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Sasha: Module 12 Pediatrics > CA powerpoint-- Normal Growth and Development > Flashcards

CA powerpoint-- Normal Growth and Development Flashcards

1
Q

considered primary care

A

pediatrics

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2
Q

pediatrics Patient population

A

newborn to age 21

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3
Q

how do we measure growth and development?

A

height
weight
vital signs

measure to same gender and age!

milestones they have to meet

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4
Q

overall goal of well child visits

A

disease prevention and health promotion

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5
Q

Frequency of well child visits

A

1-2 weeks then at 2, 4, 6, 9, 12, 15, 18, 24 months then annually thereafter

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6
Q

what are you addressing at a well child visit?

A
  1. concerns of parents caregivers
  2. check growth and development
  3. immunizations
  4. screening tests
  5. anticipatory guidance
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7
Q

physical exam, growth charts, milestones

A

thing checked in growth and development part

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8
Q

disease and health prevention at a young age can result in _______ health outcomes for decades

A

improved

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9
Q

ASK!
Build report
provide written informaiton

A

address concerns of parents/caregivers

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10
Q
  • -> Follows predictable pathway: kids go further they don’t go backwards (ie. if they can stand … if they come in again and can’t stand you have an issue)
  • ->Wide range of ‘normal’
  • ->Various factors affect development
  • ->Child’s developmental level affects how you conduct the history & physical exam
A

Principles of child development

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11
Q 
physical
cognitive
social
environmental
diseases
A

various factors that affect development

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12
Q

Remember – document source of info & reliability

Prenatal history – maternal health (exposure to alcohol, drugs, Rxs)

Gestational age at birth – preterm?

Immediate postnatal history – Apgar, hospital course

Medications/allergies- this might effect growth and development

Past medical history – immunization status, screening tests (blood test taken right after birth)

Family history – inherited d/o

Social history – living arrangement, substance use exposures

A

History taking for a well child visit

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13
Q

when do you start checking BP and how often

A

at age 3, check annually

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14
Q

physical exam

growth charts

MIlestones

A

other things to check for growth and development

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15
Q

Physical Development (fine motor skills, gross motor skills)

Cognitive and language development

Social and Emotional Development

A

Milestones

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16
Q

Typical child follows trajectory of increasing physical size & increasing complexity of function

A

Normal Growth & Development

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17
Q

Child _____ birth weight within 1st year

A

triples

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18
Q

child achieves _______ of brain size by age 2.5-3 years old

A

two-thirds

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19
Q

birth to 36 months

A

infant

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20
Q

Growth Chart

Infants, birth to 36 months

A

Length-for-age and weight-for-age

Head circumference-for-age and weight-for-length

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21
Q

2 to 20

A

children and adolescents

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22
Q

Growth chart

children and adolescents, 2 to 20

A

Stature-for-age and weight-for-age

BMI-for-age : start measuring at 2

Weight-for-stature (ages 2 to 5 years only)

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23
Q

in children normal BP is based on

A

age, gender, height

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24
Q

in children hypertension is defined as:

A

either systolic and/or diastolic BP >95th percentile measures on 3 or more occasions. the cuff size should be carefully matched to the size of the patients arm to avoid inaccurate measurements

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25
Q

the width of the bladder of the blood pressure cuff should be approximately 40 percent of the circumference of the upper arm midway between the olecranon and then acromion. the length of the bladder of the cuff should encircle 80 to 100 percent of the circumference of the upper arm at the same position

A

determining appropriate blood pressure cuff size in children

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26
Q

Vital signs – ht, wt, head circumference, BMI, BP

General appearance

Skin – lesions, bruising?

HEENT – head size/shape

Neck – lymph nodes (Hodgkins Lymphoma)

Heart – murmurs?

Lungs – pectoralis excovatum (or somethanng like that), nasal flaring, tripod (epiglotis), retractions

Abdomen – bowel sounds

GU, if indicated

Musculoskeletal – limb length, ROM, curvature/deformities

Neuro - motor (tone), sensory

A

Physical Exam- WCC

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27
Q

Make it fun!

Approach differs depending on age group

Find ways to distract young patients

Get help to hold, if necessary

Rewards

Code name for “shots”

Work well w/ your nurse

A

Clinical Pearls for PE

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28
Q

Failure to thrive

Sensory deficits – no response to loud stimuli (no tracking w/ eyes)

Congenital defects: 1 in every 33 babies in U.S. born w/ birth defect

Musculoskeletal disorders

A

most common dx detected on WCC

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29
Q

Cardiac

Fetal alcohol syndrome

Down syndrome

Cerebral palsy

A

Congenital defects

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30
Q

abnormal facial features, small head, low birth weight, poor coordination, hyperactive, cognitive defects, poor memory

A

Fetal alcohol syndrome

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31
Q

Complete physical exam

Are you ready at home?

