; Maternal Age
• Faulty chromosome • 15-29 yrs 1:1500
distribution leading to • 30-34 yrs 1:800
Down Syndrome is • 35-39 yrs 1:270
more likely to occur at
• 40-44 yrs 1:100
older maternal age.
• >45 yrs 1:50
5. DOWN SYNDROME: Principle Features in
Newborns
• Hall found at least • Hypotonia (80%)
four of these • Poor Moro (85%)
abnormalities in all • Hyperflexible joints
newborns with Down (80%)
Syndrome.
• XS skin back of neck
• Slanted palpebral
(80%)
fissures(80%)
• Flat facial profile
• Anomalous auricles
(90%)
(60%)
6. DOWN SYNDROME: Features in Newborns (2)
• Dysplasia of pelvis (70%)
• Dysplasia of midphalanx of fifth finger (60%)
• Simean crease (45%)
7. DOWN SYNDROME; Abnormalities
• General
• Hypotonia
• Tendency to keep mouth open and
protrude tongue
• Diastasis recti
• Hyperflexible joints
• Small stature
8. DOWN SYNDROME: Abnormalities
• CNS: Mental deficiency, seizures
(5-10%),ADHD, autism, dementia
• Craniofacial: Brachycephaly, flat occiput,
mild microcephaly, upslanting palpebral
fissures, late closure of fontanels, hypo- to
aplasia of frontal sinuses, short hard
palate, small nose, low nasal bridge, inner
epicanthal folds
9. DOWN SYNDROME: Abnormalities
• Eyes: Brushfield’s spots (speckling of iris)
with peripheral hypoplasia of iris, fine lens
opacities (59%), myopia (35-40%,
hyperopia (20-25%), strabismus
(23-44%),keratoconus (5-8%), blephoritis
(50% over lifetime), cataracts, nystagmus
10. DOWN SYNDROME: Abnormalities
• EARS: • Middle ear problems
• Small (fluid and recurrent
• Overfolding of otitis media)
angulated upper helix • Sensorineural hearing
• Small or absent loss
earlobes
• Small canals
11. Down syndrome: Abnormalities
• CARDIAC (30-60%) • All infants and
• AV canal children need to have
• ASD an evaluation by a
pediatric cardiologist
• VSD and ECHO before 3
• PDA months of age.
• Aberrant subclavian • SBE prophylaxis as
artery indicated
• Tetrology of Fallot
12. DOWN SYNDROME; Abnormalities
• GASTROINTESTINAL • GU
• Duodenal web or atresia • Male: small penis,
• Tracheo-esophageal decreased fertility,
fistula cryptorchidism (27%),
• Hirschprung’s decreased testosterone
production
• Celiac disease
• Female: fertile, 50% of
• GERD
offspring will have DS,
• Ulcers 20-40% of DD women
• Constipation sexually abused over
lifetime
13. DOWN SYNDROME; Abnormalities
• DIETARY • RECOMMENDATIONS
• Obesity • Reduced caloric intake
• Increased physical
• Increased
activity
triglycerides • Consider nutritional
• Decreased HDL consult earlier rather than
cholesterol, later
apolipoprotein A1,
HDL:TG ratio
14. DOWN SYNDROME; Abnormalities
• ENDOCRINE • HEME
• Thyroid Disorders: • Immune function may
• Congenital be impaired with
hypothyroidism (27X
decreased IG2 and
general population)
IG4 and increased
• Hypothyroidism (15%)
IG1 and IG3 as well
• Hyperthyroidism
as cellular immune
• Lower incidence of
deficits
Diabetes Mellitus
• Leukemia (1:95)
15. DOWN SYNDROME: Abnormalities
• MUSCULOSKELETAL • Loss of upper body
• Atlanto-axial strength, abnormal
instability(14%) neurological reflexes,
• Risk of spinal cord injury change in
(1%) Symptoms include bowel/bladder
neck pain, posturing of
head, torticollis, change
functioning
in gait • DDH
• Hand/foot deformities
19. DOWN SYNDROME: NEONATAL
• HISTORY • EXAM
• Parental concerns • Cardiac
• Check for GI problems
• Cataracts
• Hearing/Vision
•
• Otitis media
Family supports
• Fontanelles (think
thyroid)
20. DOWN SYNDROME: NEONATAL
• LABS, CONSULTS • Opthalmologist
• Chromosomal karyotype • Feeding specialist if
• Genetic counseling there are feeding
• T4, TSH difficulties (OT, SLP,
• Mandatory screening Lactation Nurse)
• Pediatric cardiology
• ECHO
• BAER
21. DOWN SYNDROME: NEONATAL
• DEVELOPMENTAL • OTHER
• Discuss Early • Refer to local Down
Intervention
Syndrome parent
• Refer for enrollment in
group or PRO
local program
(Parents Reaching
Out) for family
support
• The Web
22. DOWN SYNDROME: INFANCY (2-12 MONTHS)
• HISTORY • EXAM
• Parental concerns • General neurological,
• Respiratory infections neuromotor,
(especially otitis media)
musculoskeletal exam
• Constipation (use
aggressive dietary • TMs (refer to ENT if
measures, consider you cannot see them
Hirschprung’s) and are suspicious of
• Vision/Hearing otitis)
23. DOWN SYNDROME: INFANCY
• LAB, CONSULTS • BAER or other
• If not done as newborn, assessment of hearing by
must have pediatric 6 months if not done as
cardiology evaluation and newborn.
