Chapter 23: Sensory & Neurologic Conditions in Children

Sensory & Neurologic Conditions in Children begins by examining the ear, detailing the susceptibility of infants to otitis media due to the short, wide structure of the eustachian tube, and explores hearing impairments ranging from conductive to sensorineural loss, along with management strategies like tympanostomy tubes and cochlear implants. The discussion on the eye covers visual development and common disorders such as amblyopia (lazy eye), strabismus (cross-eye) requiring occlusion therapy or surgery, and conjunctivitis, as well as serious pathologies like retinoblastoma, characterized by the cat's eye reflex or leukokoria. A significant portion of the text is dedicated to the nervous system, outlining the assessment of cranial nerves and level of consciousness using tools like the Glasgow Coma Scale modified for infants. Critical neurological infections are detailed, including bacterial meningitis, which presents with symptoms like nuchal rigidity and opisthotonos, and Reye's syndrome, a life-threatening encephalopathy and hepatopathy often linked to salicylate use during viral illnesses. The chapter analyzes seizure disorders, distinguishing between febrile seizures and various forms of epilepsy such as generalized tonic-clonic (grand mal) and absence (petit mal) seizures, while also covering management protocols for status epilepticus and the use of the ketogenic diet. Furthermore, it addresses chronic motor disorders like cerebral palsy, classified into spastic, athetoid, ataxic, and mixed types, and the nursing care required to prevent contractures and optimize adaptive functioning. The text also reviews intellectual disabilities, focusing on adaptive behavior deficits and early intervention strategies. Finally, the chapter covers neurological trauma, including the pathophysiology of concussions, skull fractures, and shaken baby syndrome, highlighting signs of increased intracranial pressure and pathological posturing (decorticate and decerebrate), concluding with the critical care priorities for near-drowning victims involving hypoxia and aspiration management.