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138 Cards in this Set
- Front
- Back
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chance of HIV transmission mom->child
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25-30%
Inc Risk - prior to anti-retroviral = Membrane rupture > 4hrs; vaginal delivery - breastfeeding - premature delivery (37 wks gestation) |
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____ sick full-term neonates w/o risk factors for infxn will have a metabolic disorder
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1 out of 5
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All states screen for?
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PKU and hypothyroidism
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Checking for congenital toxoplasmosis
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- check infants IgM or IgA+ w/in first 6 months of life
- persistent IgG + beyond 1 yr |
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Check congenital Hep B
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- check maternal HepBsAg status
- If HepBsAg + give = - Hep B vaccine - HBIG |
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HIV testing
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Maternal HIV PCR
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Congenital Rubella testing?
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- maternal and infant IgM titers antibodies
- can check infant for IgG for up to one year |
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Congenital CMV testing?
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Infant CMV urine culture w/in 3 wks of life
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duration of breastfeeding and a reduction in incidence of:
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- obesity
- Cancer - Adult Coronary Artery Disease - certain allergic conditions - Type 1 DM - Inflammatory Bowel Disease |
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infants born to teenage mothers are at greater risk of?
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Lower birth weight = inc risk of pregnancy-induced HTN & preeclampsia
vertically acquired STDs poorer developmental outcomes |
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Birth weight classification
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Extremely Low BW = <1000 grams
Very Low BW = 1000 - 1499 grams Low BW = 1500 - 2499 grams Normal BW = > 2500 grams |
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gestational age
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- based on neuromuscular & physical characteristics
BALLARD SCORE - est. gestational age - most accurate 12-20 hrs of age - based on sum of two scores |
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Pre-term
Term Post-term |
Pre-term = < 37 weeks
Term = 37- 42 weeks Post-term = > 42 weeks |
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SGA
appropriate for gestational age LGA |
- < 10th percentile for intrauterine growth curve
AGA = 10-90th percentile LGA = > 90th percentile |
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Up 70% of SGA infants are small due to
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- maternal ethnicity
- Parity - Height - weight |
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clinical problems associated w/ SGA
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- hypoglycemia
- hypothermia - hypoxia - polycythemia |
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clinical problems associated w/ LGA
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- C/S, vaccum, or forceps => inc risk of CEPHALOHEMATOMA
Birth injuries = clavicle fx; brachial plexus injury; facial nerve palsy hypoglycemia |
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Microcephaly
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head circumference < 10th percentile for gestational age
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failure to seen red reflex
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red reflex = reflected from fundus
may indicate = - Cataracts - Glaucoma - Retinoblastoma - Chorioretinitis |
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Congenital Rubella Syndrome, Toxoplasmosis, and Congenital CMV infxn all may result in
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- Microcephaly
- Organomegaly - Rash |
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formula types
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- ready to feed
- Concentrate = 1:1 ratio to H2O - Powder = 2 scoops: 4 oz (1/2 cup) |
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Calorie needs during infancy
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calculated for kg of body weight
Term = 100-120 cal/Kg/day Preterm = 115-130 cal/kg/day Very low BW = 150 cal/kg/day |
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at what age do you introduce solid foods?`
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4-6 months
- iron-fortified rice cereal w/ formula milk |
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nutrition at 9 months
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- require 100 cal/kg/day w/ 75% coming from milk (24-48 oz/day)
- eat strained foods = STAGE 2 = toast, crackers, pasta, and banana - meat = small pieces of chicken - |
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total immunizations over 5 yrs
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5 = DTaP
4 = IPV; PCV (pneumococcal conjugate vaccine) 3-4 = Hib 3 = Hep B 2-3 = Rotavirus 2 = MMR, varicella, Hep A |
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Immunizations at 2 monts
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DTap; IPV; PCV; Hib; Rota = # 1
Hep B = #1 or 2 |
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recommended as a 2 dose vaccine for children over 12 months
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Hep A
MMR Varicella |
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Annual flu
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- household contacts
- ALL kids 6 mo - 19 y/o - out of home caregivers - of children up to 59 months (~5 yrs) HigheR Risk = asthma or immunodeficiency Fussiness more than 24 hr see right away |
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Sleep by 4-6 months
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infants should sleep thru night
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car seat recommendations
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<1 and/or < 10 kg = car seat; middle back; face rear
> 1 and > 10 kg = car seat; middle seat; face front > 4 y and 40 Ibs = booster, back seat; face front > 8 = seat belt, back seat > 12 = seat belt; front or back seat |
