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72 Cards in this Set
- Front
- Back
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What are the CNS effects of fetal alcohol syndrome?
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Mental Retardation
Poor motor skills Poor hand-eye coordination Difficulties with memory, attention, and judgment There is no "safe" amount of EtOH that can be consumed during pregnancy to ensure that fetal alcohol syndrome does not occur Note: There is no safe amount of alcohol that can be consumed during pregnancy to ensure that FAS does not occur. |
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What are the effects of tobacco on fetal development?
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Increases risk for low birth weight. No characteristic facies.
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Infants born to mothers who smoke marijuana more than ____ times a week often have _______ in the first days after birth.
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Marijuana more than 6x per week may result in withdrawal-like syndrome (high-pitched cry and tremulousness) in first days after birth
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What are the effects of cocaine and other stimulants on fetal development?
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Vasoconstriction leading to placental insufficiency and low birth weight
May lead to subtle, yet significant, later deficits in cognitive performance, including information-processing, and attention to tasks |
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What events increase the risk of vertical HIV transmission (mother to fetus)?
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Frequent, unprotected sex during pregnancy
Amniocentesis Advanced maternal HIV dz Breastfeeding Premature delivery (before 37 weeks) |
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What precautions decrease the risk of vertical HIV transmission?
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Zidovudine
C-section prior to onset of labor and membrane rupture No breastfeeding |
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What are all infants screened for at birth?
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Phenylketonuria
Hypothyroidism Some states also screen for galactosemia, hemoglobinopathy, maple syrup urine disease, homocystinuria, CAH, CF, G6PD deficiency, and toxoplasmosis |
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How can infants be screened for critical congenital heart defects?
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Measure oxygen saturation
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When is exclusive breastfeeding recommended?
When should mothers add complementary foods? |
Breastfeed exclusively for first 6 months
Then breastfeeding plus complementary foods until infant is 12 months |
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When is breast feeding contraindicated?
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Maternal HIV infection, active maternal drug abuse and infants w/galactosemia
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What are the benefits of breastfeeding?
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Stimulates GI growth and motility
Decreases risk of acute illness during time infant is fed breast milk Lower rates of diarrhea, acute and recurrent otitis media, and UTIs Maternal benefits include dec'd risk of breast and ovarian cancer and osteoporosis |
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What does the HEEADSSS interview assess?
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Adolescent risk-taking behavior that may result in accidents, homicide or suicide (three leading causes of death of adolescents in US)
Home Education/Employment Eating disorder screening Activities/Affiliations/Aspirations Drugs (and EtOH, tobacco, and steroids) Sexuality Suicidal behavior (along w/depression and mental health concerns) Safety (abuse, fights, weapons, seatbelts, etc) |
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Infants born to adolescent mothers are at increased risk of _____.
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Low birth weight, partly due to preeclampsia and vertically acquired STIs.
Also have poorer developmental outcomes |
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When is the APGAR score assessed?
What is assessed? How is it scored? |
At 1 and 5 minutes following delivery
Appearance (skin color) Pulse (heart rate) Grimace (facial expression) Activity (neuromuscular tone) Respirations (respiratory effort) Each component is given 0, 1, or 2 points, with a total highest possible score of 10 |
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What are the cutoffs for:
Small for gestational age Appropriate for gestational age Large for gestational age Causes of small/large? |
Small: <10th percentile on intrauterine growth curve; a/w hypoglycemia (poor feeding, listlessness), hypothermia (due to cold stress), hypoxia, polycythemia (due to hypoxia)--ruddy or red color to skin, resp distress, poor feeding
Must have temp and blood glucose monitored closely Appropriate: 10-90th percentile Large: >90th percentile; a/w C-section, delivery by forceps or vacuum (cephalohematoma risk), clavicle fracture, brachial plexus injury, hypoglycmia |
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What is microcephaly?
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Head circumference <10th percentile for gestational age
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What reflexes should be present in neonates?
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Rooting
Moro Palmar and plantar grasp Tonic neck response Stepping response Red reflex |
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What is a TORCH infection?
Signs? |
Toxoplasmis, Other, Rubella, CMV, HSV-2
Other = HIV, HBC, HPV, Syphilis Congenitally acquired TORCH infection may result in microcephaly, organomegaly, and rash |
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What are signs of congenital CMV infection?
