TREATMENTS &
RESEARCH

Search the
latest
treatment
information
here.

Dr. Huntley's
Diagnosis
Checklist

Have a symptom?
See what questions
a doctor would ask.
 

Decreased Activity Level

Contents
  1. Read book excerpt
  2. Hypothyroidism: Introduction
  3. Hypothyroidism Misdiagnosis
  4. Hypothyroidism Causes
  5. Hypothyroidism Complications
  6. Hypothyroidism Treatments
  7. Latest treatments
  8. News
  9. Clinical trials
  10. Hypothyroidism Overview
  11. More book excerpts for Hypothyroidism

Decreased Activity Level: Excerpt from Pediatric Complaints and Diagnostic Dilemmas

Phillip Spandorfer

Approach to the Patient with Decreased Activity Level

I. Definition of the Complaint

The term decreased activity level potentially describes a wide spectrum of existence ranging from boredom to coma. Encouraging parents to provide a detailed account, particularly with regard to the magnitude and time course of the changes, focuses the diagnostic evaluation. Clearly, the differential diagnosis of subtle behavioral changes developing over several months differs from that of changes occurring over several hours.

II. Complaint by Cause and Frequency

The cause of decreased activity level in children varies by age (Table 2-1). The etiology of decreased activity level can also be placed into several broad categories (Table 2-2). Additional issues to consider include whether there is depressed sensorium indicating an underlying central nervous system (CNS) disorder, weakness indicating a muscular disorder, or endurance problems suggesting a cardiac or pulmonary issue. Systemic illness may manifest with somnolence or lethargy.

III. Clarifying Questions

The patient who presents for evaluation of decreased activity level represents a broad differential. Several important historical questions can help to classify the etiology.
• What time course has the decreased activity level presented?
 — Infectious etiologies typically manifest over a shorter time course than do other etiologies such as iron deficiency anemia or CNS malignancy.
• Is the patient febrile?
 — Fever frequently can cause a decreased level of activity. Often a fever raises the possibility of an infectious etiology. However, neonates younger than about 8 weeks of age do not always mount a fever in response to an infection. In fact, they can occasionally become hypothermic.
• What activities are involved?
 — If the decreased activity level is related to physical exertion, then cardiac or pulmonary disease might be the etiology. In neonates, feeding constitutes physical exertion. In older children, if the decreased activity level affects school attendance, one must assess whether there is secondary gain.
• Is there a history of decreased intake or increased output?
 — Children are at a high risk for hypoglycemia because they have an increased metabolic demand for glucose and decreased stores of glycogen. If they experience decreased oral intake or increased output caused by vomiting or diarrhea, they may become hypoglycemic.
• Has there been a change in school performance or other behaviors?
 — Depression can manifest with a decreased level of activity and is usually associated with decreased school performance and changes in behavior.
• Is there any history of trauma?
 — Intracranial bleeding precipitated by accidental or intentional trauma may be the cause of depressed mental status and hence a decreased level of activity.
• Is there any reason to suspect nonaccidental trauma?
 — Child abuse can manifest in many ways and is often unsuspected. If there has been a delay in seeking care for the child, or if the history does not correlate well with the physical examination findings, there should be concern for possible child abuse. Any obvious marks on the child should also raise the clinician 's concern for child abuse.
• Is there a history of ingestion?
 — Toxins frequently alter mental status in children. The mechanism may be sedation (hypnotic agents, opiates) or hypoglycemia (oral hypoglycemic agents).
• Is there any history of abdominal pain or vomiting?
 — Intussusception can manifest with depressed mental status in a child between 6 months and 5 years of age.

Pictures

Decreased Activity Level - 5980.2.png
Decreased Activity Level - 5980.1.png

Book Source Details

  • Book Title: Pediatric Complaints and Diagnostic Dilemmas
  • Author(s): Samir S Shah MD; Stephen Ludwig MD
  • Year of Publication: 2003
  • Copyright Details: Pediatric Complaints and Diagnostic Dilemmas, Copyright © 2003 Lippincott Williams & Wilkins.

More About Hypothyroidism

More Medical Textbooks Online about Hypothyroidism

Review other book chapters online related to Hypothyroidism:

Medical Books Excerpts
  • Hypothyroidism
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
 

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



More About This Book:
Title: Pediatric Complaints and Diagnostic Dilemmas
Authors: Samir S Shah MD; Stephen Ludwig MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 0-7817-4188-2

 » Next page: Decreased Activity Level - Case 2-1: 15-Year-Old Girl (Pediatric Complaints and Diagnostic Dilemmas)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

Tools & Services:

Medical Articles:

Forums & Message Boards
 
HONcode We subscribe to the HONcode principles

By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.

Home | Symptoms | Diseases | Diagnosis | Videos | Tools | Forum | About Us | Terms of Use | Privacy Policy | Site Map | Advertise

Copyright © 2009 Health Grades Inc. All rights reserved.