Adolescents Flashcards by Emily Mosher

Social and environmental factors that affect children’s development from 1-4 y/o

. Chronic illness
. Hold abuse
. Poverty

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Physical development of kids 1-4 y/o

. Rate of physical growth slows by 1/2
. After 2, toddlers gain 2-3 kg/year and grow 5 cm/year becoming leaner and more muscular
. Walk by 15 mo
. Run well by 2 yrs
. Pedal a tricycle and jump by 4 yrs
. fine motor skills through neurologic maturation and environmental manipulation
. 18 mo old scribbles
. 2 y/o draws lines
. 3 y/o jumps in place, balances on 1 foot
. 4 y/o who makes circles
. 5 y/o skips, balances well

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Cognitive and language development in 1-4 y/o

. Toddlers move from sensorimotor learning (touching and looking) to symbolic thinking, solving simple problems, remembering songs and engaging in imitative play 
. 18 mo has 10-20 words
. 2 y/o can do 3 word sentences
. 3 y/o ca converse well 
. 4 y/o can form complex sentences 
. 5 y/o copies figures and defines words

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Social and emotional development in 1-4 y/o

. Emerging drive for independence 
. Temper tantrums common from impulsive and poor self-regulation 
. 1 y/o: plays games
. 2 y/o imitates
. 3 y/o feeds self
. 4 y/o imaginative, sings
. 5 y/o dresses self and plays games

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Physical development 5-10 y/o

. Children grow steadily but more slowly
. Strength and coordination improve dramatically w/ more participation in activities
. Children become more aware of limitations due to their physical disabilities and chronic illnesses

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Cognitive and language development 5-10 y/o

. More capable of limited logic and more complex learning (concrete operational)
. Remain rooted in the present w/ little ability to understand consequences or abstractions
. School, family, and environment greatly influence learning
. Ability to thrive in different situations
. Language increasingly complex

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Social and emotional development 5-10 y/o

. More independent, initiating activities and enjoying accomplishments
. Self esteem critical
. Develop a fit w/in major social structures
. Guilt and poor self esteem may also emerge
. More development remains simple, but there is concrete sense of right and wrong

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How to examine younger (1-4) children

. Patience, distraction, play, flexibility, caring but firm and gentle approach
. Examine on parent’s lap, try to be eye level
. Examine child’s toy and then child
. Let child do some of examination (move stethoscope)
. Engage child

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Examining older child (5-10 y/o)

. Provide gowns and leaving undies in place as long as possible
. Parents should stay in room but have opposite=sex siblings leave

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How to establish rapport

. Greet each person in room, 
. Refer to kid by name
. Address parents as Mr and Mrs
. Eye contact at their level
. Participate in playful engagement

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How to work with families

. Start questions w/ kid, simple, open-ended
. Parents verify info
. When child is embarrassed begin convo w/ parents but direct questions back to child eventually
.

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How to do health promotion w/. Children

. Offer age appropriate guidance
. Advise about upcoming developmental changes
. Integrate explanation of clinical findings w/ health promotion
. Review immunizations and anticipated vaccines for next visit

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Screening procedures for children

. Bp after age 3
. BMI after age 2
. Annual vision and hearing screenings
. Lead levels in high risk patients

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What is the critical age for preventing childhood obesity?

Age 1-4

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Health promotion for 1-4 y/o

. Visits at 12, 14, 18, 24,30, and annually at 3 and 4 y/o
. Address parents concern, evaluate child’s growth and development
. Perform comprehensive physical exam
. Provide anticipatory guidance about healthy habits and behaviors

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Health promotion for 5-10y/o

. Health visit annually
. Address parent concerns, evaluate growth and development
. Focus on healthy habits (good nutrition, exercise, reading, health sleep hygiene, screen time)
. 12-20% kids in this age range have some type of harmonic physical, developmental, or mental condition

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Allergic rhinitis

. Inflamed nasal mucosa
. Causes rhinorrhea, congestion, cough, post-nasal drip
. Adenoid facies
. High arched palate 
. Allergic shiners
. Retrognathia

Downsyndrome is assoc. w/ ____

. Duodenal atresia
. Atrioseptal defect
. Aganglionic megacolon

Hypothyroidism

. No physical signs present at birth 
. Macroglossia
. Enlarged fontanelles
. Hypotonia
. Umbilical hernia
. Hoarse cry
. Can lead to physical and neuro delays if untreated

