Adolescents Flashcards
4 principles of child development
- Child development proceeds along a predictable pathway 2. Range of normal is wide 3. various factors affect development(social, environmental, diseases) 4. The developmental conducts how one does the history and physical(hx from a 5 yr old is different than that from some bratty teen)
5 APGAR components
1.Appearance(Color): Blue=0, pink body/blue extremities=1, pink all over=2 2.Pulse(HR):Absent=0, 100=2 3.Grimace(Reflex irritability): no response=0, 4.Grimace=1, Cries vigorously, sneezes, coughs=2 5. Respiratory Effort: absent=0, slow and irregular=1, good/strong=2
APGAR Ranges at 1 minute
Normal is 8-10, at 1 minute 5-7 means some nervous system depression 0-4 is severe depression, requiring immediate resuscitation
APGAR Ranges at 5 minutes
Normal is 8-10 0-7= High risk for subsequent CNS and other organ dysfunction
Gestational age
Preterm 42 weeks
Birth weight Classification
Extremely low < 2500 g normal >= 2500
Newborn Classification
Small for gestational age(SGA) 90th percentile
True or Flase: You should examine the newborn prior to feeding since they will be the most responsive at that time.
False: The baby is most responsive 1-2 hours after feeding and that is the optimal time for the exam.
How much should an infants height and weight increase in one year?
Birth weight should triple and height should increase by 50%
At what times is it recommended to have health supervision visits?
Birth, 1st week, then at 1, 2, 4, 6, 9, 12 months. Called the Infant Periodicity Schedule.
Failure to Thrive
Inadequate weight gain for age: Growth2 quartiles in 6 months, weight for height < 5th percentile
Causes of microcephaly
ie: small head circumference= chromosomal, congenital infection, maternal metabolic disorder, neurologic insult.
Causes of macrocephaly
> 97th percentile= hydrocephalus, subdural hematoma, tumor, familial-benign with notmal brain growth
Blood pressure norms
Doppler method is the most easily used to get a systolic pressure. in males is should be 70 mmHg at birth, 85 at 1 month, and 90 at 6 months.
Heart Rates from birth to 1 year
birth to 2 months is 140 range is 90-190 birth to 6 months is 130 range is 80-180 6-12 months is 115 range is 75-155
Pulse that is too rapid may be caused by:
Paroxysmal SVT
Bradycardia in an infant:
drug ingestions, hypoxia, intracranial conditions, heart block
Respiratory Rate
between 30-60 in the newborn.
Tachypnea birth to 2 months
greater than 60/min
Tachypnea 2-12 months
greater than 50/min
Fever can raise rate by (blank) for each degree rise in temp. PNA is common cause
10
rapid shallow rates may mean:
cyanotic cardiac disease, right to left shunt, metabolic acidosis
Temperature
Average Rectal temp is higher-99.0 F until age 3 years
Fever in infants less than 2-3months
greater than 38C or 100F
Cutis Marmorata
Vasomotor abnormality in the dermis due to cooling or chronic exposure to heat. Lattice-like bluish mottled appearance on the trunk, arms, and legs. May last for months. Could also be due to hypothyroidism, Down syndrome
Acrocyanosis
Blue cast to the hands and feet when exposed to cold. Common in newborns and may occur throughout infancy. If it DOES NOT disappear within 8 hours or with warming r/o cyanotic congenital heart disease
Harlequin Dyschromia
Occasionally in newborns there is a transient cyanosis over one half of the body or one extremity, presumably from vascular instability
Central Cyanosis
Assessed at the tongue, oral mucosa, NOT the nails. May signify congenital heart disease
Cafe Au Lait spots
Pigmented light brown lesions <1-2cm. Isolated= no big deal. Multiple lesions with smooth borders may mean Neurofibromatosis
Miliaria Rubra
Scattered vesicles on an erythematous base, usually on the face and trunk, result from obstruction of the sweat ducts; disappears within weeks
Erythema Toxicum
May appear at 2-3 days of life. Rash that consists of erythematous macules with central pinpoint vesicles scattered diffusely over the entire body. Look like flea bites. Unknown etiology and should disappear in 1 week
Pustular Melanosis
More common in African American infants. Appears at birth. Rash of vesiculopustules over a brown macular base. May last for months.