Review newborn schedule

Safety

A

Newborn Visit

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32
Q

Circumcision

Screen for critical congenital heart disease w/ pulse ox after 24 hr & before d/c

A

complete physical exam

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33
Q

feeding: eat every 1-2 hours
sleeping
diapering
bathing

A

review of newborn schedule

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34
Q

Monitor weight (Should regain or exceed birth weight by 2 weeks)

make sure feeding is going okay

Postpartum depression

A

1st week visit

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35
Q

“exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.”

A

AAP’s recommendation for breastfeeding

american academy of pediatrics: AAP

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36
Q

lower rates of:

respiratory tract infection
otitis media
gastrointestinal tract infections
necrotizing enterocolitis
SID & infant mortality
allergic idsease
celiac disease
inflammatory bowel disease
obesity
diabetes
childhood leukemia & lymphoma
neuro developmental outcomes

AN IMPORTANT ONE IS DECREASING OBESITY IN ADULTS

A

Benefits of breastfeeding

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37
Q

Social and emotional

  • -> begins to smile at people
  • -> can breifly calm himself (may bring hands to mouth and suck on hand)
  • -> tries to look at parent

Language/communication

  • -> coos, makes gurgling sounds
  • -> turns head toward sounds

Cognitive (learning, thinking, problem solving)

  • -> pays attention to faces
  • -> begins to follow things with eyes and recognizes people at a distance
  • -> begins to act bored (cries, fussy) if activity doesnt change

Movement/Physical Development

  • -> can hold head up and begins to push up when lying on tummy
  • -> makes smoother movements with arms and legs
A

milestones: 2 month visits

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38
Q

…..

A

4 month slide 25

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39
Q 
....
MAY BE SITTING PROPED AND SUPPORTED
MORE VERBAL SKILLS
MORE NOISES
RESPONDING TO THEIR NAME
A

6 months slide 26

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40
Q

adding food….

4 steps

A

AT 6 MONTHS

“Baby Food” : (Cereal, Fruits, Veggies, Meat, Snacks): THEY WILL NEED MORE IRON!

Start w/ thin consistency, gradually thicken

Continue w/ breastfeeding and/or formula

Most infants can go through night w/o being fed

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41
Q 
....
sitting on their own by themselvels
playing games
understand word NO
maybe pulling up on furniture maybe walking
A

9 months slide 28

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42
Q

….
ON THE MOVE
but still not coordinated

A

12 months slide 29

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43
Q

food when turning 1

and other things happening

A

grazing: smaller stomach eat throughout the day… not really three main meals

can switch from formula/ breastfeeding to whole milk

THEY ARE ON THE MOVE!

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44
Q

….

need to be standing here!

A

18 Months. slide 31

45
Q

…..
can say 2-4 words
learn their independence

A

2 years slide 32

46
Q

“terrible twos”

food
other things hapening

A

can switch from whole to skim milk (want to cut down on fat .. but still need calcium from milk… want to cut down on obesity rates)

avoid choking (sit down!!!!!!!)

TOILET READINESS

reassure parents that it is okay .. and to stay calm,… need to support parents and help them

47
Q

…..

A

3 years slide 34

48
Q

…..

A

4 years slide 35

49
Q

…..

pre school

A

5 years slide 36

50
Q

achievement by trial & error, goal-directed

A

middle childhood

6-10yrs

51
Q

Physical
Enhanced strength & coordination
Competence in various tasks & activities

Cognitive
“Concrete operational,” focus on the present
Achievement of knowledge & skills, self-efficacy

Social
Achieving good “fit” w/ family, friends, school
Sustained self-esteem
Evolving self-identity

A

6-10 years

52
Q

11-21

A

adolescence

53
Q

Physical
Puberty – physical transition from childhood to adulthood
Onset – age 10 for girls & age 11 for boys
End w/ growth spurt by age 14 for girls & age 16 for boys
Duration of puberty varies widely but stages follow same sequence (sexual maturity rating or Tanner stages)

Cognitive
Learn to reason logically & abstractly, consider future implications of current actions
Often erratic, still limited ability to see beyond simple solutions
Moral thinking becomes sophisticated

Social/Emotional
Tumultuous time, marked by transition from family-dominated influences to autonomy & peer influences
Struggle for identity, independence & eventually intimacy

A

11-21 years

54
Q

sexual maturity ratings (SMR)

A

picture coming… slide 39

55
Q

School (bullying, academic performance, sports)

Mental health (self-esteem, temper issues, independence)

Nutrition & Development (healthy eating, BMI, puberty, exercise, sexuality & orientation)

Oral health (regular dental visits, brush/floss)

Safety (helmets, tobacco/alcohol/drugs, pregnancy, driving, screen time)

