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299 Cards in this Set
- Front
- Back
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how often is the APGAR chart applied to newborns?
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at 1 minute from birth and 5 minutes from birth
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what are the criteria for scoring heart rate in APGAR?
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0 is for absent HR
1 is for slow <100 2 is for any HR >100 |
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what is the criteria for respiration rate in the APGAR ?
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0 is for absent RR
1 is for slow, irregular RR or weak cry 2 is for good RR or strong cry |
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what are the criteria for muscle tone?
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0 is for limp
1 is for Some flexion; knees, elbows are usually flexed 2 is for Active |
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what are the criteria for response to nasal stimuli?
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0 is for none
1 is for Grimace 2 is for Cough, sneeze |
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what are the criteria for color of the baby on apgar score?
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0 is for blue
1 is for Pink body/Blue extremities 2 is for all pink |
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how many weeks are the range for preemies?
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< 37 weeks
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what is the weight category of a LBW (low birth weight) baby in?
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2500 grams or 5.5 lbs
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what is the percentage of births that are in the LBW category?
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7 %
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what is the probability of infant death in LBW category
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2 out of 3 babies
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what is the weight category for VLBW (very low birth weight)
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1500 grams (3.3 lbs)
they fit in the palm of your hand "it is a miracle when they survive" |
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what is the percentage of babies being born in the VLBW category?
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1%
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what is the probability of infant death in VLBW category?
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50%
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what are the common maternal factors for premature babies?
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Low SES (socioeconomic status)
education Lack of prenatal care < 10 lb gain < 16 or > 35 years of age for the first pregnancy |
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What are the 10 high risks of a preterm infant?
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1. Suck, swallow, breathing
2. Decreased body Temp 3. Pulmonary immaturity 4. Apnea, bradycardia 5. Patent Ductus Arteriosus 6. Immature cerebral vasculature 7. Impaired absorption by GI tract 8. Immature renal function 9. Susceptible to infection 10. Hypoglycemia, hypocalcemia |
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what kind of eye prophylaxis does a new born receive?
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1 hour postpartum
*Erythromycin ointment Silver nitrate 1% drops They either receive E-mycin or Silver nitrate not both. |
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what vitamin is given IM or SubQ at birth
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Vit K
First 4 hours postpartum Prevent hemorrhagic disease (it’s for clotting) |
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What kind of vaccination is given at birth?
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Hep B
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what is screened for before discharge from the hospital in the newborn?
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PKU (autosomal recessive; both parents have it)(described as a mousy-odor in the urine)
Galactosemia (inability to metabolize simple sugars)(these sugars can damage CNS, kidneys, liver) Sickle cell disease Hypothyroidism Cystic Fibrosis Hearing screening |
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where on the skin would we look for bruising in our PE
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(presenting part of the body)(could come out with cone head)
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what is meconium staining?
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first stool baby passes that is in the womb
if the amniotic fluid is dark, then the meconium has been passed recently if the amniotic fluid is greenish then the meconium was passed a while back It is more dangerous for recent meconium staining |
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what do we look for on the skin in our PE
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bruising
meconium staining Jaundice Pallor Lanugo Vernix caseosa Mongolian spots Birth marks Cyanosis Milia Milaria |
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what is lanugo?
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Downy hair on the body of the fetus and newborn baby. It is the first hair to be produced by the fetal hair follicles, usually appearing on the fetus at about five months of gestation. It is very fine, soft, and usually unpigmented. Although lanugo is normally shed before birth around seven or eight months of gestation, it is sometimes present at birth. This is not a cause for concern: lanugo will disappear within a few days or weeks of its own accord.
"Lanugo" is the Latin word for down, like the fine small hairs of plants. |
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what is vernix caseosa?
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a waxy substance found on early babies
Dr. Fien states: Vernix caseosa is a white “cheesy” material that results from desquamation of epithelial cells mixed with sebum which is present at birth |
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what are mongolian spots?
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A blue-black macule found over the lumbosacral area in 90% of native america, african american and asian descent. These spots are occasionally noted over the shoulders and back and may exten over the buttocks. Histologically, they consist of spindle-shaped pigment cells located deep in the dermis. the lesions fade somewhat with time as a result of darkening of the overlying skin, but some traces may persist into adult life.
DONT CONFUSE WITH BRUISING |
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what is a hemangioma?
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a red rubbery nodule; these lesions are often not present at birth but are represented by a permanent blanched area on the skin that is supplanted at age 2-4 weeks by red nodules. hemangiomas are benign tumor of capillary endothelial cells that may be superficial, deep, or mixed.
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what are milia?
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tiny epidermal cysts filled with keratinous material. These 1-2 mm white papules occur predominantly on the face in 40% of newborns. Their intraoral couterparts are called epstein pearls and occur in 60-85% of neonates. These cystic structures spontaneously rupture and exfoliate their contents
AKA Baby Acne |
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miliaria
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when the sweat glands are blocked and will have white papules.
