Threatening and intimidating behavior
Threatening and intimidating behavior - www datingadvice4men com
In a study17 of children requiring cardiopulmonary resuscitation (CPR), investigators reported that 18 of 77 children in whom a diagnosis was reached had been deliberately suffocated; another seven were victims of Munchausen syndrome by proxy.
This syndrome is characterized by a frightening constellation of symptoms in which the child exhibits some combination of apnea, change in color, change in muscle tone, coughing, or gagging.Height, weight, and head circumference measurements should be plotted on appropriate growth charts.A careful neurologic examination, including assessment of muscle tone and physical findings appropriate for the age of the child (e.g., head lag, posturing, motor abilities, eye tracking, social smile), should be performed.Once a presumptive diagnosis is made, events should cease after appropriate intervention.If not, reviewing the history, performing another physical examination, and reassessing the need for laboratory and imaging studies are the next steps.Uncovering the cause of the ALTE is important: in one half of patients, an etiology is found, implying that there is a potential for intervention that could eliminate further events.
In the remaining patients, a specific diagnosis is never made, placing them in the “idiopathic” category.Although consensus statements by the National Institutes of Health and the American Academy of Pediatrics support home monitoring, the relationship of apparent life-threatening event syndrome to sudden infant death syndrome is controversial.Many physicians have received a frantic call from an anxious parent stating that his or her child stopped breathing, became limp, or turned blue, but then quickly recovered.Abdominal findings and any sign of trauma or bruising also should be noted.In one study,6 retinal hemorrhages leading to a diagnosis of child abuse were observed during the dilated ophthalmologic examinations of two children.This finding prompted the investigators to include this examination as standard in the work-up at their center.