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2 month mile stones
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Gross = head up to 45 degress
Fine = follows past midline Language = laughs Social = smiles spontaneously |
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6 month mile stones
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Gross = rolling over; sits unsupported; puts feet in mouth while supine
Fine = unilateral reach for objects; looks for dropped objects Language = turns to voice; babbles Social = feeds self; stranger recognition (prelude to anxiety) |
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9 month mile stones
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Gross = stands holding on; pulls self to stand
Fine = transfers objects from one hand to another; takes 2 objects Language = combine syllables "mama" & "dada"; but nonspecifically Social = pat-a-cake; waves bye-bye; indicates wants; stranger anxiety |
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12 month mile stones
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Gross = stands alone (many can walk)
Fine = bangs two objects together; puts block in cup Language = "mama" & "dada" specifically; 1 or 2 other words Social = hands book for parent to read; protodeclarative pointing; imitates activities; plays ball w/ examiner |
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Growth rules
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weight
- avg wt gain for term infant = 20-30 g/day - 2x birth weight by 4-5 months - 3x birth weight by 12 months Height - 2x birth length by 4 yrs |
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steps to deal w/ eating problems
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Stop the bottle when child is 1 = throw away/ big boy,girl cup/ child forgets in a few days
-Eating to 3 meals and 2 snacks - Thirsty give water - No bargaining or cajoling - By 3 should eat table foods w/ rest of family - Provide meals they will eat but don’t make “special foods” - Eat at meals = if hungry later offer plate the he left unfinished earlier |
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3 y/o miles stones
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Gross = jumps in place; kicks ball; rides tricycle
Fine = Copies circle and cross; wiggles thumb Language = 2 actions; 1 color; speech 1/2 way understandable Social = name, age, and sex; self-care skill; early imaginative behavior |
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hemoglobinopathy look for
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- black, mediterranean, asian
- microcytic anemia w/ low RDW |
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BMI > 95 th percentile
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obese "overweight"
85-95th percentile - at risk for overweight |
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HTN and obesity
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- 9x more likely in obese children
1/3 of obese children have HTN |
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blount disease & SCFE
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blount - looks like bow leg
slipped capital femoral epiphysis - Displacement of the femoral head from the femoral neck through the physeal plate - Occurs at onset of pubery in obese pts w/ delayed sexual maturations - Antalgic gait due to pain referred to hip, thigh and/or knee w/ limited range of motion (esp internal rotation) on examination of the hip - SCFE can be dx on xray of pelvis which shows widening of physis |
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weight loss in BMI >95th pts
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- Not more than 1 lb per month in preteens
- not more than 1 lb per week in teens until BMI 85 th percentile |
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DM dx
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- random screen > 200 mg/dL (>11.1 mmol/L)
- fasting screen > 126 mg/dL (> 7 mmol/L) - Oral glucose tolerance w/ 2 hr glucose > 200 mg/dL |
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DM2 screening Guidelines for Children and Adolescents
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Overweight (BMI > 85 percentile; wt:ht > 85 percentile or wt > 120% ideal for ht) plus any 2 of following risk factors
- fam hx; race; signs of insulin rx Start screening at 10 yr old - every 2 yrs - fasting serum glucose gold stand. |
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Studies of HTN in children
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85-95th percentile and NO risk factors
- fasting lipid profile 85-95th percentile and risk factors - fasting lipid + AST, ALT, fasting glucose > 95th percentile - fasting lipid + AST, ALT, fasting glucose + BUN, Cr |
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puberty begins
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Girls = 8 - 13 y/o
Boys = 10-15 y/o |
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puberty girls
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10-11 = breast buds; pubic hair
12 y/o = growth spurt 12-13 = menarche 15 y/o = adult height |
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puberty boys
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12 = growth of testicle; pubic hair appears
13-14 = penis, scrotum growth; first ejaculations 14 = growth spurt 17 = adult height |
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labs VWD
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PT = normal
PTT= long BT= long vWF and Factor VIII = low microcytic anemia, normal retic count Normal platelet count |
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Precordial Catch Syndrome worsens with
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Deep Inspiration
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Murmur of hypertrophic cardiomyopathy is worse with
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standing
valsalva |
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murmurs that require further evaluation
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- louder than grade III/IV
- Diastolic murmur - worse w/ standing; valsalva |
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Tanner stage 1
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childlike phallus
testicular vol = < 1.5 ml no pubic hair |
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Tanner stage 2
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childlike phallus
testicular vol = 1.6 - 6 ml reddened and thinner scrotum small amount of fine hair on base of scrotum,phallus |
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Tanner stage 3
