3 Flashcards
Vision and hearing screening
Vision screening using a chart begins at age 3 years.
Hearing evaluation through audiometry beings at age 4 years.
Nursemaid elbow
Nursemaid’s” elbow (radial head subluxation) reduced in the local emergency room.
Secondary to being pulled or lifted by the hand
Ex. Uncle had been swinging him around with his arms out straight. Cried loudly and was immediately brought to ED. Subluxation reduced by supination and external rotation. No fracture. After about 10 minutes he began to use the arm again so was discharged.)
Eczema Aka atopic dermatitis
2 things to ask about that can accompany it that start with an a
Familial?
Differential dx - 2
Treatment - 4 (what is inadequate and what is a second line tx)
Eczema has been called “the itch that rashes,” because there is a cycle of irritation leading to scratching, leading to the rash. Educate parents that anything leading to itching (even a child’s rubbing his face on Mom’s sweater) can exacerbate eczema.
Eczema and Allergies
Although eczema often occurs without a history of allergies, such a history would support an atopic diathesis and should prompt you to ask additional questions about allergic triggers and asthma symptoms.
Family History
While eczema tends to be familial, there is typically a multifactorial inheritance pattern and often clear environmental (allergic) triggers.
Ask about allergic rhinitis and asthma
Differential Diagnosis
Sometimes eczema may be confused with the other common inflammatory rashes:
Psoriasis: Although psoriasis can occasionally first look like eczema, it is rare in young children. When present, it occurs as a generalized rash known as guttate (droplet-shaped) psoriasis. Guttate psoriasis is usually precipitated by a strep infection.
Seborrhea: This should also be part of the differential diagnosis, especially in early infancy (e.g., cradle cap). It is unusual to have a new case of seborrheic dermatitis at age 3.
Treatment
The basic tenets of the treatment of eczema are:
Protecting skin by lubricating extensively
Using anti-inflammatories in short bursts, and
Treating associated skin infections aggressively.
Pharmacological Treatment
In developing an effective treatment plan, it is important to understand what treatment has been used already and with what results.
Steroids
Prescribe topical steroid, alternating a higher potency for severe flares with a lower potency for minor bouts.
Often over-the-counter hydrocortisone is inadequate.
Topical anti-inflammatories
Calcineurin inhibitors are considered second line therapy. Although effective, safety concerns remain for long term use.
Antihistamines
Remember that sometimes simply prescribing antihistamines can help with the itch:
The non-sedating antihistamines approved for children, loratidine, fexofenadine and cetirizine may be effective. Traditional antihistamines (with sedative side effects) such as diphenhydramine and hydroxyzine are often used at bedtime to decrease itch.
Tips with juice and dental caries
Dental appt
No more than 4-6 oz of juice per day, bottle after 12-15 months increase chances of dental caries, also too much milk and juice can increase the chances as well
Bathing teeth throughout the day with milk or juice from a bottle can result in early dental caries.
Within 6 months of first tooth eruption or by one year of age
Early childhood caries typically have a lag time before visible decay. Thus the patterns established when a child is 1 to 3 years old may result in caries when the child is 3 to 5 years old.
Although constant use is most damaging, even routine bedtime use of the bottle can lead to cavities. It is recommended that parents discontinue the bottle by the time the child is 12- to 15-month-olds. In older toddlers, it becomes more difficult if the bottle has become their transition object or “lovey.”
Lead testing, tb testing and fingerstick hb/hct
All children 12 to 24 months of age in areas where > 25% of housing was built before 1960 or where the prevalence of blood lead levels > 5 μg/dL in children is 5% or greater.
· Individual children who live in or regularly visit homes/facilities built before 1960 that are in poor repair or have been renovated within the past 6 months.
Risk factors warrant tb
Fingerstick hemoglobin (A) is recommended as a screening test for anemia at 12 months for all children and at any age if risk factors for iron deficiency are present. A CBC is more expensive. Poor nutrition/picky eater puts child at risk for anemia, in a healthy child iron deficiency is most likely ( iron def has a possible impact on cognition)
Combating a picky eater
Stop the bottle now. If a toddler is still using a bottle, this should be stopped. It is helpful to actually have the toddler and the caregiver jointly discard the bottle in the trash to show him it is gone for good. Usually children stop their requests for the bottle after a few days.
Limit the child’s eating to 3 meals and 2 snacks, stopping the food and drink grazing. If the child is thirsty, give him water, not juice. Limiting the amount of juice a toddler drinks may improve his nutrition in several ways. For one, when he is drinking juice or milk, his appetite for solids is blunted. He needs adequate solids for energy and vitamins.
No bargaining or cajoling. The child should eat at time-limited meals. He needs to have his hunger ultimately drive his choices, and only healthy options should be provided. Dessert should never be held as an incentive for “good” eating.
Gradually change his diet content by introducing new foods he is likely to try and slowly decrease the quantity of old favorites.
Strabismus
Misalignment of the eyes (crossed eyes/eyes don’t look in the same direction)
Can lead to amblyopia Aka lazy eye (poor visual development)
Anemia 3 tiers
Microcytic - iron def, thalassemia, chronic infection, sideroblastic
Normocytic - acute blood loss, sickle cell dis, g6pd deficiency, hereditary spherocytosis
Macrocytic- folate def, b12 def, liver dis, hypothyroidism, hemolytic anemia
