Adolescents Flashcards
Social and environmental factors that affect children’s development from 1-4 y/o
. Chronic illness
. Hold abuse
. Poverty
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
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
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
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
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
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
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
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
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
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
.
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
Screening procedures for children
. Bp after age 3
. BMI after age 2
. Annual vision and hearing screenings
. Lead levels in high risk patients
What is the critical age for preventing childhood obesity?
Age 1-4
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
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
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