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inc phallus length
testicular vol = 6 - 12 ml greater scrotal enlargement moderate amount of curly pubic hair |
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tanner stage 4
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inc phallus length and circumference
testicular vol = 12 - 20 ml further scrotal enlargement and darkening Adult pubic hair but not on medial thigh |
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Tanner stage 5
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adult phallus
testicular vol > 20 ml adult hair on medial thigh |
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MC cause of chest pain in children
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precordial catch syndrome
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dx perinatal asphyxia
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hypoxemia and metabolic acidosis
umbilical artery sample |
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infants of DM mothers
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inc risk of RDS
LGA > 4000g hypoglycemia hypocalcemia shoulder dystocia and birth trauma when delivered vaginally > 5000 g fetal glucose is kept 2/3 of maternal glucose glucose stabilizes 3-4 hrs if hyperinsulinemic glucose drops = keep glucose at 41-50 g/dl |
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acrocyanosis at how many hrs indicates workup
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8 hrs
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Assessing transition following birth
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1st hour of life
- HR = 120-160 bpm - RR = 60-80 bpm Successful transition 2 hours - HR = 160-180 - RR 40-60 Signs of distress - tachypnea > 60 bpm - retractions |
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RDS risk factors
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- prematurity, IDM (delay lung maturation up to 37 wks)
- siblings w/ RDS - Males - C/S without labor - perinatal asphyxia |
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TTN risk factors
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- C/S
- males - macrosomic (IDM) |
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TTN CXR
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Perihilar streaking = interstitial fluid and lymphatic engorgement
coarse, fluffy densities = fluid-filled alveoli fluid in plural space & small amount of fluid in fissures on lateral view |
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passage of meconium in utero
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- indicates fetal stress and hypoxia
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monitoring TTN
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12 hrs = RR dec to 50-55 bpm
36 hrs = stabilized at 50 bpm |
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before discharging a premies
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- stabilized temp
- ensure good feeding |
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before discharging term baby
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- minimal or no jaundice
- no blood group incompatibility - breastfeeding every 2-4 hrs - 6 or more wet diapers daily - meconium -> breast fed stools - weight loss < 10% - Vit D prescription |
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don't give cow's milk until age?
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1
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colostrum
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yellow fluid made 1st 5 days post-partum
replaced by milk contains more minerals & protein but less fat and carbs than milk, IgA |
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newborn nutrition
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Breastfeeding
- nurse 8-12 times in 24 hours - 10-15 mins each breast (10-30 min range) |
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newborn output
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Stools
3rd day of life = poops should look yellow 6-7th day = 3-4 stools/day (some have stools w/ every feed) Urine 3rd day = 3-4x/day 6th day = pale yellow urine at least 6xs/day |
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risks for severe hyperbilirubinemia
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o Jaundice in the first 24 hrs
o Visible jaundice before discharge o Previous jaundiced sibling o Gestation 35-38 wks o Exclusive breastfeed o East Asian race o Bruising/ Cephalohematoma o Maternal age > 25 years o Male sex |
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indications for further jaundice evaluation
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o Fam Hx of hemolytic disease
o Vomiting; lethargy; Poor feeding; Fever o Jaundice onset after 3rd day o High-pitched cry o Dark urine; light stools |
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baby's should return to birth weight by
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2 wks
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avg diameter of anterior fontenelle in newborn
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2.5 - 5.0 CM
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Caput succedaneum
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- Edematous swelling over the presenting portion of the scalp of an infant
- Overlies the periostem and therefore crosses suture lines = consists of serum = would not cause hyperbilirubinemia |
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Cephalohematoma
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Subperiosteal hemorrhage and thus will not extend across a suture line
Can cause hyperbilirubinemia |
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Risk factors Developmental Dysplasia of Hip (DDH)
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Left hip (3:1)
Girls Breech presentation Caucasian, Native Americans Family hx of DDH |
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physiologic jaundice
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Term newborn peaks at 3-4 days & resolves by 4-5th day of life
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liver disease presentation in newborn
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jaundice at 3-6 wks eventually stools become acholic
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at what total bilirubin level should you think that the process is not physiologic
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> 15 mg/dL
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Kernicterus
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- stains basal banglia & hippocampus
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signs of encephalopathy due to bilirubin