Milia
Pin sized smooth white raised areas without surrounding erythema on the nose, chin, and forehead resulting from retention of sebum in the openings of the sebaceous glands. Appears within the first few weeks and disappears over several weeks.
Lanugo
Fine, downy growth of hair that covers the entire body, especially the shoulders and back. Sheds within the first few weeks. More prominent in premature infants
Jaundice
You should know what this is. You should also know that if it appears within the first 24 hours it may mean hemolytic disease of the newborn. If it persists beyond 2-3 weeks it may mean biliary obstruction of liver disease
Salmon Patch
also called a stork bite or capillary hemangioma. May appear on the nape of the neck, eyelids, forehead, or upper lip. They are distended capillaries and not nevi and should disappear in a week.
Anterior Fontanelle
at birth it measures 4-6cm in diameter and usually closes between 4 and 26 months(90% twixt 7-19 months)
Posterior Fontanelle
usually measures 1-2cm and closes by 2 months. Enlarged posterior fontanelle may mean congenital hypothyroidism
Molding
Overlap of the sutures at birth. Due to passage of the head in vaginal birth. disappears in 2 days
Caput Succedaneum
Swelling in the occipital region from vaccuum effect of amniotic sac rupture. CROSSES the suture lines. resolves in 1-2 days
Cephalohematoma
scalp swelling caused by subperiosteal hemorrhage from trauma at birth. This does NOT cross over the suture and resolves in 3 weeks. May have calcified rim with a soft center
dolichocephaly
Premature infants head that has a long occipitofrontal diameter with a narrow bitemporal diameter. Resolves in 1-2 years
Plagiocephaly
asymmetrical shape of the head when an infant lays on one side too much. Can resolve spontaneously or it signify torticollis-injury to the SCM, or lack of stimulation of the infant
Craniosynositis
Premature closure of the cranial sutures-abnormally shaped skull
Sagittal suture synositis
Narrow head from lack of growth of the parietal bones
Craniotabes
upon palpation of the infant skull, the bones may feel soft. In this condition they will feel “springy”. Signify increased ICP with hydrocephaly, metabolic disturbances like rickets, and congenital syphilis
Chvosteks sign
Palpate the infants face. + sign is cosistent facial contraction and it may mean hypocalcemic tetany, tetanus, or tetany due to hyperventilation
Strabismus
Convergent or divergent persisting beyond 3 months, or persistent strabismus of any type may indicate ocular motor weakness.
Visual Milestones in infancy
Birth- Blinks, may regard face 1 month- Fixes on object 1.5-2 months- Coordinated eye movements 3 months- Eyes converge, baby reaches 12 months- Acuity around 20/50
Optic Blink Reflex
Blinking in response to bright light and to the quick movement of an object toward the eyes
Red Relfex
Red color from the retina reflected when viewing the infants eyes through the opthalmascope from 10 inches away
Cloudy Cornea
Due to congenital glaucoma. obscures the normal red reflex
White Retinal Reflex
Leukokoria-could be caused by cataract, retinal detachment, chorioretinitis, or retinoblastoma
True/False: Small retinal Hemorrhages can be normal in some newborns.
True. But extensive retinal hemorrhages may mean severe anoxia, subdural hematoma, subarachnoid hemorrhage, trauma
True/False: Retinal pigment changes are common and normal during the ocular development of a newborn?
False: pigment changes occur with things like congenital toxoplasmosis, cytomegalovirus, rubella
Assess the position of the ears in a newborn
An imaginary line from the inner/outer canthi of the eyes should cross the auricle or pinna. If not the kid has low set ears. May indicate congenital defects like renal disease
Acoustic blink reflex
blinking of the infants eyes in response to a sharp sound.
Signs that an infant is able to hear
0-2 months- startle in response to loud noise, calms to soothing voice/music. 2-3 months- change in body movements in response to a sound, change in expression to familiar sounds. 3-4 months- Turning eyes and head to sound. 6-7 months- turns to listen to voices and conversation.
What is the most important component of assessing the newborn nose?
Patency of the nasal passages. Occlude one nostril then the other. If you occlude both simultaneously, you are an idiot.