HEAT Rash |
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Cephalohematoma
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a swelling over one or both parietal bones contained within suture lines should go away after 3 weeks
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Caput succedaneum
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edema over the presenting part that CROSSES suture lines this will reabsorb in 3-4 days
Per Dr. Fien: Swelling of the skull of the neonate noted after birth which crosses the suture lines |
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Craniosynastosis
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premature closure of the fontanelles
Complications: Fractures picture found on slide 15 |
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Subgaleal hemorrhages
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beneath the scalp, uncommon, but can lead to extensive blood loss into this large potential space with resultant hypovolemic shock
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when should we investigate further with caput succedaneum?
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if the mass does not reabsorb after 3-4 days
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when should we investigate further cephalohematoma?
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if the mass does not go away after 3 weeks
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anterior fontanelle
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1 to 4 cm in any direction. Will close from 18-24 months
created by the coronal, sagittal and frontal suture "its like a diamond" |
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third fontanelle
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a bony defect along the sagittal suture in the parietal bones and may be a feature of certain syndromes, such as trisomy 21.
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useful reasons for palpating fontanelles
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1) bones of skull have not fused together and allow brain to grow
2) if pressure of cranium increases we would be able to appreciate this on PE; vice versa with sunken fontanelles with dehydration |
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3rd fontanelles are common with which genetic condition
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down syndrome (aka trisomy 21)
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what must we look for when observing facies?
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Odd facies
Trauma Swelling Anomalies Palsies |
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what are the characteristics of down syndrome?
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palpebral fissures
epicanthel folds brushfield spots in the iris small pinkies low set ears they will have 1 palmar crease |
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what is a special characteristic of turners syndrome?
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short stature, lymphoedema, broad chest, low hairline, low-set ears, and webbed neck
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what are we looking for when we do an EENT exam?
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Eyes:
Red Reflex (must do this) White Reflex (may indicate retinoblastoma)(white reflex is also called leukochoria) Ears: Malformation Malpositioned Nose: Obligate nose breathers Choanal atresia |
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choanal atresia
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babies will breath through mouth which will lead to feeding problems
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epstein pearls
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gingival cysts of the newborn (benign)
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natal teeth
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teeth present at birth
they cause a problem with breast feeding when the baby bites (scolding the babies) |
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cancers of the mouth are usually found where?
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between the cheek and gum
she stresses us using a light source and tongue depressor (this statement was more focused at geriatrics) |
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what are common features found in chest and lung exams in peds
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Fractured clavicles
-Common birth trauma (Right clavicle is fx the most due to rotation of the fetus at delivery. Especially common in large babies from diabetic mothers.) Pneumothorax -Decreased breath sounds -Respiratory distress Muffled heart sounds |
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heart murmurs in newborns are usually...
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present in the first few hours but are benign
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what PE findings would we see in neonatal congenital heart disease
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Cyanosis (low apgar score)
Congestive heart failure Aortic coarctation Pulses are diminished in lower extremities |
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prune belly
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when there are no abdominal muscles at birth
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turgor check for baby
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pinch the skin and if it stays then they are probably dehydrated
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what should we look for when examining the abdomen?
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Softness
Distension Bowel sounds Kidneys Liver Spleen anomalies |
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importance of checking the testicles in a newborn due to...
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absence of descended testicles leading to testicular cancer
technique includes keeping room warm or examining them in a warm bath so there is no cremasteric muscle retraction of testicle might be important to educate the parents to check for the testicles if they can't be palpated in the office |
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is vaginal discharge at birth normal for babies?
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yes, it's commonly "whitish or clearish or milky"
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if there is a malodorous or green vaginal discharge at birth you should...
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suspect STD or UTI
you must culture the discharge |
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when testing anal patency in a newborn you should...
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use a rectal thermometer and turn the baby's bottom away from you so as to avoid "explosive diarrhea"
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when testing sensory of hearing, evaluation would include...
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rattling on each side of the baby and seeing if they turn their head (you can also whisper or clap)
putting the bright contrasting rattle in front of them face and have them follow it with their head and eyes as you slowly move it |
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how do you test for the suckling reflex?
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gloved finger in the mouth and see if they suck on it
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how do you test for rooting reflex?
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stroke the side of the cheek and see if the baby turns their head to the side being stroked as if to feed
most babies "are smart" and will smell where the food is |
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how do you test for traction response?
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have the patient grasp your fingers and pull them upright while supporting their back and there will be a positive sign of their head flopping forward up to the age of 2 months
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how do you test for the moro reflex?
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you test for the startle reflex by clapping in a room when a baby would not know you were there. They should give a body jolt right after the clap if they can hear you.
this is a life-preserving reflex if they're deaf, play drop them and see if they startle |
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how do you test for tonic neck?