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- Early signs of = lethargy, poor feeding, vomiting and hypotonia
- Late signs of = irritability, hypertonia, opisthotonus, seizures, extrapyramidal disturbances & deafness |
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All vitamins except what are in human breast milk
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vitamin K
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Risk factors Developmental Dysplasia of Hip (DDH)
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Left hip (3:1)
Girls Breech presentation Caucasian, Native Americans Family hx of DDH |
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physiologic jaundice
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Term newborn peaks at 3-4 days & resolves by 4-5th day of life
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liver disease presentation in newborn
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jaundice at 3-6 wks eventually stools become acholic
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at what total bilirubin level should you think that the process is not physiologic
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> 15 mg/dL
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Kernicterus
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- stains basal banglia & hippocampus
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signs of encephalopathy due to bilirubin
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- Early signs of = lethargy, poor feeding, vomiting and hypotonia
- Late signs of = irritability, hypertonia, opisthotonus, seizures, extrapyramidal disturbances & deafness |
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Interrupting breastfeeding is discouraged, but if the
serum bilirubin is 16-25 mg/dL, tx teams may decide to interrupt breastfeeding for 24-48 hrs; substitute w/ formula; and either observe or administer phototherapy |
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- In babies w/ hemolysis = phototherapy doesn’t keep bilirubin below 17.5-23.4 may need exchange transfusion
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All vitamins except what are in human breast milk
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vitamin K
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after 6 months if infant's water doesn't conatain fluoride supply it
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n
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vit d
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Breastfed infants may need Vit. D before 6 mos if the baby not exposed to adequate sunlight (at least 15 mins per week)
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Salt-wasting CAH (Classic) = complete enzyme deficiency; presents as adrenal crisis, w/ lethargy, vomiting, and dehydration that can progress to shock
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•Occurs at 1-2 wks; leads to hyponatremia and hyperkalemia
non classic partial enzyme def = no virilization; only presents when infant stressed |
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jitteriness is distinct from seizures
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passive flexion of limbs can diminish
brief myoclonic jerks = common when infant is falling asleep |
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clonus
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- Newborns = < 10 beats, in not distinctly asymmetric, no other neurologic signs = normal
- 1-2 month old = > 3 beats abnormal |
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breastfeeding assessment
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o > 6 feedings/day & feeding every 2-3 hrs for 10-15 mins each breast
o Weight gain 3-5 days old - 3-5 urines - 3-4 stools - 5-7 days old 4-6 urines 3-6 stools |
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Congenital hypothyroidism signs/sx
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appear normal at birth due to maternal T4
signs evident after 6 weeks of age Early Signs • Feeding problems; dec activity • Constipation • Prolonged jaundice; skin mottling • Large fontanels • Hypotonia; hypothermia • Umbilical hernia Late Signs - large tongue; hoarse cry; puffy myxedematous facies |
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kernig
brudzinski |
KERNIG
- flex hip, extend knee - + if resist extend Brudzinski - supine = flex neck - see if flexes both hips and knees |
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nitrates
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highly specific for bacteruria = few false positive
negative nitrate very poor Sensitivity = lots of false negatives |
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unilateral cervical adenitis
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o Cervical adenitis
o Cat-scratch disease o Reactive node from pharyngeal infxn o Kawasaki disease o Mycobacterial infxn |
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palmar rash
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o Rocky Mt. Spotted Fever
o Kawasaki Disease o Syphilis |
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stawberry tongue
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Erythematous tongue w/ prominent papillae
o Streptococcal pharyngitis o Kawaski o Infectious mono but usually cocontaminant w/ strep pharyngitis |
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diffuse adenopathy and splenomegaly
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o Infectious Mono (EBV or CMV)
o HIV o Histoplasmosis o Toxoplasmosis o Lymphomas/Leukemia/ histiocytosis o Metastatic neuroblastoma & rhabdomyosarcoma |
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Kawasaki Disease
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Fever > 5 days always consider kawaski
Pts < 4 y/o 4/5 criteria in addition to fever for dx |
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4/5 criteria in addition to fever for dx of kawasaki
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• Non-specific rash often involving groin
• Arthralgia • Red eyes or conjunctivitis w/o discharge + limbal sparing o Anterior uveitits present by slit lamp examination in 83% of patients if examined during 1st wk of illness • Strawberry tongue • Lymphadenopathy • Puffy hands & feet, occasionally followed by peeling of superficial skin |
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measles
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• After prodrome fever (over 101) rash develops
• Cough, coryza, and conjunctivitis • Maculopapular rash starts on neck, behind ear, and along hairline. Rash spreads downward reaches feet in 2-3 days |
