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Continuity Clinic Notebook:

 Chapter II. The Evaluation of the Sick Child

Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT

3. Cardiopulmonary
--Heart Murmurs: When to Refer
--How to Feed Infants with Heart Disease
--Syncope in the Pediatric Age-Group
--Asthma: Classification and Management
--Asthma Medication
--Exercise Induced Asthma (EIA)

  

Home Monitoring: The Role of the Pediatrician

Given by Drs. Guill and Hudson

Introduction: The critical part of prescribing a home monitor is to make sure the parents have been carefully instructed in the following: the reasons the monitor is needed, the workings of the machine, what to do if the machine buzzes, CPR and when to institute it. Parents should be told that most alarms are due to equipment problems.

Commonly Asked Questions About Home Monitoring:

1. Who Prescribes the Monitor most frequently?: Pediatricians and neonatologists

2. What are the Most Common Indications for prescribing a home monitor?

  • Premature Infant with apnea and bradycardia
  • SIDs siblings
  • Child who presents with ALTE (life threatening event) for whatever reason

3. How Does the Monitor Work?: Actual mechanisms are the detection of chest impedance and of heart rate. The monitor is set to go off if there is any variation in respiratory signal, or if the ECG signal is interrupted.  Healthdyne is one of the better monitors because it gives the actual qRS complex.  This is the preferred monitor if there is any concern over arrhythmia.

4. How Should the Monitor be set for Heart Rate and Apnea?

Heart Rate:

            Term Infant 2 mos premature 3 mos premature
Age: 1 month:      

100

100

100
        2 months:

80

100

100
        3 months:

70

80

100
        4 months:

60

70

80

Apnea: 20 seconds for all ages whether premature or not.

5. How do you document problems in monitors?  If parents note problems, download and look at tracings yourself at the time.  If there are no problems, each machine should be downloaded at least once a month and reviewed by the pediatrician.

6. How Long Should Monitor be Used?: (Criteria for discontinuing monitor):

  • 2 months with no clinical apneas; if have episodes of apnea that are concerning but not 20 seconds (ie 10-18 second apneas) then should do sleep study.
  • normal sleep study: there should be 50% quiet time during sleep and NO episodes of hypoxemia.  There can be increased periodic breathing and that is normal. However, if hypoxemia documented, then need to give nasal O2 at home.
  • If sibling of SIDs: one month beyond the SIDs event.

7. Should the Monitor be on the Child at all Times?: The answer is NO.
The purpose of the monitor is to identify and document unsuspected events; therefore, the monitor only needs to be used when the child is either alone or asleep.

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Department of Pediatrics  |  Medical College of Georgia
 Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004