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you extend one of their arms, the baby will turn their head to that extended arm
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how do you test for placing?
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hold the baby and stroke the dorsum of the foot, the baby should feel stroke and take a step when they are being held over a flat surface upright like they are walking
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how do you test for stepping?
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hold the baby over a table and allow their foot to make contact with the table and they should flex their foot like they are stepping
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a plantar reflex should prodcue a...
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babinski response (feet should fan out); it is abnormal above the age of 2 year old
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what are common problems confronting the newborn?
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Neonatal jaundice
Hypoglycemia Respiratory distress Meconium aspiration Neonatal Sepsis |
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which type of jaundice is benign?
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physiologic jaundice
they will have 5 mg/dL of bilirubin will cause a yellow tinge in the skin TREATMENT: lamps or sunlight for a few minutes each day |
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what is Kernicterus?
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severe jaundice
>15 mg/dL consequences of kernicterus are liver problems when the baby can't clear it... it is important to gather serial bilirubin levels for these kids and if it does not improve with sunlight, transfusions will be needed |
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what are the effects of hypoglycemia on the newborn?
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growth retardation
mental retardation |
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what are the risk factors for hypoglycemia in the newborn?
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LGA (large for gestational age)
SGA (small for gestational age) Stress (in utero) |
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what are the signs and symptoms and treatment of hypoglycemia in babies?
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S&S
Lethargy Poor feeding Irritability Seizures Poor growth (according to charts) Tx IV dextrose Oral glucagon (if no IV access) |
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meconium aspiration leads to...
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perinatal asphyxia
10 – 15% pass meconium 50% of those with meconium staining have aspirated |
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what is a risk factor for meconium aspiration
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increased risk in postmature infants (>42 weeks)
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when does neonatal sepsis occur?
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24 hours of life
Most - < 12 h |
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what are the early causes of early neonatal sepsis?
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Early:
***Group b B-hemolytic streptococci (GBS)(most common) E. Coli - other: Hemophilus influenza, Listeria moncytogenes |
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what are the causes of late neonatal sepsis?
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Late:
Coagulase-negative staphylococci (if central line) Staphyloccoccus aureus, GBS, Enterococcus, Pseudomonas, other gram-negative |
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when does the first feeding occur?
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3 hours after birth
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what is the first breast milk batch from the mother?
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colostrum
it has all the immunity from the mother (good start in life for the baby) |
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who will feed more often, breast-fed or bottle-fed babies?
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breast fed babies
on demand – every 2-5 h where the baby decides when to feed or... the mother can get on a schedule with the kiddo and feed every 3 hours |
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are formula-fed babies receiving the same % of fat, carbs and protein?
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yes
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what are breast-feeding guidelines?
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-Well fitting bra
-Nutrition, daily: increase 500 calories 3 quarts liquid -Avoid: caffeine, onions, garlic, alcohol, nicotine Medications (you can be on tylenol) -Plenty of rest -nipples will be very sore for the first 2 weeks -Rinse the nipples with warm water (soap will dry nipple) -break the suction of the baby by placing finger between cheek of baby and the nipple before they release -alternate sides (15 minutes total on each breast, start on the same breast as you left off if 15 minutes was not completed) |
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what are reasons for sore breast?
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Blockage of milk ducts (warm showers help)
Engorgement (express with pump) Tight bra Mastitis |
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umbilical cord details
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there are no pain fibers in the cord
it has 2 arteries and 1 vein clamp the cord 1 inch away from umbilicus it will take 2 weeks to dry out and fall off fold the diaper away from the stump so that it is exposed to air and try to spot when it falls off so as to clean the spot |
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circumcision is elective if...
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it is done at the hospital
insurance will not pay for it afterwards |
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in order to prevent SIDS (sudden infant death syndrome)...
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place the baby supine in crib
you can lay the baby on their side with the arm they are laying on extended above their head; rolled blankets help to prop the baby up but be careful that they don't roll into the blanket |
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what % of birthweight is lost in the first 10 days of newborn life?
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10%
but it is gained back within 2 weeks |
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Doll's eyes
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Fien question: Infant’s eyes should turn in direction of rotation & then opposite direction when rotation stops.
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Anal Wink
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Dr. Fien underlined this...
Usually present at birth but abdominal reflexes are absent in newborn & appear within first 6 months You can elicit anal reflex by straightening & raising lower legs with baby in supine position & scratching perianal region with a pin You will observe contracture of external anal sphincter |
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Placing
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-Seen at about 4 days of age & its disappearance varies.
-Hold infant upright under arms next to a table or chair -Touch dorsal side of foot to table or chair edge -Observe flexion of hips & knees & lifting of foot as if stepping up on table |
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Tonic Neck Reflex
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Fien question:
Forcibly turn baby's heat to one side, arm & leg on that side will extend & opposite arm & leg flex? Appears by 2 to 3 months |
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Parachute sign
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Occurs between 4 to 6 months & does not disappear.
