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62 Cards in this Set

  • Front
  • Back
body weight in infants and children
newborn looses 10% of BW in 1st week
newborn regains or surpasses BW in two weeks
30g/d first month
20g/d at 3-4 months
BW is doubled by 6 months and triples by 1 year
between 6-12 - 3-6 growth spurts; myelination complete by 7
breast feeding contraindications
HIV
CMV, HSV (if lesions on breast)
HBV (before vaccination)
acute maternal disease
breast cancer
substance abuse
not contraindicated in mastitis
absolute drug contraindications for breast feeding
antineoplastics
radiopharmaceuticals
ergot alkaloids
iodine
atropine
lithium
chloramphenicol
cyclosporin
nicotine
alcohol
relative drug contraindications for breast feeding
neuroleptics
sedatives
tranquilizers
metronidazole
tetracycline
sulfonamides
steroids
formula feeding
do not give cow milk before 1 year
can develop iron deficiency anemia with cow milk
solid foods in infant
2 months --> breast or formula milk
4-6mo --> iron fortified cereals
6-7mo --> strained vegetables and fruits, unsweetened fruit juice, avoid orange juice
6-8mo --> plain yogurst, cottage cheese, egg yolk, strained meats
7-9mo --> soft meats, poultry, mashed fruits and vegetables, cheese, cereals
8-10mo --> soft finger foods
9-12mo --> regular table foods
12mo --> whole eggs, orange juice, cow milk
foods to avoid in first year
egg whites
nuts
wheat products
chocolate
citrus
fish
honey
CA = BA
normal --> ideal, genetic short stature
abnormal --> genetic, chromosomal, endocrine related
CA > BA
normal --> constitutional delay
abnormal --> chronic systemic disease, endocrine related
CA < BA
normal --> obesity
abnormal --> precosious puberty, congenital adrenal hyperplasia, hyperthyroidism
pathologic short stature
start out in normal range but then abnormal
suspect Turner if female
suspect cranipharyngioma if vision problems
also hypopituitarism, hypothyroidism
failure to thrive
malnutrition --> malabsorption (infection, celiac, CF, protein-loosing enteropathy); allergies; immunodeficiency; chronic disease
initial tests --> CBC, urinalysis, liver function tests, serum protein, sweat chloride, stool for ova, document caloric intake
nonorganic failure to thrive presentation
thin extremities, prominent ribs
neglect of hygine
delays in social and speech development
avoidance of eye contact, expressionless, no cuddling response
feeding aversions
nonorganic failure to thrive causes
not fed adequeately
emotional and maternal deprivation
psychosocial deprivation is most common cause
retarded or emotionally disturbed parents, poverty
nonorganic failure to thrive diagnosis
feed under supervision (hospitalization if necessary) for 1 week
should gain >2oz/day
monitor or videotape mother
nonorganic failure to thrive management
underfeeding from maternal neglect --> must report to CPS
infants discharged need intensive long-term intervention
obesity in children risk factors
predisposition
parental obesity
inactivity
overfeeding baby
obesity in children presentation
tall stature
abdominal striae
early puberty
increased adipose in mammary in boys
obesity in children diagnosis
obesity --> BMI > 95% (BMI > 30)
overweight --> BMI 85-95% (BMI 25-30)
obesity in children complications
increased risk of obesity in adulthood
hypertension
hypercholesterolemia
hyperinsulinism
slipped capital femoral epithesis
sleep panea
type 2 diabetes
obesity in children treatment
exercise and balanced diet
no medications
protein/energy malnutrition
formerly Kwashiorkor
inadequeate caloric intake + severe protein deficiency
edema
dermatitis
sparse hair
decreased subcutaneous tissue
decreased muscle tone
Kwashiorkor Vs marasmus
Kwashiorkor --> generalized edema
marasmus --> distended abdomen
vitamin A
function --> retinal pigments, bone and teeth, epithelial maturation
manifestations --> ocular lesions, dry scaly skin, anemia, retardation, growth retardation
B1
thiamine
coencyme in carbs metabolism, generates NADP
manifestations --> beriberi, peripheral neuritis, CHF, ptosis, ataxia, nerve paralysis
riboflavin
functions --> energy production, general growth, tissue maintenance
manifestations --> glositis, keratitis, conjunctivits, photophobia, seborrhea
niacin
functions --> glycolysis, electron transport
manifestations --> pellagra (dermatitis, diarrhea, dementia), depression
B6
pyridoxine
functions --> CNS function, amino acid metabolism
manifestations --> convulsionsipheral neuritis, dermatitis, anemia
vitamin C
functions --> enzymatic reactions, collagen synthesis
manifestations --> scurvy, costochondral rosary
vitamin D
deficiency --> rickets (osteomalacia, tetany)
alpha tocopherol
functions --> nucleic acid metabolism
manifestations --> creatinuria, striated muscle necrosis
vitamin K
functions --> oxydative phosphorylation, clotting factors
manifestations --> hemorrhage
skill areas in development
visual-motor
language
motor
social
adaptive
mental retardation definition
IQ <70-75 + related limitation in at least two adaptive skills
pica
predisposed by --> retardation, lack of care and neglect