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Rash, jaundice, chorioretinitis, hearing loss, intracranial calcifications
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How is CMV tested?
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Urine CMV culture
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What test is necessary to determine if a newborn is at risk for HBV?
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HBsAg
Note: Presence or absence of maternal hepatitis B core antibody does not predict risk for vertical hepatitis transmission. |
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WHat tests is necessary to determine whether a mother is immune to Rubella?
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Rubella IgG
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Hearing loss is common in infants who have ______.
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Congenital CMV infection
IN many infected infants, onset of hearing loss may be after newborn period (newborn hearing screen may be normal). |
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Management of congenital CMV infection.
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Regular opthalmologic exams to monitor for chorioretinitis
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What routine medications are given to newborns in the US?
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Vitamin K (IM injection)
Topical ophthalmologic antibiotic (erythromycin, tetracycline, or silver nitrate) to decrease risk of transmission of gonococcal conjunctivitis (this does little to prevent conjunctivitis from chlamydia, which occurs 7-14 days after birth) HBV vaccine regardless of maternal testing results HBIG if mother tests positive for HbSAg |
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What is the average daily weight gain for a term infant?
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20-30 grams per day
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When does a baby's birth weight double? Triple?
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Doubles at 4-5 months
Triples at 12 months |
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When does a baby's birth length double?
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48 months
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When do most babies begin to sleep through the night?
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By age 4 to 6 months; infants at 6 months of age usually sleep through night and take two naps during day
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What is the recommendation regarding use of walkers?
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Not recommended due to risk of injury, esp when there are stairs in home
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What is the most effective car-seat restraint?
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Five point harness consisting of two shoulder straps, a lap belt, and a crotch strap
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What vaccines should be administered during the first 5 years of life?
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TDaP
IPV HiB PCV13 (Pneumococcal conjugate vaccine) MMR Varicella Rotavirus HepA HepB |
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When should children receive the influenza vaccine?
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All children 6 months through 19 years of age
Children an dadolescents in high-risk groups (asthma, lung or heart disorders, and immune deficiencies) are higher priority |
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When should plain water be given to infants?
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When infant is eating solid food
Note: Until 4-6 months, infant should be given only breast milk or formula |
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What is the caloric requirement of infants based on when they're born?
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Term: 100-120 cals/kg/day
Preterm: 115-130 cals/kg/day Very low birth weight: Up to 150 cals/kg/day |
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Breastfeeding infants need ______ supplementation.
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Vitamin D--most cost-effective method is with a multivitamin
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When does the transition to solid foods occur?
What are the signs that a child is ready for solid foods? |
At 4-6 months
Child should be able to sit up and keep head up on his/her own; can manipulate pureed foods like rice cereal in mouth (will not spit it out) (note: many infants will not be ready for solid foods at 4 months) |
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How often should new foods be introduced to an infant? Why?
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Every 5-7 days so that allergies can be identified
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What are the caloric requirements of a 9 month old?
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100 cals/kg/day with approx 75% of calories from breast milk or formula (i.e., 24-28 oz per day)
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Describe milestones for 2-9 month olds.
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2 months: lifts head, follows to midline, vocalizes, smiles responsively/spontaneously
4 months: sits with head steady, rolls over; follows 180 degrees, grasps rattle, laughs, turns to rattling sound, regards own hand 6 months: Sits without support, puts feed in mouth while supine, no head lag when pulled to sit from supine, reaches, looks for dropped yarn, turns to voice, babbles, works for toy, feeds self, stranger recognition 9 months: Stands holding on, pulls to stand; takes 2 ice cubes, passes cube (transfers), neat pincer grasp; single syallables (dada, mama), feeds self, plays pat-a-cake, waves bye bye, indicates wants, exhibits stranger anxiety |
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What does a red reflex indicate?
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Substitute for fundoscopic exam since an infant will not hold gaze long enough to visualize retina consistently
Gives direct information about clarity of eye structures Should be elicited in all infants and children, beginning at birth Failure to see red reflex may indicate cataracts, glaucoma, retinoblastoma, or chorioretinitis |
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What is Moro reflex?