Hold infant suspended in prone position & slowly lower its head toward a surface Infant should extend its arms & legs as if to protect itself |
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what is the normal growth weight per day?
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30 grams
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when does birth weight double?
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4-5 months
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when does birth weight triple?
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1 year (1.5 X length)
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when does genetic influence start kickin in?
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6 months
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females experience their growth spurt around...
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10 years
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males experience their growth spurt around
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12.5 years
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what is the physiological cause of a growth spurt
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GnRH =--> LH, FSH =--> sex steroids
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what signals the end of the female growth spurt
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menarche
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what are the growth velocities of males and females:
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Females - 9 cm/yr
Males - 10.3 cm/yr |
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when is brain growht usually completed by?
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3 month gestation
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what are the properties of head circumference in a baby?
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-At Birth = 75% of adult size (25% of baby’s length)
-In first year - HC increases 12 cm -Then, HC increases by 2cm/yr |
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when do child brains reach adult weight?
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10 years
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what needs to occur in order for development of skills to occur
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CNS maturation
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When should the house be made totally safe for babies
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Crawling- 6 months
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Why is the first breast milk so important for the baby
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It contains the colostrum with all the mothers immunities
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How long should a baby be given breast milk
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exclusively fo the first 6 months
then can start combining with food but continue with breast milk through 12 months |
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Immunologic protection in moms breast milk
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(IgA, lysozyme, lactoferrin, macrophages)
Associated with less asthma and allergy; Reduced GI and respiratory infections |
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How frequent should you breast feed
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Avg Q2h, with 15 min per side
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What are the absolute contraindications for breast feeding
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HIV, Maternal TB, infant inborn metabolism errors (galactosemia), Women receiving chemotherapy, radioactive isotopes, anti-metabolites, Lithuim, atropine, cyclosporine, chloramphenicol, bromocriptime, ergot, iodides
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What shoulf breast fed babies be supplemented with after 6 months
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Flouride, multivitamin fortified with vitamin D (Polyvisor or Polyviflor- has flouride in it)
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What is the composition of breast milk
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7% protein
55% fat 38% CHO |
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Do infants need low iron formulas
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No
The American Academy of Pediatrics sees no role for the use of low-iron formulas in infant feeding and recommends that all formulas fed to infants be fortified with iron |
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What is the typical feeding schedule for formula feeding
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3-4 times at birth
2-4 oz per feed |
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what was piaget's perspective on human behavior?
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Sensorimotor, preoperational, concrete operational, formal operational
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what was erikson's perspective on human behavior?
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trust v mistrust
autonomy v shame and doubt initiative v guilt industry v inferiority identity v role confusion, intimacy v isolation; generativity v stagnation |
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what was freud's perspective on human behavior?
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oral, anal, oedipal, latency, genital, young adulthood, adulthood, old age
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Which babies sleep longer through the night, breast fed or formula fed
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formula fed- after 8 weeks
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what babies get soy milks
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Lactose intolerance
AGE – 2 to 3 weeks Galactosemia Hereditary Lactase deficiency Often given for milk protein allergy, but 20% cross reactive, therefore may not be beneficial |
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what formulas are good for babies with malabsorption problems
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Pregestimil, Nutramigen, Alimentum
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What is the recommended caloric intake for a baby
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100 Kcal/kg/day up to 120 kcal/kg/day
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What is the major cause of growth delay
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Psychosocial
neglect |
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what are other causes of growth delay
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improper mixing of formula
milk allergy chronic illness RTA metabolic disorder etc |
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What characterizes a growth delay in a baby
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a drop-off on the growth curve by two %
Dehydration developmental delay |
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What is wasting
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The acute loss of weight, or failure to gain weight at the expected rate, produces a condition of reduced weight for height
Tall but thin |
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What is stunting
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reduction in height for age, as is seen with more chronic malnutrition
Short and chubby |
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What is marasmus
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Severe wasting secondary to significant calorie deprivation
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What is Kwashiokor
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Severe protein deprivation,
but adequate energy intake; edematous malnutrition |
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what should be the circumference of the upper arm
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12 cm or undernourished
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what are recommended age for weaning breast milk to cows milk
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Breast milk recommended to age 1 yr
Can have whole cows milk till age 2 At 2 switch to 2% |
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what can occur if an infant is weaned off milk too fast
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Too fast could lead to more allergies
Put milk in the formula 1 : 8 and move up |
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What age can you begin to introduce solids
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age 4-6mo
able to sit with support, hold head upright and loss of tongue-thrust reflex |
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What solid food should you begin infants on
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rice then
oatmeal, barley, wheat cereal pureed vegetables, fruits, vegetables, and meats. Introduce the green vegetables first Mix with water Same vegetable for a week Then Yellow vegetables The orange vegetables |
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What foods have high allergies to them
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Strawberries and eggs are high in allergies
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when can a baby drink juice
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When they can hold a cup then they can drink juice
Dilute the juice bc of caloric intake |
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What foods should be avoided with babies
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peanuts (choking and allergy), berries, citrus, egg whites until after 1 yr
Whole milk at least until age 2, then may give 2% |
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What is a prudent diet for children
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Fat <30%
Chol < 100mg CHO – 55-60% Limit: Grazing Eating & TV soft drinks, candy and refined sugar products Sodium intake |
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what is stunting?
