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57 Cards in this Set
- Front
- Back
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Growth chart
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Measure head circumference, length and weight.
Plotted on chart to determine growth percentile. |
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Pyloric Stenosis
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Common concern at the 2 month checkup
Marked increase in the circular musculature of the pylorus, causing an obstruction of the lumen. |
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Etiology of pyloric stenosis
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More apt to occur in firstborn infants
More likely to occur in males than in females, 4:1 |
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S/S of pyloric stenosis
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S/S will likely occur at 2-12 weeks of age
Projectile vomiting within 2 hours of each feeding Vomitus does not contain bile Irritability; child appears hungry Weight loss, dehydration Jaundice occurs in 2-5% of patients Olive-shaped’ mass can be palpated in the right upper quadrant (RUQ) Mass felt best immediately following vomiting |
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When do symptoms of pyloric stenosis most commonly appear?
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Between 2-12 weeks of age
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What is the hallmark of pyloric stenosis?
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An ‘olive-shaped’ mass can be palpated in the right upper quadrant (RUQ).
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What diagnostic studies should be performed for pyloric stenosis?
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US demonstrates a hypertrophied pyloric muscle
Upper GI series |
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Treatment/management of pyloric stenosis
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Rehydrate, correct electrolytes
Surgical intervention curative |
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Prognosis of pyloric stenosis
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Excellent following surgery
Recurrence unlikely |
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At what age is colic a common concern?
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2 month well check
Usually resolves by 4 months |
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Wessel criteria
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Rule of threes
Cries for more than 3 hours, at least 3 days a week and persists for at least 3 weeks. |
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Thrush
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Oropharyngeal candidiasis
Usually occurs in pre-term infants, more common in babies who are formula fed from the beginning. |
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Treatment of thrush
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Nystatin 100,000 IU QID
Put in mouth and swish around, usually resolves around 24-48 after treatment. Treat mother's nipples and sterilize bottles. |
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What is the hallmark of diaper candidiasis?
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Satellite lesions
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Diaper candidiasis
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Yeast infection in diaper area, satellite lesions are present.
Avoid baby wipes or rinse with water. Use topical clotrimazole for treatment. |
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Gastroesophageal reflux
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"Happy spitters" - not projectile vomiting
Treat with ranitidine (Zantac) |
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What is the first line treatment for infant reflux?
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Ranitidine
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Physical developmental milestones at 2 months
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Can hold head up and begins to push up when lying on tummy.
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Cognitive developmental milestones at 2 months
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Pays attention to faces, recognizes parents
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Language developmental milestones at 2 months
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Coos, makes gurgling sounds
Turns head toward sounds |
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Emotional developmental milestones at 2 months
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Begins to smile
Can briefly calm self (hand to mouth and suck on hand). |
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What increases risk of developing otitis media in infants?
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Cigarette smoke
Giving a baby a bottle while lying flat or before bed. |
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What are the most common bacterial pathogens of otitis media?
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S. pneumoniae
H. influenzae Moraxella cattarrhalis |
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What is the 1st line treatment for S. pneumoniae for otitis media?
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Amoxicillin, unless contraindicated
<20 kg 50 mg/kg - BID for 10 days 80-90 mg/kg /BID ??? |
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What is the 2nd line treatment for S. pneumoniae for otitis media?
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Augmentin (amoxicillin + clauvanate)
Azithromycin If amoxicillin fails or otitis media recurs, use 2nd line. If penicillin allergy exists, skip augmentin. |
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Emotional developmental milestones at 4 months
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Laughs
Likes to play with people |
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Strabismus
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Nasal deviation - esotropia
Temporal deviation - exotropia |
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When should strabismus be referred?
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Immediately refer for estropia at any age.
Refer is exotropia exists after 4 months. |
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Language developmental milestones at 4 months
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Begins to babble
Different cries to show hunger, pain or being tired |
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Cognitive developmental milestones at 4 months
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Responds to affection
Recognizes familiar people and things at a distance |
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What eye exams should be completed at 6 months?
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Cover test - strabismus
Red reflex - retinoblastoma |
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Physical developmental milestones at 4 months
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Holds head steady
Reaches for objects Can hold a toy and shake it |
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Why does constipation often increase around 6 months?
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Introduction to solid foods
Switching from breast milk to cow's milk formula |
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Treatment of constipation
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Try introducing small amounts of juice
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When should tooth brushing begin?
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At eruption of first tooth - no toothpaste.
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When should children begin using fluoride toothpaste?
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At age 2
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Intussusception
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Medical emergency!
Characterized by the telescoping of a proximal portion of the intestine into a more distal position. Results in impairment of blood supply and necrosis of involved bowel segment. In 95%, involves ileum into colon (ileocolic). |
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What is the most common cause of intestinal obstruction in infants?
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Intussusception
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Etiology of intussusception
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One of most dangerous surgical emergencies in early childhood
- gangrene/perforation/infection - death Most common in infants 3 months-1 year of age In 95%, no cause can be found In older patients look for underlying diagnosis |
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S/S of intussusception
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Nearly all infants present with an acute onset of episodic colicky pain and vomiting.
Sausage-shaped mass may be palpated in the area of the hepatic flexure. Fever Signs of dehydration may be present ‘Currant jelly” stools - late sign |
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Diagnosis of intussusception
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Barium enema discloses the intussusception outlined as an inverted cap, and an obstruction to the progression of the barium is noted.
Barium enema is both diagnostic test of choice and treatment of choice. Contraindication if perforation present. |
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Treatment of intussusception
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IV rehydration should be instituted immediately and an NG tube placed.
75% of cases can be successfully reduced using a barium enema under fluoroscopy. Contraindications to barium reduction: - Free intraperitoneal air or peritoneal and systemic signs of compromised intestine. - These patients should be taken directly to surgery Surgical reduction or resection and anastomosis should be performed if barium enema reduction is unsuccessful. |
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Prognosis of intussusception
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Recurrence rate is 5%, and occurs shortly after reduction.
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Physical developmental milestones at 6 months
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Sits alone without support
Rolls over in both directions |
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Cognitive developmental milestones at 6 months
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Begins to pass things from one hand to the other
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Language developmental milestones at 6 months
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Strings vowels together
Responds to own name Begins to say consonant sounds (b- m-) - mama, dada |
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Emotional developmental milestones at 6 months
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Likes to look in mirror
Responds to other’s emotions |
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Physical developmental milestones at 6 months
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Stands, holding on
Crawls Pulls to stand |
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Cognitive developmental milestones at 6 months
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Plays “peek-a-boo”
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Language developmental milestones at 6 months
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Understands “no”
Copies sounds and gestures of others Points with fingers |
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Emotional developmental milestones at 6 months
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May be afraid of strangers
Has favorite toys |
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What condition can develop as a result of excessive fluoride?
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Fluorosis - white spots on teeth
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Conjunctivitis
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Pain, itching, drainage
Usually viral, adenovirus most common |
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Emotional developmental milestones at 12 months
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Cries when mom or dad leaves
Shy with strangers |
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Physical developmental milestones at 12 months
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Pull to stand, coasting the furniture
Rolls over in both directions |
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Cognitive developmental milestones at 12 months
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Follows simple direction, “pick up the toy”
Starts to use things correctly; brushes hair, drinks from cup. |
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Language developmental milestones at 12 months
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Uses simple gestures, wave bye-bye, shake head no
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