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Symmetric abduction and extension of arms followed by adduction of arms, sometimes with a cry, when head position abruptly changes
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What is a normal Babinski response in infants?
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Toes going upward bilaterally
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What is the most frequently diagnosed neoplasm in infants? How does it present?
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Neuroblastoma; presents as mass in neck, chest, abdomen
May be asyx or may be chronically ill and have bone pain from mets to BM or skeleton Fever, pallor, and weight loss are frequent presenting syx |
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Asymptomatic RUQ abdominal mass without lymphadenopathy or jaundice
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Wilms' Tumor
Syx in 50% of pts: abdominal pain and/or vomiting, pts may also be hypertensive |
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Why would a CBC be indicated in a child with abdominal mass?
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Could identify anemia and cytopenia that may be a/w bone marrow infiltration
Can assess mets to bone via X-ray (Skeletal survey) |
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Utility of urinary VMA/HVA.
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Measures metabolites of catecholamines, which are elevated in neuroblastoma.
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What pathologic finding is diagnostic for neuroblastoma?
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Hyperchromatic nuclei and scant cytoplasm (small-cell rosettes) in bone marrow
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When should tuberculosis be screened in children?
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If there is a risk factor
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When should lead exposure be screened in children?
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When mouthing objects, pre-1950s housing, housing near busy interstate, or recent immigrant
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When should anemia be screened in children?
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12 months, and again at preschool or kindergarten entry (if there are risk factors, then testing may be done at any visit)
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Many of the vitamins preschoolers consume come from _____________.
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Fortified foods
Note: Preschool kids consume 80% of recommended fruit/day, and 30% consume recommended vegetables/day |
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What vitamin should children receive supplements of?
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Vitamin D
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Predominant sources of iron for toddlers include __________.
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Meat, legumes, and iron-fortified cereals
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Recommended servings of fruit juice a day.
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1-2 servings
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When should bottle use be discontinued? Why?
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By 12-15 months--can result in early dental caries
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When should children be seen by a dentist?
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General dentists say 3 years, but AAP states should be screened by 6 months for risk of caries.
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When can children use a forward-facing car seat?
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Older than 24 months or have outgrown height/weight limits on car seat
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When can booster seats be discontinued?
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When children reach height of 4 feet 9 inches
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What are the recommendations for food rewards/punishment?
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Don't do it; may promote obesity by interfering with children's ability to regulate their own food intake
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Social/behavioral skills of:
3 year-old 4 year-old 5 year-old |
3: Dresses self, feeds self, 75% understandable, rides a tricycle, copies a circle, throws a ball overhand
4: Knows gender and age, is friendly to other children, plays with toys, engages in fantasy play; sings song, mostly understandable, states first and last name 5 year-old: Listens, and attends, tells a story using full sentences, counts to 10; ties a knot, mature pencil grasp, draws a person with ≥body parts, copies squares/triangles, undresses w/minimal assistance |
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What is strabismus?
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Eyes not properly aligined with each other
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Pear-sized, nontender, mobile nodes in ___________ chains are normal in children.
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Cervical and inguinal chains
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Most pediatric murmurs will be ______.
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Functional
New murmurs of congenital heart dz unlikely |
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Abdominal masses found on pediatric exam are likely _____.
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Stool
Occasionally an enlarged kidney. Very rare: Wilms' or neuroblastoma (abdominal tumors) |
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What is the most common variant found in the pediatric musculoskeletal exam?
What is it due to? |
In-toeing; usually due to tibial torsion--usually resolves spontaneously by 8 years; if doesn't resolve by 4 years old, refer to orthopedics
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Why do young girls tend to have nonspecific vulval erythema?
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Underdeveloped self-hygiene
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In what populations are thalassemias common?
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Mediterranean, Asian, African
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How is anemia screened in children?
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Fingerstick hemoglobin; may be done in office. Rapid result.
Normal result is 10.5-14 g/dL |
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What is the radioallergosorbent test?
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RAST: blood test used to determine to which substances a person is allergic
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Management of mild anemia in child.
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Supplementation (not further workup)
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Management of atopic dermatitis.
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Lubricate extensively
Anti-inflammatories in short bursts--topical hydrocortisone Anti-histamines to reduce itching Treat associated skin infections aggressively |
