The Pediatric Illness PANDAS: Easy to Misdiagnose, Often Overlooked

What would you do if your young, previously healthy and happy child suddenly developed obsessive-compulsive disorder or symptoms of Tourette’s syndrome?

In “PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection,” authors Christine Pabst and Kim Subasic discuss an unusual pediatric illness that, although identified more than 20 years ago, is not well recognized by clinicians: PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection.

PANDAS is characterized by the sudden and dramatic onset of “psychiatric” symptoms such as the ones above, appearing during or shortly after infection with group A streptococcus.

Two factors make PANDAS difficult to diagnose.

  • First, it seems so obviously a psychiatric disorder that psychotropic or other psychiatric medications may be prescribed without further investigation.
  • Second, carrying group A streptococcus without signs of actual infection can also precipitate PANDAS, making it difficult to connect PANDAS symptoms with a previous medical illness.

[…]

2020-08-24T06:27:32-04:00August 24th, 2020|Nursing, pediatrics|0 Comments
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The Baby with Tetralogy of Flow

It is a good day so far—none of the 16 critically ill babies in the neonatal intensive care unit has coded or died. So far, the shrill electronic alarms for dying babies have been silent.

As the neonatologist on call, this gives me the opportunity to talk to Anna and Jake, Baby Milo’s parents. Milo peers up at them with big brown eyes as Anna leans over his crib and whispers to him. A small transparent plastic mask covers Milo’s tiny nose to help him breathe, and a cluster of saliva bubbles percolate between his lips. Despite a sleeve of tape securing his right hand, his tiny fingers tug the orange orogastric tube taped to his cheek.

Milo’s father, a brawny man wearing scuffed brown shoes, ripped blue jeans, a T-shirt, and a tattered Green Bay Packers cap, sits in a chair and nervously taps his knee while he stares with bloodshot eyes at the vital signs on Milo’s bedside monitor.

“Milo is adorable,” I say from the doorway. His parents look over to me as I step into the room.

“We think so,” Anna says with a smile.

“How are you both doing?” I ask. “Being in the NICU can be pretty stressful.”

Milo’s parents glance at each other and nod. Anna takes a seat next to Jake, who touches her shoulder.

I pull up a chair. “Can you tell me Milo’s story? How did you end up in the NICU?” I say.

“We were celebrating my birthday at a steakhouse,” Jake says. “Right after they brought […]

2020-07-15T11:23:21-04:00July 15th, 2020|family, family experience, pediatrics|0 Comments
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Is This Child in Pain?

When the child is nonverbal.

Nurses regularly assess patients’ pain. It’s a much more difficult task when the patient is unable to articulate what they’re feeling or even where they hurt. How much more difficult is it when the patient is a nonverbal child with a complex medical history?

In this month’s AJN, Brenna Quinn and colleagues share their research on pain in these children. They define “children with medical complexity” as “those having a cognitive-chronological age mismatch, profound developmental delays, limited or no verbal abilities, and multisystem diagnoses, and who are completely dependent on others for care.” These kids tend to experience pain more frequently (often, daily or weekly), and are more likely to be hospitalized than are neurotypical children.

A ‘wide range of pain-associated behaviors.’

While it is often harder to assess pain in children than in adults, most children have a narrow range of “pain behaviors” that are easily identifiable. This isn’t true of children with medical complexity; some may even seem, from their expressions, to be laughing when they are in pain.

“More than 40 pain assessment tools have been developed for use in infants and children who cannot provide self-report. Despite the availability of these tools, the evaluation of pain in children with medical complexity remains challenging, […]

2018-08-13T08:09:58-04:00August 13th, 2018|family caregiving, Nursing, Patients, pediatrics|0 Comments
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A Nurse’s Open Letter to Parents Who Have Lost a Child

“You are never alone as you miss these children, as you laugh recalling moments with them. Don’t worry that the memory of them is fading—their presence is strong and lives even beyond you and your love for them. We remember them, too.”

Illustration by Barbara Hranilovich for AJN. All rights reserved.

In this month’s Reflections column, author Jessica L. Spruit has written an open letter to parents who have lost a child. Spruit, a pediatric NP in a hematology/oncology department, makes it clear that the children in her care are not forgotten and that their deaths are never routine, even on a hem/onc unit. Here, she shares memories of her patients from over the years, recalling the things that made them unique—as children, and not just as “patients.”

In her letter, Spruit describes something that is often hard to convey about our work. In spite of all of the stress and frustrations of nursing today, we still are able to engage deeply with other people. The courage and grace (and fun and joy, too) that we have the privilege to witness become part of who we are. When our patients are children, their gifts to us are particularly memorable.

“Please don’t ever think that we ‘do this all the time’ or that it is ‘just part of our job.’ Please don’t fear that you are the only ones who remember and miss your children.”

Read “We Remember Them, Too” in […]

2018-07-17T14:28:09-04:00July 17th, 2018|Nursing, pediatrics|0 Comments
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Recognizing Delirium in Hospitalized Children

A hospital can be a scary place for any of us, but the experience is likely to be especially upsetting for children. An unfamiliar environment, possibly painful procedures, immobility, food that’s not from home (or no food), and disturbed sleep are hard on most people. A child’s particularly vivid imagination may exacerbate an already-frightening experience. It’s not surprising that delirium can occur in hospitalized children.

Characteristics of pediatric delirium.

Delirium in children has not been explored to the extent that it has been in adults, but research suggests its manifestations in either group can include five characteristics: agitation, disorientation, hallucinations, inattention, and sleep–wake cycle disturbances. Some evidence also suggests that children with delirium may have a more labile affect than adults, and more severe perceptual disturbances. […]

2018-04-25T10:05:56-04:00April 25th, 2018|Nursing, pediatrics|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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