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term used to define the reduction in height for age
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what chromosomal disorder is trisomy 21
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-a flat facial profile
-up slanted palpebral fissures -epicanthral folds -a small mouth with protruding tongue -small genitalia -simian creases |
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what is the makeup of the umbilical cord?
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3 vessels 2 arteries and 1 vein
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what is the immunization schedule for DTaP?
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2,4,6,15-18 months and 4-6 years
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what type of food is introduced at 6 months
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solid foods
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What constitute obesity for a child
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>120% Ideal Body Weight
BMI: 85 – 95th % on age-and gender-appropriate charts |
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What labs should be done in a child suspected for obesity
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Lipids, insulin, glucose, LFTs, TSH
can lead to DM, high cholesterol |
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what is the main form of childhood abuse
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neglect 69%
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What is a parental risk factor for child abuse
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hx of being an abused child, poor socialization, lower socioeconomic group, limited ability to cope with stress, drug/alcohol addiction, psychosis, membership in cults
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what type of infant is abuse more prevalent in
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Prevalent more in premi babies
They need extra care and can stress parents out |
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What are the most common triggering events for abuse
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crying and toilet training
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What are some child risk factors for abuse
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age < 3 yr, infants separated from mothers at birth (preemie, ill), children with chronic illness or anomalies, foster children
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What people group perform the majority of abuse
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58% of cases abuser is the father or boyfriend of the mother, 21% of abusers are the babysitter, 13% abuser is the mother
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What Hx questions should trigger suspicion of abuse
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The history is incompatible with the type or degree of injury
The mechanism of injury is vague The history changes each time it is told Parents give different histories when interviewed separately History is not credible |
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What are some red flags for abuse
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Delay between time of injury and time of presentation
Inappropriate concern Pathologic parent-child interaction History or evidence of repeated visits/injuries/ingestions |
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what increases the risk for Reye's syndrome?
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giving aspirin to chicken pox 4 y/o kiddos
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what are the rule of 3's for colic?
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Colic is around 3 months of age. They nonstop cry with no consolation. 3 months of age, late in afternoon, dry diaper. Everything. Crying for 3 weeks, at 3 months, for 3 hours. Reassure the parent that it will go away.
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what developmental age would include a kiddo that could:
copy a circle hop on 1 foot tell a story potty-trained |
3 year old
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what is the most common cause of late neonatal bacterial sepsis?
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staph aureus
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when would an infant sit without support?
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6 months
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what is the most common cause of early neonatal bacterial sepsis?
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group-b hemolytic strep
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what is the primary mode of communication for peds
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crying
Peaks at 6 – 12 weeks As other responses develop, crying decreases |
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when do babies start cooing and smiling?
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2 months
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when do babies begin to babble repeat?
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6-9 months
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when should the baby utter their first words
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12 months
First word; pointing Receptive language develops earlier than expressive |
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What are some physical findings in abuse cases
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Bruises, marks or imprints in multiple places
Unusual locations Scarring, marks of varying ages and in varying stages of healing Rule out underlying coagulopathy Old fractures |
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What information is required in the medical record for vaccines
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Manufacturer
Lot number Date of administration Date of expiration Name & address of person administrating Date of administration Site and route of administration Vaccine Information Statement |
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If a mother refuses to be vaccinated, what is the procedure
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They must go down to the dept of health and get a waiver
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What is proper preparation of the child for a vaccine shot
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Disposable syringes & needles
70% alcohol – disinfecting stopper Lidocaine-prilocaine cream prior Follow the manufacturer’s recommendations of administration |
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How do you administer vaccines
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Vaccines with adjuvant
IM @ 90 degrees Infants < 18 mo - anterolateral thigh Older children – deltoid or triceps Needles 22 gauge 7/8 - 1 ¼ in – children 25 gauge 7/8 – 1 in – infants |
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What vaccines must be given at the same time
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MMR and Chicken pox
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What is the vaccine schedule for the Hepatitis B vaccine
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Birth, 1 mo, 6 mo
Depends if mother is HBsAg status (surface antigen) |
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What is the vaccine schedule for the Rotavirus vaccine
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2 m, 4 m, 6 m
First dose not earlier than 6 weeks or later than 12 weeks Final dose before 32 weeks |
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What is the most common cause of diarrhea in children
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Rotavirus
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What is the schedule for the DtaP vaccine
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2,4,6,15-18 months and 4-6 years
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when should the child be uttering 20-50 words?