A

Priorities For The Visit:Middle Childhood & Adolescence

56
Q

Standard and catch-up schedules

Immunization Registry:
data base (state or region),
“ImmPactII” in Maine

School minimum requirements (state)

Exception information
religious, philosophical or medical reason
parent must submit written statement

Contraindications
severe allergic reaction
severe combined immunodeficiency (SCID)
pregnancy

A

Immunizations

* if you are immunodeficient you can opt out of vaccines*

57
Q 
Chicken pox- varicella vaccine
Diphtheria- DTaP vaccine
HiB- Hib vaccine (against hemoaphilus influenzae type B)
Hep A: Hep A vaccine
Hep B- Hep B vaccine
influenza: Flu vaccine
Measles: MMR
Mumps: MMR
Pertussis: Tdap
Polio: IPV
Pneumococcal: PCV vaccine
Rotavirus: RV
Rubella: MMR
Tetanus: Dtap
A

all vaccine - preventable diseases and the vaccines that prevent them

58
Q

Newborn Metabolic Screening

A

check 24 hours after birth

59
Q

Hematocrit or hemoglobin

A

screen at 12 months

risk assessment at 15 and 30 months

because they can start eating table foods…
and if the kid is obsessed with moms breast milk then they are not getting adequate iron

60
Q

lead screening

A

screen at 12 months

61
Q

Tuberculin test

A

if risk factors present

country with high risk
or someone around them

62
Q

Visual acuity

A

start at age 3 (if able), check periodically

63
Q

hearing

A

after birth
then at age 4
check periodically

64
Q

dylipiddemia screening

A

once between 9-11 years old and again between 17-21 years

65
Q

STI screening

A

screen for HIV between 16 and 18 years
additional testing if sexually active, at least annually

pap- NO! but consider a pelvic exam

66
Q

3-Hydroxy-3-methylglutaryl-CoA lyase deficiency
3-Methylcrotonyl-CoA carboxylase deficiency
Argininemia
Argininosuccinic acidemia
Beta-ketothiolase deficiency
Biotinidase deficiency
Carnitine palmitoyl transferase deficiency Type II
Carnitine uptake deficiency
Citrullinemia
Congenital adrenal hyperplasia
Congenital hypothyroidism
Cystic Fibrosis (CF)
Galactosemia
Glutaric acidemia type I
Glutaric acidemia type II
Homocystinuria
Hyperammonemia Hyperornithinemia Homocitrullinemia (HHH Syndrome)
Isovaleric acidemia
Long-chain acyl-CoA dehydrogenase (LCAD) deficiency
Long-chain hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency
Maple syrup urine disease
Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency
Methylmalonic acidemia
Multiple carboxylase deficiency
Phenylketonuria (PKU)
Propionic acidemia
Short-chain acyl-CoA dehydrogenase (SCAD) deficiency
Sickle cell disease/hemoglobin disorders
Trifunctional protein deficiency
Tyrosinemia type I
Tyrosinemia type II
Very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency

A

hahahhahahhahahahahahahahah
memorize this…hahaha jkjk

list of condisitons in a newborn metabolic screening

67
Q

visual care screening at primary care office

A

inspections of eye and lids: all ages

red reflex: birth until child can read eye chart

Assessment of fixation and following: starting at 2 months

Corneal light reflex for assessing strabismus: 3 months to 5 years

Cover testing for assessing strabismus: 6 months to 5 years

Fundoscopic examination: starting at 3 years

Preliterate eye chart testing: starting at 3-4 years

68
Q 
Healthy habits
Nutrition & healthy eating
Safety & prevention of injury
Physical activity
Sexual development & sexuality
Family relationships
Emotional & mental health
Oral health
Recognition of illness 
Screen time
Prevention of risky behaviors
School & vocation
Peer relationships
A

Anticipatory guidance

69
Q

Rear facing seats until at least age:

A

two

70
Q

as long as possible, until hgt/wgt max limit by manufacturer

A

Forward-facing:

71
Q

up until 4’9” AND age 8-12 yrs

A

Booster seat:

72
Q

In rear seats until age

A

13

73
Q

there are child seat inspection station locator

A

k cool.. now you know

74
Q

“safe to sleep”

A

increase tummy time.: avoid flat heads??? huh!? haha

reduce risk of SIDS

75
Q 
Pets
Plants
Stove/oven
Water heater
Electrical outlets
Bathtub
Cleaning supplies
Adult medications
Fertilizer 
Street traffic
A

safety proof the house

inside and out

76
Q

nutrition and healthy eating

A

my plate

eat together as a family

77
Q

lets move campaign

A

… ok so move

78
Q

aka “baby teeth”

By age 3, 20 teeth

A

Oral health

primary teeth

79
Q

1st tooth eruption usually between

A

4-15 months old

80
Q

Eruption starts ~5-7 yrs, ends by age 13-14 yrs

A

permanent teeth

81
Q

what is the number 1 chronic disease in children?

