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62 Cards in this Set
- Front
- Back
body weight in infants and children
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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 |
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breast feeding contraindications
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HIV
CMV, HSV (if lesions on breast) HBV (before vaccination) acute maternal disease breast cancer substance abuse not contraindicated in mastitis |
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absolute drug contraindications for breast feeding
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antineoplastics
radiopharmaceuticals ergot alkaloids iodine atropine lithium chloramphenicol cyclosporin nicotine alcohol |
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relative drug contraindications for breast feeding
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neuroleptics
sedatives tranquilizers metronidazole tetracycline sulfonamides steroids |
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formula feeding
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do not give cow milk before 1 year
can develop iron deficiency anemia with cow milk |
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solid foods in infant
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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 |
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foods to avoid in first year
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egg whites
nuts wheat products chocolate citrus fish honey |
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CA = BA
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normal --> ideal, genetic short stature
abnormal --> genetic, chromosomal, endocrine related |
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CA > BA
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normal --> constitutional delay
abnormal --> chronic systemic disease, endocrine related |
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CA < BA
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normal --> obesity
abnormal --> precosious puberty, congenital adrenal hyperplasia, hyperthyroidism |
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pathologic short stature
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start out in normal range but then abnormal
suspect Turner if female suspect cranipharyngioma if vision problems also hypopituitarism, hypothyroidism |
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failure to thrive
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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 |
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nonorganic failure to thrive presentation
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thin extremities, prominent ribs
neglect of hygine delays in social and speech development avoidance of eye contact, expressionless, no cuddling response feeding aversions |
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nonorganic failure to thrive causes
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not fed adequeately
emotional and maternal deprivation psychosocial deprivation is most common cause retarded or emotionally disturbed parents, poverty |
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nonorganic failure to thrive diagnosis
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feed under supervision (hospitalization if necessary) for 1 week
should gain >2oz/day monitor or videotape mother |
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nonorganic failure to thrive management
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underfeeding from maternal neglect --> must report to CPS
infants discharged need intensive long-term intervention |
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obesity in children risk factors
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predisposition
parental obesity inactivity overfeeding baby |
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obesity in children presentation
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tall stature
abdominal striae early puberty increased adipose in mammary in boys |
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obesity in children diagnosis
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obesity --> BMI > 95% (BMI > 30)
overweight --> BMI 85-95% (BMI 25-30) |
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obesity in children complications
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increased risk of obesity in adulthood
hypertension hypercholesterolemia hyperinsulinism slipped capital femoral epithesis sleep panea type 2 diabetes |
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obesity in children treatment
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exercise and balanced diet
no medications |
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protein/energy malnutrition
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formerly Kwashiorkor
inadequeate caloric intake + severe protein deficiency edema dermatitis sparse hair decreased subcutaneous tissue decreased muscle tone |
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Kwashiorkor Vs marasmus
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Kwashiorkor --> generalized edema
marasmus --> distended abdomen |
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vitamin A
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function --> retinal pigments, bone and teeth, epithelial maturation
manifestations --> ocular lesions, dry scaly skin, anemia, retardation, growth retardation |
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B1
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thiamine
coencyme in carbs metabolism, generates NADP manifestations --> beriberi, peripheral neuritis, CHF, ptosis, ataxia, nerve paralysis |
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riboflavin
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functions --> energy production, general growth, tissue maintenance
manifestations --> glositis, keratitis, conjunctivits, photophobia, seborrhea |
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niacin
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functions --> glycolysis, electron transport
manifestations --> pellagra (dermatitis, diarrhea, dementia), depression |
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B6
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pyridoxine
functions --> CNS function, amino acid metabolism manifestations --> convulsionsipheral neuritis, dermatitis, anemia |
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vitamin C
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functions --> enzymatic reactions, collagen synthesis
manifestations --> scurvy, costochondral rosary |
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vitamin D
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deficiency --> rickets (osteomalacia, tetany)
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alpha tocopherol
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functions --> nucleic acid metabolism
manifestations --> creatinuria, striated muscle necrosis |
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vitamin K
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functions --> oxydative phosphorylation, clotting factors
manifestations --> hemorrhage |
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skill areas in development
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visual-motor
language motor social adaptive |
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mental retardation definition
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IQ <70-75 + related limitation in at least two adaptive skills
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pica
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predisposed by --> retardation, lack of care and neglect
more common in autism and low socioeconomic status leads to lead poisoning, iron deficiency and parasites |
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enuresis
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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 |
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encopresis
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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 |
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sleep walking and terrors
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during first third of night in slow-wave sleep
no daytime sleepiness or recall common family history treat with reassurance and take safety precautions |
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nightmares
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during last third of night in REM sleep
daytime sleepiness and vivid recall if recurrent --> investigate possible abuse or anxiety disorder |
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autistic disorder
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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 |
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asperger disorder
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impairment in social interactions
repetitive behaviors obsessional idiosyncratic interests no language impairment as in autism treatment --> group social skills trainning |
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Rett syndrome
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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 |
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ADHD
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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 |
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types of abuse
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physical --> intentional injuries, fractures, bruises, burns
psychological --> terrorizing, putting down, comparing, insulting |
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types of neglect
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physical --> food, clothing, schooling, medical care, safety
psychological --> love, support, stimulation, recognition |
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most common cause of underweight infant
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nutritional neglect; 50% of all cases of failure to thrive
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when to suspect physical abuse
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injury is unexplained or implausable
injury is incompatible with the history or development of child delay in seeking medical care |
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how to document suspected physical abuse
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take photographs
include color chart include scale |
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battered child syndrome
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bruises, scars, internal organ damage and fractures
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bruises in physical abuse
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usually in buttocks, genitals, back, back of hands, thoraco-abdominal
symmetrical or geometrical shape bruises in different stages are incompatible with single event |
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fractures in physical abuse
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highly specific --> rib fracures in infants, fractures at different stages, bilateral, complex skull fractures
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burns in physical abuse
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cigarette burns --> circular, punched-out of uniform size
immersion burns --> glove-stocking pattern of extremity, demarcation is uniform, no splash burns |
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haed trauma in physical abuse
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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 |
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lab studies if physical abuse is suspected
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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 |
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physical abuse first step in management
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prompt medical, surgical or psychological treatment
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reporting to CPS
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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 |
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when to hospitalize physical abused child
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medical condition requests it
diagnosis is unclear no alternative safe place if parents refuse hospitalization or treatment --> get emergency court order |
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what to explain to parents of abused child
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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 |
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Munchausen syndrome by proxy definition
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parent fabricates or induces illness in child
usually a healthcare worker or model parent |
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Munchausen syndrome by proxy presentation
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symptoms not compatible with any specific disease
presentation varies --> diarrhea/laxatives; rash/caustic substances; seizures/insulin |
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Munchausen syndrome by proxy diagnosis
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if high suspicion --> don’t perform any tests
examine all specimens review old medical records including siblings if necessary, hidden camera |
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Munchausen syndrome by proxy management
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confront parent after confirmation and offer help
report to CPS protect siblings |