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18 months
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when should a child be evaluated for no spoken words?
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after 18 months
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when should the child be uttering 3 word or more phrases?
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2 years
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when should preopositions be used?
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2 years
Why?! |
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when should a child begin to use words to create mental images, stories, imaginary friends?
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2-6 years
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what is the social development of a 6 month old
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perception of reality revolves around self and what infant can see and touch. Once object leaves field of vision, it ceases to exist
Turn taking games popular |
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what would be the social development of a 9 month old?
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object permanence develops
applied first to mother separation anxiety “peek-a-boo” |
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what would be the social development of a 12 month old?
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emotional attachments become stronger.
Parents meet needs of baby, baby learns to trust that needs will be met Fears develop; stranger Walking = independence Emerging sense of self “terrible two’s”, tantrums, struggle to control Empathy develops with sense of self |
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what is the infant motor milestone at birth
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head lag
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what is the infant motor milestone at 1-2 months
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lifts head; turns
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What is the schedule for the PCV vaccine
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2;4;6;12;15 months
pneumococcal conjugate vaccine |
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What are contraindications for giving vaccines
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specific allergies, fever
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What is the type of administration for IPV
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Injectable
Oral can give polio to immunocompromised family member |
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What is the dosing schedule for Hib vaccine
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2;4;12-15 months
Don’t have to give if they miss last dose Not in children less than 6 weeks Haemophilus influenza type b |
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What is the dosing schedule for the MMR vaccine
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12-15 months, 4-6 years
give in conjuction with varicella |
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Has there been any documented link between the MMR vaccine and autism
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never has been shown clinically
thought to be because autism first present around the time that this shot is given |
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What is the vaccine schedule for the varicella vaccine
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12-15 months, 4-6 years
must give with MMR shot or at least 30 days after |
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What is the dosing schedule for Td/Tdap
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11 yo
Combined Tetanus, Diphtheria and Pertussis Vaccines |
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What strands of HPV are most prone to give cervical cancer
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HPV 16,18,30 cause cervical cancer
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What is the dosing schedule for the influenza vaccine
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New vaccine every year as a new strand comes from Asia every year
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what is the infant motor milestone at 3 months?
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head stable when pulled; Raking grasp; start to scratch
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when should an infant role over (motor milestone)?
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3-4 months
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when should an infant be reaching for objects (motor milestone)?
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4-5 months
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when should an infant be using their thumbs to pick up objects (milestone)?
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7 months
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when a kiddo begins to use their pincer grasp?
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around 9 months
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What are the contraindications to the influenza vaccine
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Allergy to eggs (must be severe)
If you don’t know if allergic to egg you can rub a bit of egg on arm and see if there is a reaction |
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What are the requirements for the administration of the Hepatitis A vaccine
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Not required unless in a CDC high risk area
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when should a child begin to crawl?
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around 7-10 months
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when should a child begin pulling up to stand and cruising?
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9-11months
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what could be causes for growth delay?
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Causes include psychosocial (the most common)
improper mixing of formula (common dilution in poor families) neglect milk allergy chronic illness metabolic disorder etc |
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what are the principles of infant colic?
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“Rule of 3’s “
3 wks, 3 hrs/day, 3x/wk for 3 months Healthy infant Severe, paroxysmal crying in late afternoon. Knees drawn, fists clenched, flatus Reassurance, soothing, comforting Changing diet |
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what is the triad of ADHD?
