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Pediatrics > Baby checks > Flashcards

Baby checks Flashcards

1
Q

History

A

Maternal

  • Obstetric
  • medical
  • surgical
  • family/social

Present pregnancy

  • maternal: antenatal, medical etc
  • fetal
  • investigations

Newborn

  • Labour: gestation, gender type, infection, fetal distress
  • Birth: delivery, APGAR, growth parameters, resuscitation
  • Prognosis since birth: concerns, feeding, observations, stool/urine, medications, immunisations
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2
Q

Approach to examination

A 
Generally appearance
Growth
Chest->respiratory and cardiac: easier when quiet
Head, face, neck
Shoulders, arms and hands
Abdomen
Genitourinary
Hips, leg, feet
Back
Neurological
Discuss, document, refer

Parent present

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3
Q

What to discuss with parents

A 
Purpose
Process
Timing 
Limitations
Parental concerns
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4
Q

When to perform checks

A

Initial immediately after birth
Detailed assessment within 48 hours, always prior to discharge
F/U at 5-7 days and 6 weeks

If unwell/immature, as clinically indicated

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5
Q

Environment for examination (5)

A

Lighting, warmth
Correct identifiction
Infection control
Privacy

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6
Q

Equiptment required

A 
Warmer
Stethoscope
Opthalmoscope
Tongue depressor
Pensil Light
Tape measure, scales, centile charts
Pulse oximetry
Documentation->infant personal health record, medical health record
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7
Q

Components to assess at general appearance

A 
Skin colour, integrity, perfusion
Alertness
Activity, ROM
Posture
Tone
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8
Q

Growth status components

A

HC
Length
Weight

Check 3 times for HC

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9
Q

Head, face, neck components

A 
• Head shape, size
• Scalp, fontanelles, sutures
• Eye size, position structure
• Nose, position, structure
• Ear position, structure
• Mouth, palate, teeth, gums
tongue, frenulum
• Jaw size
Neck
Clavicles
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10
Q

Shoulders, arms and hand components

A 
Length
Proportion
Symmetry
Structure
Number of digits
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11
Q

Chest components

A 
• Size, shape, symmetry,
movement
• Breast tissue, nipples
• Heart sounds, rate, pulses
• Breath sounds, resp rate
• Pulse oximetry (optional)
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12
Q

Abdomen components

A

Size, shape, symmetry
Palpate liver, spleen, kidneys
Umbilicus

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13
Q

GU components

A 
Male- penis, foreskin, testes
Females- clitoris, labia, hymen
FEMORAL PULSES
Anal position, patency
Passage of urine and stool
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14
Q

Hip, legs, feet comopnent

A

Ortolani, Barlows

Leg length, proportions, symmetry, digits

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15
Q

Back component

A

Spinal column, skin

Symmetry of scapulae and buttocks

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16
Q

Neurological component

A 
Behaviour
Position
Muscle tone, spontaneous movements
Cry
Reflexes->Moror, suck, grasp
17
Q

Risks of DDH (4)

A

Female
First born
Feet first
Family history

18
Q

Further investigations required if findings on growth and appearance- include the urgent and reasons

A

Dysmorphic- syndromes
Excessive weight loss- breast fed baby may lose up to 10% body weight in first few days
Petechiae not a result of mode of delivery->thrombocytopenia, coagulation, vascular disorders (autoimmune, infections etc)
Pallor
Hemangioma->may rarely cause high output CF

  • Billious vomiting
  • Jaundice
19
Q

Further investigations required if findings on head and neck

A 
Macro/microcephaly
Caput/cephalohematoma
Fused sutures
Facial palsy/assymmetry
Hazy/dull cornea
Absent red reflex->retinoblastoma, congenital cataracts
Unequal pupils/dilated/constricted
Purulent conjunctivitis
Dacryocyst->nasolacrimal duct obstruction= infection and epiphora
Cleft lip/palate
Unresponsive to noise
Ear drainage
Small receeding chin/micrognathia
Neck masses/swelling/webbing
Swelling over or fractured clavicle
  • Enlarged/buldging/sunken fontanelle
  • Subgaleal hemorrhage->+association with head injury
  • Non patent nares
20
Q

Further investigations required if findings on upper limbs

A

Limb hypotonia, contractures or palsy

Palmar crease pattern

21
Q

Further investigations required if findings on chest

A

Abnormal HR, rhythm, regularity
Heart murmurs

  • Respiratory distress
  • Apnoeic episodes
  • Weak or absent pulses
  • Positive pulse oximetry
22
Q

Further investigations required if findings on abdomen

A

Inguinal hernia

23
Q

Further investigations required if findings on GU

A

Hypospadias
Penile chordee
Micropenis

  • No urine/meconium in 24 hours
  • Ambiguous genitalia
  • Testicular torsion
24
Q

Further investigations required if findings on Hips, legs and feet

A 
Risk factors for hip dysplasia
\+Barlows/Ortolani
Contracture, hypotonia
Fixed talipes
DHD
25
Q

Further investigations required if findings on back

A

Curvature of spine
Non-intact spine
Tufts of hair/dimple along the spine

26
Q

Further investigations required if findings on neurological

A

Weak/absent cry
Absent reflexes
No response to consoling
Inappropriate carer response to crying

  • Seizures
  • ALOC
27
Q

Discaharge requirements

A

Review discharge requirements->observations, feeding, output

Discuss:

  1. Routine tests->Hearing, hepatitis B, NNST
  2. Support agencies–>GP, Child/community health, lactation support, 13 health
  3. Health promotion
    - Feeding and growth
    - Jaundice
    - SUDI (sudden unexpected death in infancy), injury prevention
    - Immunisation
    - Signs of illness
  4. Infant personal health record
  5. Referral and follow-up->routine at 5-7 days and 6 weeks
28
Q

Aspects of health promotion

A 
Feeding and growth
Jaundice
SUDI, injury prevention
Immunisation
Signs of illness

Pediatrics (58 decks)

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