Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
CBY Discussion:
How would you evaluate and manage a pediatric patient who has BP and BMI greater than what is expected for his/her age group? Which additional conditions would you want to screen for and why?
A physical examination of the child is always the first start in evaluating the patient. The American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) recommend measuring BMI in children 2 years old and older. For a pediatric patient with BMI greater than his or her age, I would manage the patient by educating the parent on healthy nutrition for the child. The parent would be aware on nutritious food and snacks to provide and to make the food enticing and enjoyable for the child. For help with adequate food resources I would also refer the parent to Women, Infants, and Children (WIC) program and Supplemental Nutrition Assistance Program (SNAP). Physical activity is also important to sustaining a healthy nutrition. It is recommended that children and adolescents engage in 60 minutes of physical activity every day. By increasing the child physical activity, it creates a demand for more calories and nutrients and improves weight status. The diagnostic studies recommended: are “HDL, cholesterol screening, random glucose test, Thyroid screen: TSH, T4, AST, ALT, HbA1c and Vitamin D level” (Burns, et al., 2019. pg. 232). The results would identify if the child has thyroid problems, high cholesterol, and liver problems from fatty food intake as well as type 2 diabetes mellitus from high consumption of sugar and carbohydrates.
What physical exam findings and diagnostic results would be concerning to you in this patient and why? What would be three differentials in this case?
The physical examination findings that are concerning to me in this patient are: Patients blood pressure was mildly elevated at 116/76 mmHg. Patient is 80th percentile for height. His repeat systolic BP of 116 mmHg places him between the 90th and 95th percentile which is elevated blood pressure category (Dell, 2021).This is concerning if it is not addressed as it could spill over into the category of stage 1 hypertension. The patient height age is 8 years old and his weight age is that of 13 years old. The patient height is 133 cm (52 in); 80th percentile for his age and weight is 45 kg (99 lbs) > 97th percentile for age. The patient is over the 95th percentile for his age which puts him in the obese category (Dell, 2021).
Three differential diagnoses in this case are:
Mood disorder: Children with ADHD also have a higher rate of mood disorders than control populations. The patient in this case has a history of ADHD (Dell, 2021).
Dyslipidemia: Hypertriglyceridemia and low HDL cholesterol is strongly correlated with metabolic syndrome, which occurs almost exclusively as a consequence of obesity. The patient in this case BMI of 25.4 kg/m2 and plots above the 97th percentile for an 8 year old boy puts him in the obese category (Dell, 2021).
Type 2 diabetes mellitus: Obesity is the most prominent risk factor for the development of type 2 DM in children. The average BMI for pediatric patients with type 2 DM ranges from 35 to 39 kg/m2. The patient in this case BMI of 25.4 kg/m2 and plots above the 97th percentile for an 8 year old boy puts him in the obese category (Dell, 2021).
What are your final assessments (diagnoses) for this patient?
ADHD: Patient has a history of ADHD
Obesity: The patient in this case BMI of 25.4 kg/m2 and plots above the 97th percentile for an 8 year old boy puts him in the obese category.
Hypertension: Patients blood pressure was mildly elevated at 116/76 mmHg and has an 80th percentile for height. Based on the blood pressure norms for height and age of 8 years old, the patient repeat systolic BP of 116 mmHg places him between the 90th and 95th percentile which is elevated blood pressure category (Dell, 2021).
What is your treatment recommendation and education for the patient and family? Why?
Medication: Adderall XR (dextroamphetamine/amphetamine, extended release) 5mg (one capsule) by mouth once daily in the morning. Adderall XR has a very positive effect on attention and behavior in most kids who have ADHD (Dell, 2021). Encourage parent to ensure medication adherence and to follow up for any questions or concerns regarding the medication. Regarding obesity and hypertension, As mentioned earlier I would encourage healthy diet and exercise and encourage patient to return for lab draws while patient is on fasting for and accurate cholesterol levels as well as fasting glucose Call clinician if having poor appetite, difficulty sleeping, or other problems. “Read through this website for parents on ADHD and questions or concerns can be addressed at the next visit” (Dell, 2021).
References
Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C. (2019). Burns’ pediatric primary care (7th ed.). Saunders. ISBN:9780323581967.
Dell, M.S. (2021). Pediatrics 04: 8-year-old male well-child check. Retrieved from https://southu-nur.meduapp.com/document_set_document_relations/30219?section_uid=root
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