more common in autism and low socioeconomic status
leads to lead poisoning, iron deficiency and parasites
enuresis
bedwetting after 5 years
primary -->no significant dry period due to hyposecretion of ADH and very deep sleep
secondary --> after a period of >6 monts dry due to disease; may need urinalysis and ultrasonography
encopresis
2/3 of cases are retentive
diagnose with hard stool on rectal; if negative --> abdominal x-ray
first step --> clear impacted feces; short term mineral oil and laxatives; behavioral changes and therapy
sleep walking and terrors
during first third of night in slow-wave sleep
no daytime sleepiness or recall
common family history
treat with reassurance and take safety precautions
nightmares
during last third of night in REM sleep
daytime sleepiness and vivid recall
if recurrent --> investigate possible abuse or anxiety disorder
autistic disorder
qualitative impairment in verbal and nonverbal communication and social interactions
failure to attach as infant
delayed/absent social smile
failure to anticipate interactions
echolalia
outbursts of anger
solitary play
possible retardation
diagnosis --> clinical
treatment --> behavioral therapy and specialized education
asperger disorder
impairment in social interactions
repetitive behaviors
obsessional
idiosyncratic interests
no language impairment as in autism
treatment --> group social skills trainning
Rett syndrome
X-linked dominant, affects mostly girls
normal development until age 1-2 then regression of language and motor skills
microcephaly
loss of purposeful hand movements
ataxia
excessive sighing
autistic behavior
sudden death from status epilepticus
ADHD
inattention
poor impulse control
motor overactivity
symptoms interfere with child's functioning in two or more settings
symptoms present before 7 years old
diagnosis of exclusion --> chronic illness, substance abuse, sleep disorders, adjustment disorder
behavioral scales are good but not enough for diagnosis
treatment --> 1st stimulants +- clonidine; 2nd bupropion; atomoxetine
types of abuse
physical --> intentional injuries, fractures, bruises, burns
psychological --> terrorizing, putting down, comparing, insulting
types of neglect
physical --> food, clothing, schooling, medical care, safety
psychological --> love, support, stimulation, recognition
most common cause of underweight infant
nutritional neglect; 50% of all cases of failure to thrive
when to suspect physical abuse
injury is unexplained or implausable
injury is incompatible with the history or development of child
delay in seeking medical care
how to document suspected physical abuse
take photographs
include color chart
include scale
battered child syndrome
bruises, scars, internal organ damage and fractures
bruises in physical abuse
usually in buttocks, genitals, back, back of hands, thoraco-abdominal
symmetrical or geometrical shape
bruises in different stages are incompatible with single event
fractures in physical abuse
highly specific --> rib fracures in infants, fractures at different stages, bilateral, complex skull fractures
burns in physical abuse
cigarette burns --> circular, punched-out of uniform size
immersion burns --> glove-stocking pattern of extremity, demarcation is uniform, no splash burns
haed trauma in physical abuse
consider when infant presents with coma, convulsions, apnea or increased ICP
subdural hematoma with no scalp marks or skull fracture
retinal hemorrhages
obtain head CT and eye exam
lab studies if physical abuse is suspected
PT, PTT, platelets, bleeding time
skeletal survey if <2y/o
if severely injured --> head CT +- MRI + opthalmic exam
if abdominal trauma --> urine and stool for blood, liver and pancreatic enzymes, abdominal CT
physical abuse first step in management
prompt medical, surgical or psychological treatment
reporting to CPS
report any child suspected of abuse or neglect
meet with case worker
law enforcement forensics and criminal prosecution
initial phone report then written report within 48 hours
when to hospitalize physical abused child
medical condition requests it
diagnosis is unclear
no alternative safe place
if parents refuse hospitalization or treatment --> get emergency court order
what to explain to parents of abused child
why an inflicted wound is suspected
that physician is obligated to report
report is to protect the child
the family will be provided services
that a CPS worker and law enforcement officer will be involved
Munchausen syndrome by proxy definition
parent fabricates or induces illness in child
usually a healthcare worker or model parent
Munchausen syndrome by proxy presentation
symptoms not compatible with any specific disease
presentation varies --> diarrhea/laxatives; rash/caustic substances; seizures/insulin
Munchausen syndrome by proxy diagnosis
if high suspicion --> don’t perform any tests
examine all specimens
review old medical records including siblings
if necessary, hidden camera
Munchausen syndrome by proxy management
confront parent after confirmation and offer help
report to CPS
protect siblings