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Impulsivity
Inattention hyperactivity |
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How do you avoid White Coat Syndrome
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Be gentle, friendly, soft
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Do children regularly provide their own history
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No
Parental interpretation History detailed, vague, unreliable Chief complaint |
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What are some reasons for Health Supervision Visits
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Development & Behavior
Growth Parameters Blood Pressure Vision & Hearing Laboratory Screening Anticipatory Guidance Nutrition Counseling Immunizations Lots done in the first years |
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What are some Development and Behavior tools
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Denver II
Parents’ Evaluation of Developmental Status (PEDS) Denver Articulation Screening Examination Early Language Milestone Scale |
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What type of anticipatory guidance do you give for injury prevention
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MVI
1st killer of children Bicycle Firearm Violence Drowning Can occur in 2in of water Fire/burn injuries |
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How high of a fever is common in children
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Up to 38 C or 100.4 F
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What is the conversion for F to C temperature
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F to C: 5/9 (F – 32)
C to F: (9/5 x C) + 32 |
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What symptoms are an emergency in children
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Vomiting****
Not moving**** |
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What is the max temp for a child to have before emergency
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105 F
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What are main causes of temperature in a child
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Viral - most cases
Well hydrated, well appearing |
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What are the treatments for a child with a fever
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Symptomatic care
Acetaminophen - 15mg / kg q 4- 6 h Ibuprofen - 10mg / kg q 6-8 h ASA - contraindicated Reye Syndrome NEUROLOGICAL PROBLEM THAT CAUSES SEIZURES |
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What are the most common bacterial causes of fever
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H. influenza
S. pneumoniae |
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What are the Tx for childhood bacterial infections with fever
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Look for source
Outpatient: Ampicillin, penicillins, cephalosporins Hospitalize – infants; toxic children CBC, blood culture, UA, Urine culture, lumbar puncture, CXR broad spectrum antibiotics - cultures pending. If cultures are negative and patient looks well likely viral etiology and no further therapy necessary. |
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When should you start taking BP on children
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3 yo
unless renal or cardiovascular abnormalities |
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What is the proper width of the BP cuff
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Width of inflatable portion should be 40% – 50% of circumference of limb
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what does photophobia or tearing in a child suggest
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glaucoma
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what is the main visual PE finding you look for in an infant
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red light reflex
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what chart do you use for visual acuity in a child
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Tumbling E Chart; Picture
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what are some signs of hearing impairment in a child
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Impairment in speech, language, cognitive development
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What are some common screening labs done in infants
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PKU
Hypothyroidism Galactosemia Sickle cell disease Cystic fibrosis Lead |
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Where is lead most commonly found with infants
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In almost anything with color made in a foreign country
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what are some common questions to ask a parent with a child suspected of lead poisoning
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Where does the child spend lots of time
Is anyone in family or do you live close to a place where they work on autos or batteries Live near major road Any foreign objects that are from another country |
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What is the most common nutritional deficiency
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Iron Deficiency Anemia
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When do you screen for Iron Deficiency anemia
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9 - 12 mo; 15 - 18 mo
Annually to age 5 Annually after menarche Pregnant teenagers Athletic activity Lead poisoning |
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What is the Tx for Iron Deficiency Screening
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Iron rich foods
supplementation |
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when do you screen a child for Hyperlipidemia
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Family Hx > 240 mg/dL
Family Hx – CVD |
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What are common laboratory screenings done in adolescents
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Cholesterol
TB (PPD) HIV HCT -Heavy menses -Weight loss -Poor nutrition -Athletics STI – if sexually active Pelvic and PAP -@ 18 yo or sexual activity -Then every 3 yrs -Screen for STIs |
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What is the leading cause of death in children
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MVI – leading cause of death
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What are the guidelines for car safety seats
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Infants – 1 yo, < 20 lbs – rear facing
20 – 40 lbs - > 1 yo – forward facing > 40 lbs – belt positioning booster seat > 4 ft tall – lap/shoulder belt |
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What are some injury prevention topics
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Pedestrian safety skills
Bicycle injuries – head trauma 75% Firearm injuries AA males; homicide, suicide Remove guns from home; lock Violence prevention Drowning & near drowning – 2nd cause of death; bathtub; swimming pool Fire & Burn injuries – scalding water |
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when does adolesence begin and end?
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Begins: 11- 12 yo
Ends: 16 – 18 yo |
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what are the major steps of adolesence?
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Puberty and somatic growth
Developing socially, emotionally Independent identity Preparing for career |
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in 2003 what was the % of US population in adolesence?
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14%
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who is projected to be the majority of adolence in 2040
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hispanics
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what is the leading cause of death in adolesence?
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MVA (drinking and driving)
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76% of all adolescent deaths are...
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preventable
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what are the growth velocities of adolescents?
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Females - 9 cm/yr
Males - 10.3 cm/yr |
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what are the early indicators for depression?
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1) Decline in school performance
2) Excessive school absences 3) Frequent psychosomatic complaints 4) Changes in sleeping of eating habits 5) Difficulty concentrating, boredom 6) S & S of depression, stress, anxiety 7) Withdrawal 8) Rebellious behavior Conflict with parents 9) Sexual acting out 10) Conflicts with the law 11) Suicidal thoughts 12) Drug and alcohol use 13) Running away from home |
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memorize the Tanner pictures
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For our purposes, Tanner starts at 2 (8-10 y/o in females)(10-13 y/o in males)
(Tanner 1 would be the stage up to adolescence) |
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Macules
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alteration in skin color that can not be felt (flat like freckles)
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papules
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solid lesions that will be elevated <1 cm (acne)
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nodules
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larger than 1 cm solid lesions (tumors)
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vesicles
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raised fluid-filled (clear fluid) lesions ~ 0.5 cm
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bullae
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larger fluid filled lesions greater than 1 cm
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pustules
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contain purulent material (also acne)
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wheals
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flat-topped, palpable lesions (allergic reactions like urticaria)
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cysts
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circumscribed, thick walled lesions located deep in the skin
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plaques
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aggregations of papules and pustules (psoriasis)
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scales
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compressed layers of skin cells retained on the skin surface (dandruff, plaque of psoriasis)
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erosions
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focal loss of epidermis that heals without scars (depression in skin from burn)
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ulcers
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extend into the dermis and heal with scarring
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exoriations
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Linear or angular ulcers that are inflicted by scratching
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fissures
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splitting or cracking
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crusts
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matted, retained accumulations of blood, serum, pus, or skin debris (impetigo, honey-colored crust)
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lichenification
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thickening of the skin with accentuation of normal skin lines caused by chronic irritation or inflammation
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Milia
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baby acne white papules, 40% of infants, resolve. Pyelosebaceous follicles.