ECHO. Remember, • Pediatric opthalmology
patients with VSD or AV evaluation by 6-12
septal defect may quietly months if not done as
be developing newborn.
progressive pulmonary • ENT for recurrent otitis.
hypertension • T4, TSH if not done yet.
24. DOWN SYNDROME: INFANCY
• DEVELOPMENTAL • RECOMMENDATION
• Early Intervention S
• PT, OT evaluations • Apply for SSI
• Developmental
• Estate planning
assessment
• Custody
arrangements
• Family support
• SBE prophylaxis as
indicated
25. DOWN SYNDROME: CHILDHOOD (1-12 YRS)
• HISTORY • Ear problems
• Parental concerns • Sleep problems
• Current level of
• Constipation
functioning
• Current programming (EI, • Obesity
3-4 year old program, • Review audiologic
school, special education) and thryoid function
• Behavior problems tests
• Review opthalmologic
and dental care
26. DOWN SYNDROME: CHILDHOOD
• EXAM • EXAM
• General pediatric and • Eye exams every 2 years
neurologic exam. if normal, more often if
• LABS, CONSULTS abnormal
• T4,TSH yearly • Lateral C-spine films
• ECHO if not done (neutral, flexion and
extension) at 3 years and
• Auditory testing yearly
l2 years for atlanto-axial
1-3 yrs, every 2 years instability
3-13 years
• Dental at 2 yrs & q6 mo.
27. DOWN SYNDROME: CHILDHOOD
• DEVELOPMENTAL • RECOMMENDATIONS
• Enroll in appropriate • Twice daily tooth
educational program brushing
• Yearly IFSP 0-3 yrs, IEP • Caloric intake below RDA
4-21 yrs. • Monitor diet, high fiber
• SLP evaluation • Exercise
• Consider augmentive • OT, PT, SLP as needed
communication device as • SBE prophylaxis as
indicated needed
28. DOWN SYNDROME: CHILDHOOD
• RECOMMENDATIONS • Reinforce the
• Monitor family needs for importance of good
respite care, supportive self-care skills
counselling, behavior
(grooming, dressing,
management techniques
money management
• Consider pneumovax and
annual flu vaccines
skills)
29. DOWN SYNDROME: ADOLESCENCE (12-18
YEARS)
• HISTORY • EXAM
• Interval medical history • General physical and
• Sleep apnea neurological exam (r/
• Vision/Hearing o atlanto-axial
• Behavioral problems dislocation
• Address sexuality issues • Obesity
• Pelvic if sexually
active
30. DOWN SYNDROME: ADOLESCENCE
• LAB, CONSULTS • Consider gynecologist
• T4, TSH yearly experienced in
• Hearing and Vision every working with special
other year needs individuals for
• ECHO for individuals pelvic exam for
without CHD once in sexually active
early adulthood (18-20
teenager
years) to rule out valvular
disease
31. DOWN SYNDROME: ADOLESCENCE
• RECOMMENDATIONS • Diet and exercise
• Begin transition planning program
• Dental exams twice • Update estate
yearly planning and custody
• SSI arrangements
• SBE prophylaxis as • Social/recreational
needed programs
• Annual flu shot • Register to vote and
selective service at
18
32. DOWN SYNDROME: ADOLESCENCE
• RECOMMENDATIONS • Smoking, drug,
• Discuss plans for alcohol education
alternative long term
• Health and sex
living arrangements
education including
• Reinforce good self-care
skills counselling regarding
• Yearly IEP and abuse prevention
psychoeducational • Continue SLP
evaluations services as needed
• Vocational issues
33. DOWN SYNDROME: ADULT (>18 YEARS)
• HISTORY • Incontinence of urine and/
• Interval medical history or stool)
• Sleep apnea • GERD
• Thyroid • Atlanto-axial instability