Shrill or high pitched cry:
increased ICP. Or kids born to narcotic-addicted mothers.
Hoarse cry
Hypocalcemic tetany or congenital hypothyroidism
Continuous inspiratory and expiratory stridor
upper airway obstruction or delay in development of the laryngeal cartilage
Absence of cry
severe illness, vocal cord paralysis, or profound brain damage
Epstein’s Pearls
tiny white or yellow rounded mucous retention cysts located along the posterior midline of the hard palate. Disappear within months
Apnea
Cessation of breathing for more than 20 seconds. May be accompanied by bradycardia
Peripheral pulses in neonates
Brachial, ante cubital fossa, femoral and temporal
Most common dysrhythmia in infants
Paroxysmal SVT or paroxysmal atrial tach. Can occur at any age or in utero.
Closing ductus murmur
In newborns- transient, soft, ejection murmur at ULSB
Peripheral pulmonary murmur
Soft ejectile murmur(systolic) ULSB radiating to axillae
Premature thelarche
Breast development that occurs twixt 6 months and 2 years
True/False: the clavicle may be fractured at birth.
TRUE
Ortolani test
tests for a posteriorly dislocated hip. Abduct both hips. Listen for the “clunk”. A palpable movement of the femoral head back in= positive Ortolani.
Barlow
Tests the ability to sublux an intact but unstable hip.
Galeazzi or Alice test
Test done at 3 months to assess for femoral shortening. Baby supine, knees bent with feet flat on table-are the knees in line or not?
True/False: True deformities of the feet do not not return to the neutral position with manipulation.
True. Inward deviation of the feet is common position in utero. The clinician should be able to align them into the neutral position, unless it is a deformity.
Talipes Equinovarus
Club foot. Most common severe congenital foot deformity.
Assess CN I
Difficult to assess.
Assess CN II
hold the baby and look him/her in the eye and look for facial response and tracking
CN III
Response to light, blink reflex
EOM’s
III, IV, VI- observe the baby tracking a light or a zit on your face.
CNV
Motor- rooting reflex, sucking reflex
CN VII
Observe baby crying, smiling. Not symmetry of face and forehead.
CN VIII
Acoustic blink reflex
CN IX, X
swallowing? gag reflex
CN XI
observe symmetry of shoulders
CN XII
sucking swallowing, tongue thrusting, pinch the nostrils and observe reflex opening of the mouth
Anal Reflex
Present at birth and should be assessed for spinal cord patency
Grasp reflex
baby will flex all fingers when something is placed in the palm. birth to 3/4months
Plantar grasp reflex
toes should curl when the sole of the foot is touched at the base of the toes. Birth to 6/8months. Persistence may suugest pyramidal tract issue.
Moro reflex
hold baby supine ad lower abruptly. arms should abduct, hands open and legs flex. birth to 4 months. Persistence may suggest cerebral palsy
Asymmetric tonic neck reflex
baby supine, turn head to one side, arms and legs on the side where the head is turned should extend the opposite side should flex. Birth to 2 months. persistence may suggest cerebral palsy or asymmetric CNS issue
Positive support reflex
hold the baby up and let legs extend and feet touch the table, kid should partially stand. birth or 2 months to 6 months. Lack of this= hypotonia, spasticity= neurologic disease or palsy
Rooting reflex
Stroke perioral skin, mouth should open and baby will turn toward stimulus. absence may indicate general CNS issue
Trunk Incurvation(Galant’s Reflex)
hold baby prone and stoke one side of the back 1 cm from midline from shoulder to butt-spine should curve towards the stimulated side. Birth to 3/4 months. Absence may mean spinal cord injury
Placing and stepping reflex
pretend walking reflex. variable age to disappear. absence may mean paralysis, also babies born breech may not have placing reflex.
Landau reflex
hold baby prone with one hand. The head should lift up and spine will straighten. Persistence may indicate delayed development
Parachute reflex
suspend the baby prone and slowly lower the head, arms and legs will extend in a protective fashion. 4-6 months and does not disappear. Delay may indicate delays in voluntary motor development.
Development Quotient
developmental age divided by chronological age times 100. Normal is greater than 85 possibly delayed is 70-85 delayed is less than 70
