2 Flashcards
Transition to regular cow milk
Why no cow milk until that age?
is important to never give regular cow’s milk until 12 months of age.
Infants do not tolerate the protein mixture of unaltered cow’s milk and may develop colitis, causing microscopic bleeding and gradually worsening anemia. also high concentration of protein and minerals can stress newborn kidneys
Calorie requirement of 1-2 month olds
Term infant Adequate growth for a term infant requires approximately 100 to 120 cal/kg/day. Average daily weight gain for a term infant is 20 to 30 grams.
Preterm infant Preterm infants require 115 to 130 cal/kg/day.
VLBW (very low birth weight) infants These infants require up to 150 cal/kg/day.
Car seat safety
Children under age 13 years old should not sit in the front seat.
Until age 2 years, children should face rearward.
The National Safety Transportation Board and the AAP stress that the back seat is the safest place in a vehicle for children.
The middle of the back is the most protected part of the automobile.
Car seats for children are required by law in all 50 states. Proper use is essential for optimum performance.
The most effective car-seat restraint is a five-point harness, consisting of two shoulder straps, a lap belt and a crotch strap.
Healthy Infants weight
Lose weight right after birth, but should be back to birth weight in 2weeks
Double birthweight at 4 months and triple it by 12 months
Some anticipatory guidance about sleep and intro of food
Introducing new foodat 6 months every 5-7 days, can start introducing food between 4-6 months if baby ready
Babies sleep through the night between 4-6 months, at 6 months they should take 2 naps
Neuroblastoma
Labs
Prognosis
The most frequently diagnosed neoplasm in infants; more than half of patients present before age 2.
The tumor may present as a painless mass in the neck, chest, or abdomen.
Children with an abdominal neuroblastoma may be asymptomatic; however, they may also appear chronically ill and may have bone pain from metastases to the bone marrow or skeleton.
Fever, pallor, and weight loss are frequent presenting symptoms.
Neuroblastoma is a likely diagnosis in an infant younger than a year of age who has an asymptomatic RUQ abdominal mass and pallor and no jaundice.
Associated with neurofibromatosis and hirshsprung disease and n-Myc oncogene
Histopathology reveals “small round blue cells” or small, uniform cells containing dense, hyperchromatic nuclei and scant cytoplasm, forming small cell rosettes.
Urinary HVA/VMA will be elevated in 90-95% of cases.
A CBC may reveal anemia or other cytopenias that are secondary to bone marrow infiltration.
Less than 1 yoa, tumor likely to regress spontaneously (embryonal cell line origin), non n myc oncogene amplification is a good prognosis
18 month old dev milestones
At 18 months, a child should be able to walk backward, and 50–90% of children can run at this stage. An 18-month-old should be able to scribble, build a tower of 2 cubes, have 3-6 words in her or his vocabulary, and be able to help in the house and remove garments.
Mark is a 5-month-old male who is brought to the urgent care clinic with a three-day history of rhinorrhea and non-productive cough. When he was born he was large for gestational age, and his exam then was notable for macrocephaly, macroglossia, and hypospadias. On physical exam now his vitals signs are stable. He has copious nasal discharge, but his lungs are clear to auscultation. On abdominal exam, you palpate an abdominal mass on the right side just below the subcostal margin. It is 7 cm in diameter and does not cross the midline. The abdomen is soft and non-tender with active bowel sounds. What is the most likely cause of his mass?
Wilms’ tumor is a renal tumor and is commonly associated with Beckwith-Wiedemann syndrome, a genetic overgrowth syndrome. Other features that may be seen in children with this syndrome include omphalocele, hemihypertrophy, hypoglycemia, large for gestational age, and other dysmorphic features.
Usually in 2-5 year olds and usually don’t cross midline
Also assoc with neurofibromatosis (A condition that causes tumors to form in the brain, spinal cord, and nerves.), wagr syndrome ( wilms tumor, aniridia, gu abnormalities, mental retardation)
Screening for autism
Specific autism screening is recommended at 18 months and age 2 years.
Give vitamin d for less than how many oz
32 oz
Diff dx for RUQ mass in child 5
Hepatic neoplasm- rare in children, jaundice maybe
Hydronephrosis- upj obstruction cause kidney to swell up bc urine can not flow; multicystic kidney disease can be another cause of obstruction
Neuroblastoma - commonly seen in adrenal glands, before age 2; fever, weight loss and pallor, may cross midline
Wilms tumor Aka nephroblastoma- rarely cross midline, abd pain or vomiting may be seen in 50% of patients, median age is 3 years old
Teratoma- rare form of cancer and also rare in children