• Monitor for loss of skills, • Obesity
behavioral changes,
mental health problems,
dementia (decline in
function memory loss,
ataxia, seizures,
34. DOWN SYNDROME: ADULTS
• EXAM • Yearly breast exams
• General physical and • Testicular exam for men
neurologic exams • Prostate exam for men
• Monitor weight
• Pap smears for sexually
active women every 1-3
years
• Pelvic every 3 years for
non-sexually active
women
35. DOWN SYNDROME: ADULTS
• LAB, CONSULTS • Mammograms yearly
• T4, TSH yearly from age 50 years
• Eye exam every 2 years • Mammograms yearly
• from age 40 years for
Auditory testing every 2
women with first degree
years
relative with breast
• Repeat C-spine films
cancer
once in adulthood
• Twice yearly dental
• ECHO to rule out valvular
exams
disease once in early
• Mental health referral ?
adulthood
36. DOWN SYNDROME: ADULTS
• RECOMMENDATIONS • Update estate planning
• SLP as needed • Guardianship issues
• Consider augmentive • Social/recreational
communication device programs
• Vocational issues • Voting, selective service
• Discuss plans for • Reinforce self-help skills
alternative long term • Bereavement counselling
living arrangements when indicated
• Discuss advanced
directives
37. DOWN SYNDROME: ADULTS
• RECOMMENDATIONS
• SBE prophylaxis for
patients with cardiac
disease
• Annual flu shot
• Diet and exercise
programs
38. DOWN SYNDROME: ADULTS
• PSYCHIATRIC • Consider pain from
DISORDERS GERD, dental
• First rule out medical abscess, sinusitis,
cause for changes in
otitis, fracture,
behavior, SIB, loss of
skills, incontinence, glaucoma
change in appetite, • Thyroid
weight, sleep or energy • Sleep apnea
level, aggressive
behavior, crying. • AAI
• Polypharmacy
39. DOWN SYNDROME: ADULTS
• PSYCHIATRIC • Depression may be
DISORDERS seen in reaction to
• Depression: sad, irritable loss: death in the
mood, disturbances in family, loss of
appetite, sleep, energy, caretaker, roommate.
loss of interest in • Psychosis and
previously enjoyable schizophrenia
activities, skill and uncommon
memory loss, self-talk,
withdrawal. • OCD
• Anxiety disorders
40. DOWN SYNDROME: ADULTS
• PSYCHIATRIC • occupational
DISORDERS functioning. It is
• Dementia (Alzheimer) progressive and is
• A neuro-psychiatric associated with senile
syndrome of memory loss plaques and
that prevents new neurofibrillary tangles
information from being in the brain on
learned, decline of postmortem exam. It
intellectual skills which results in inability to
impairs social and care for oneself and,
eventually, death.
41. DOWN SYNDROME: ADULTS (Patients showing
Deterioration by Age Groups)
AGE n %
<39 0 0
40-49 10 11
50-59 33 80
60-69 20 91
>70 2 100
42. DOWN SYNDROME: REFERENCES
• 1. Cohen, W.I. “Health Care Guidelines for Individuals with Down
Syndrome” Down Syndrome Quarterly Vol 1 No 2 . 6-96
• 2. Visser, F.E., etal. “Prospective Study of the Prevalence of
Alzheimer-Type Dememtia in Institutionalized Individuals with Down
Syndrome” AJMR Vol 101, No 4, l997, 400-412.
• 3. Caring for Individuals with Down Syndrome and Their Families.
Third Ross Roundtable on Critical Issues in Family Medicine. 1994.
• 4. Pueschel, S.M. and Sustrova, M. Adolescents with Down
Syndrome. Paul H. Brookes Publishing Co., Inc. 1997.
• 5. Smith, D.W. Recognizable Patterns of Human Malformation.
Third Edition. W.B.Saunders Co. 1982.