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Miliaria
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heat rash. All over the body. Remove clothing. Closure of the eccrine glands
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Which of the following is the most common type of infection of the skin?
Bacterial Viral Fungal Anthropod bites |
Bacterial
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What is the most common type of bacterial skin infection found in children that we'd see in the office?
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Impetigo
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of impetigo, what is the most common? bullous or nonbullous?
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nonbullous
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what are the first and second most common causes of nonbullous impetigo?
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1) staph aureus
2) GABHS |
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What is the most diagnostic sign/symptom of nonbullous impetigo?
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Develops into a honey-colored crusted plaque DIAGNOSTIC
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What are signs and symptoms of nonbullous impetigo?
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-Begins on skin of face and extremities
-Trauma - Insect bites, chickenpox, scabies, abrasions -Initially a tiny vesicle or pustule that is scratched -Develops into a honey-colored crusted plaque DIAGNOSTIC -Pruritus -Spread by fingers, towels, or clothing -Usually resolves spontaneously |
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What are the main causes of bullous impetigo?
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-Staphylococcus aureus
-Also B-Hemolytic strep |
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where is bullous impetigo most commonly found?
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MOST COMMON IN THE GROIN and the rest of the body (as opposed to nonbullous which is normally found on the face and extremities)
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what are signs and symptoms of bullous impetigo?
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-Flaccid, transparent bullae
-Rupture easily |
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how do we diagnose bullous impetigo?
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-Culture the fluid of the intact blister
-Blood cultures for ill appearing patients |
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what are rare complications of bullous impetigo?
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-osteomyelitis, septic arthritis, pneumonia, septicemia
-Cellulitis in 10% in nonbullous form -GABHS – poststreptococcal glomerulonephritis |
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how do we treat bullous impetigo?
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(start with ointment, if that doesn’t help then go to antibiotic)
Cephalosporin Augmentin Mupirocin ointment |
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what is sss caused by
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scalded skin syndrom is caused by staphylococcus exotoxin
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what are signs and symptoms of sss?
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-Sudden onset of bright red, painful skin
-Axillae, popliteal, neck (can spread to rest of the body) -Can start with bullae |
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how do we treat sss?
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-treat with semisynthetic ampicillin
-she stressed that this is an emergency (ampicillin or oxacillin IV) |
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How often is acne seen and what is it caused by?
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-80% of adolescents
-Due to obstruction of the sebaceous follicle from overproduction of stratum corneum cell (androgen-dependent) -Follicular inflammation |
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What are open comedomes?
What are closed comedomes? |
-open (black heads from air contact oxidation)
-closed (white heads) |
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when should a child be walking independently?
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12 months
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when should a child be able to stack a tower of 2 cubes?
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12-18 months
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when should a child be able to scribble?
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12-18 months
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when should a child be able to walk down stairs and stack a tower of 4 cubes?
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2 years
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when should a child be able to copy a circle, hop, and walk up and down stairs without help?
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3 years
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when should a child be able to copy a cross or square?
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4 years
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when should a child be able to draw a person with 8 details?
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5 years
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when should a child be able to draw a person with 12 details?
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6 years
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when should a child be able to tie their shoe laces?
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7 years
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when should a child be able to walk up steps and kick a ball forward?
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2 years
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when should a child be able to throw a ball forward?
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18 months to 3 years
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when should a child be able to ride a tricycle and hop?
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3 years
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when should toilet training occur
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18 months to 3 years
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what is the most common cause of delayed language development?
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-Hearing impairment is the most common, followed by:
-frequent otitis media -lack of encouragement in communication -failure to thrive or developmental delay |
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when should a child be able to throw a ball forward?
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18 months to 3 years
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when should a child be able to ride a tricycle, hop and walk up and down stairs without help?
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3 years
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when should toilet training occur
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18 months to 3 years
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what is the most common cause of delayed language development?
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-Hearing impairment is the most common, followed by:
-frequent otitis media -lack of encouragement in communication -failure to thrive or developmental delay |
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what are the clinical forms of acne that we will see?
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-comedomes (open and closed)
-papules -pustules -nodulocystic lesions |
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does dietary restriction improve acne?
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no
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when should we see closure of the posterior fontanelle?
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4 months
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