Psychiatry
Pediatric Psychiatry
Psychiatry

Pediatric Psychiatry

ADHD, ASD, ODD, Tourette, enuresis, anorexia/bulimia.

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◆ADHD

  • •Inattention + hyperactivity in ≥2 settings (home + school)
  • •Age <6: behavioral therapy only
  • •Age ≥6: stimulants first-line (methylphenidate, amphetamines)
  • •Non-stimulants (atomoxetine, guanfacine, clonidine) if substance abuse, parent refusal, AEs

◆Autism spectrum disorder

  • •Social communication deficits + restricted/repetitive behaviors
  • •Early intervention with ABA (intensive behavioral therapy)
  • •Risperidone/aripiprazole for severe irritability
  • •Don't wait until school age

◆Other peds

  • •ODD: arguing, defying, spite toward authority
  • •Conduct disorder: violates rights of others before 15 (→ antisocial if ≥18)
  • •Tourette: motor + vocal tics >1 yr; habit reversal training, tetrabenazine, antipsychotics if severe
  • •Primary nocturnal enuresis: child ≥5 yr; reassurance + motivational therapy; alarm > desmopressin long-term
  • •Adolescent distancing + peer attachment + late sleep = normal development

◆Eating disorders

  • •Anorexia: BMI<18.5, denial, amenorrhea, lanugo, bradycardia, osteoporosis; nutritional rehab + CBT; no antidepressants until weight restored
  • •Bulimia: normal/↑ BMI, binge + purge; CBT + SSRI (fluoxetine); BUPROPION CONTRAINDICATED
  • •Binge eating: most common ED in US; CBT, SSRI, lisdexamfetamine

◆Postpartum mood disorders

  • •Postpartum blues: 2–3 days to <2 wk; reassurance
  • •Postpartum depression: 4 wk to 12 mo; SSRI + CBT
  • •Postpartum psychosis: days–weeks; delusions, hallucinations, infanticide risk → emergency hospitalization

◆Factitious vs malingering

  • •Factitious: internal/primary gain ('sick role')
  • •Malingering: external/secondary gain (disability, drugs, release)

High-yield pearls

  • ◆Spiral humeral fracture + inconsistent history → report to CPS (non-accidental trauma)
  • ◆Acute sexual assault → safety + privacy + emergency contraception + STI ppx + nonjudgmental support; offer forensic exam if consented
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