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roseola
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• Macular or maculopapular rash starts on trunk and spreads to arms and neck
• Rash preceded by 3-4 days of high fevers which end as rash appears • Pts < 2 y/o |
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varicella
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• Rash starts on trunk & spreads to extremities & head
Erythematous macule -> papule -> vesicle -> pustule -> crusts over |
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tx of kawaski
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o High- dose aspirin
o High-dose IVIG = only known therapy to reduce the risk of coronary artery sequelae |
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complications of kawaski
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o CNS (irritability, lethargy, aseptic meningitis) = 90%
o Coronary artery aneurysms = 20-25% untx’d pts o Liver dysfxn = 40% o Arthritis = 30% o Hydrops of gallbladder = 10% o Mitral valve regurgitation and pericarditis |
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grunting
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• Forced expiration against a partially closed glottis
• Suggests diseases of air space such as atelectasis, pneumo or pulmonary edema |
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Acute Bronchiolitis
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• CXR = hyperinflation and scattered atelectasis from bronchial obstruction
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asthma
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• CXR = bilateral hyperinflation and flattening of diaphragms (global air trapping); atelectasis (mucus plugging)
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pneumonia organisms
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3 wk to 4 months old = chlamydia trachomitis
5-6 y/o = strep pneumo school aged child = myoplasma; s. pneumo |
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pertussis
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Whooping cough = vaccine efficacy 70-90%; caused by bordatella pertussis
Triphasic course 1.) Catarrhal stage (1-2 wks) = URI sx 2.) Paroxysmal stage (lasts 4-6 wks) = repetitive forceful coughing episodes followed by massive inspiratory effort; results in whoop (quick staccato cough) Covalescent stage Cough gradually decreases in severity and freq. episodic cough may persist for months |
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foreign body aspiration younger than 5
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Asymmetry of lung sounds (wheezing) = also seen in asthma & bronchiolitis
Inspiratory and expiratory films show unilateral air trapping indicative of a foreign body One hemidiaphragm, flattened, suggesting unilateral hyperexpansion |
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Epiglottitis “supraglottitis”
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Children 2-5 y/o
emergency; Hib |
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croup
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Viral infxn upper and lower respiratory tract causes subglottic inflammation
Causes = parainfluenza, influenza virus, RSV, adenovirus, Mycoplasma pneumo, measles Sx = inspiratory stridor and a barky cough |
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rhonchi and rales
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Rhonci = course crackles
- secretions in large airways - pneumo or bronchitis Rales = fine crackles - secretion small airways - pneumonia |
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volume loss CXR
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foreign body aspiration
or significant mucus plugging |
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uncertain dx of AOM
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< 6 months = antibiotic tx
6 months to 2 yrs = antibiotic if severe illness; observation if nonsevere illness > 2 yrs = observation |
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Abx tx AOM
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High Dose Amoxicillin/clavulanate w/ fevers > 39C or moderate to severe otalgia due to its greater efficacy against nontypeable H. flu
High dose Amoxicillin appropriate first-line tx for rebeccas |
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Otitis media w/ effusion (OME)
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Fluid in middle ear w/o signs or sx of infxn
Asymptomatic; plugged ears; hearing loss; vertigo • TM = amber, non-poorly mobile opaque and retracted |
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Referal for bilateral placement of tympanostomy tubes
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Conductive hearing loss and language delays justify
If not present wait 3-6 months following hearing test and reassess |
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Complications of TM tubes
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- Otorrhea, tympanosclerosis
- Nonfxnal tube due to blockage - Residual perforation after extrusion of tympanostomy tubes |
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normal TM
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translucent TM w/ neutral or retracted position and normal mobility
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correction of hypernatremic dehydration
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Serum Na+ should be lowered slowly < 1 meq/2 hr (10 meq/24)
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degree of dehydration
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Subtract pts’s dehydrated weight from prior weight = assume all weight loss is from total body water
Weight loss in grams equivalent to water loss in cc’s |
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Fluid Composition
D5W D10W NS 1/2NS 1/4NS |
D5W = CHO 5 g/100 ml, 252 mOsm/L
D10W = CHO 10 g/100 ml, 505 mOsm/L NS (0.9% NaCl) = 154 Na+, 154 Cl-, 308 mOsm/L ½ NS (0.45% NaCl) = 77 Na+, 77 Cl-, 154 mOsm/L D5 ¼ NS (0.225% NaCl: CHO 5g/100ml, 34 Na+, 34 Cl-, 329 mOsm/L |
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Osmotic diuresis occurs at
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180 mg/dL
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DKA = follow what to see response to therapy
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ketones
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Hypernatremic and DKA correct evenly over
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48 hrs to prevent cerebral edema due to rapid shifts in intracellular fluid volume
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hyponateremic/tonic
isonatremic/tonic |
24 hrs
12 hrs |