Hyperthyroidism

Graves’ disease
. Elevated T3/4, low TSH
. Goiter and bulge eyes

Fetal alcohol syndrome

. Distinct facial features
. Intellectual disability
. Slow physical growth and small brain size
. Thin upper lip, smooth philtrum

Congenital syphilis

. Centrally notched incisors (Hutchinson’s teeth)
. Saddle nose
. Rhinitis
. Frontal bossing
. Desquamating, vesiculo-bulbous rash on hands and feet

Facial n. Palsy

. Common birth injury
. CN VII
. Mm. Of facial expression effected

Otitis media cause and treatment

. High dose amoxicillin
. Augmentin if fails
. Causes: strep pneumo, haemophilus influenzae, moraxella catarrhalis, strep pyogenes

Oral thrush

. Candida albicans . Causes bleeding when scraped . Treat w/ oral nystatin if it doens’t go away

Hermetic stomatitis

``` . Painful oral ulceration . Patients drooling, bleeding . Often admitted for hydration . Refusal to eat . Supportive therapies . Acyclovir warily in course may shorten duration of illness ```

Issues w/ eyes seen in children

. Brushfield spots: on periphery of iris . Strabismus . Sclera icterus

Issues with teeth in children

. Dental caries: avoid bottle after 1, no bottle in bed, dental hygiene once first tooth is present . Teeth discoloration: tetracycline

Lymphadenopathy

. Bilateral vs unilateral . Causes: EBV, Tb, Cat scratch disease, malignancy . Bacterial cervical lymphadenitis typically unilateral

Strep Pharyngitis

``` . Palatal petechiae . Tonsillar exudates . Diagnosis: fevers, LAD, tonsillar exudates, absence of cough . Stage 0-1: under 10% . 2-3: 11-35% . 4: 50% . Rapid strep swab: sensitive screening test . Throat culture: specific, 24-48 hrs . Treatment: amoxicillin or azithromycin ```

Tanner sexual maturity staging

. Scale for determining stage of puberty . Helps to determine if pubertal delay is present . Pubic hair staging

Female tanner sexual maturity stages

1: prepubertal, elevation of papilla only 2: breast buds are noted or palpable, enlargement of areola 3: further enlargement of the breast and areola w/ no separation of the contours 4: projection of the areola and papilla to form a secondary mound above the level of breast 5: adult contour breast w/ projection of papilla only, areola recesses to breast contour

Tanner stages for males

. 1: describes prepubertal genitalia . 2: enlargement of testes and scrotum, w/ reddening and thinning of scrotum, but no enlargement of penis . 3: the penis begins to enlarge, first in length and later in diameter, testes and scrotum continue to enlarge . 4: testes and scrotum continue to enlarge w/ continued lengthening of the penis and enlargement of the glans . 5: represent genitalia of adult size and proportion

Preventable diseases that have vaccinations

``` . Measles . Polio . Tetanus . Meningitis . Rubella, varicella, HPV/cervical cancer, HiB . Pertussis ```

Measles

``` . Rubeola . Part of MMR vaccine . Cough, coryza, conjunctivitis, Koplik spots . Highly contagious . Can lead to encephalitis ```

Polio

. Paralytic illness . Fever, headache, stiffness, weakness . Infected children typically have 1 affected leg . Last known case in USA was in 1993

Tetanus

. DTaP vaccine . Clostridium tetanus . Muscle rigidity, lockjaw, inability to swallow, seizures . Neonatal tetanus typically from infected umbilical stump or from home births

Rubella

. Pinpoint maculopapular rash, fever, lymphadenopathy . Congenital rubella syndrome: Blueberry muffin rash, congenital heart disease, cataracts, hearing loss, hepatosplenomegaly, jaundice

Varicella zoster

. Vaccine developed in 1995 . Fever, malaise, pharyngitis . Rash in various stages . Can lead to Reye’s syndrome (encephalopathy and hepatic illness)

HPV in children

. Causes cutaneous and genital warts . Strains 6 and 11 cause 90% of genital warts . Almost all cases of cervical cancer linked to HPV . 86% decline in serotypes 6, 11, 16, 18 in cervical samples of women from age 14-19

HiB

``` . Epiglottitis . Symptoms: dysphagia, drooling, respiratory distress . Abrupt onset . Hot potato voice . Tripod position, sniffing position . Meningitis, otitis media, pneumonia ```

Bordetella pertussis

``` . DTaP vaccine . Whooping cough . Apnea in infants . Paroxysmal cough . Treat w/ azithromycin and treat home contacts ```