A

dental caries

82
Q

what should we brush with BID

A

Fluoridated toothpaste

83
Q

what is a cool way to remember brushing teeth for kids

A

Brush, book, bed

AAP initiative
structured bedtime

84
Q

Children from birth through age 5 years

A

recommended that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride

recommends that primary care clinicians apply fluoride varnish to primary teeth of all infants and children starting at age of primary tooth eruption

Conclude the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental carries performed by primary care clinicians in children from birth to age 5 years.

85
Q

Recommended for children ages 6 mo – 5 yrs

USPSTF: “Once teeth are present, fluoride varnish may be applied to all children every 3-6 months in the primary care or dental office.”

A

Fluoride Varnish

86
Q

pictures of teeth

A

slide 62

87
Q

screen time

… like TV or computer or whatever has a screen

A

AAP screen time recommendations:
Avoided before age 2
Limited to 2 hours for children & teens

“Screen-free zones”

Monitor content

88
Q

Excessive media use can lead to:

A 
attention problems
school difficulties
sleep & eating disorders
obesity
can provide platforms for illicit & risky behaviors
89
Q

________ are the leading cause of death in children & adolescents after 1st year of life

A

Injuries

90
Q 
Motor vehicle injuries 
Bicycle injuries 
Skiing & snowboarding injuries
Firearm injuries
Drowning & near drowning
Fire & burn injuries
Choking
A

different types of injuries

91
Q

when do you do depression screening

A

screen ages 11 through 21

92
Q

Part A (in past 12 months):

Drank any alcohol

Smoked any marijuana

Used anything else to get “high”

Part B (if “yes” to any in part A):

Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or other drugs?

Do you ever use alcohol or other drugs to RELAX, feel better about yourself, or fit in?

Do you ever use alcohol or other drugs while you are ALONE?

Do you ever FORGET things you did while using alcohol or other drugs?

Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?

Have you ever gotten into TROUBLE while you were using alcohol or other drugs?

A

Alcohol and Drug Use screening tool (CRAFFT):

93
Q

Repeated urination into clothing during the day & into the bed at night in children >5 years old & pattern must occur at least twice weekly for 3 months

15.5% of 7.5 year olds “bed wet”

Workup – complete H&P and UA/UC

A

toileting problems: Enuresis

94
Q

treatment of Enuresis

A 
education
limit liquids before bedtime
awake child @ night
bedwetting alarms
desmopressin (DDAVP)
95
Q

Repeated passage of stool into inappropriate places by child who is >4 years old

90% of cases result from constipation

Often kept secret by family & child

1-3% of children ages 4-11 years suffer from “this”

Workup – complete H&P (w/ DRE)

A

Toileting Problems:Encopresis

96
Q

tx of Encopresis

A

after age of 4 they shouldn’t be doing this!!!! before that whatever….poop in the closet do it do it!

education (avoid shame)

behavioral strategies (i.e., place child on toilet after meals)

treat constipation (start w/ “bowel cleanout”)

97
Q

Healthy infant cries for >3 hours per day, for >3 days per week, for >3 weeks (“rule of threes”)

Usually peaks by age 2-3 months

Unknown cause

A

Colic

98
Q

management of colic

A

reassurance

learn ways to soothe/comfort:

quiet environment
swaddle
avoid excessive handling
rhythmic stimulation – gentle swinging, rocking, soft music, car rides

99
Q

rule of threes?

A

Healthy infant cries for >3 hours per day, for >3 days per week, for >3 weeks

100
Q

Usually food refusal

Infants & young children

Will refuse to eat if:
painful
frightening

Often causes parental frustration & anger

Recognize different styles & food preferences

Red flag: failure to thrive (often due to poor caloric intake)

A

Feeding problems

101
Q

weight

A

Red flag: failure to thrive (often due to poor caloric intake)

102
Q

Screaming, thrashing about, sweating, ↑HR & RR and child incoherent & unresponsive to comforting

W/n 2 hours after falling asleep, episode lasts

A

night tremors

103
Q

Occurs between ages 4-8 years old

Benign

Ensure that home is safe

A

sleep walking

104
Q

Wakes alert

Peak occurrence between ages 3-5 years, w/ incidence 25-50%

Self-limited

A

nightmares

105
Q

:trouble initiating sleep and/or waking up at night

Night waking occurs in 40-60% of infant/young children

Good sleep hygiene

Be consistent

A

Dyssomnias

106
Q

Common between ages 1-4 years

Occurs ~1x/wk in 50-80% of children in this age group

Usually when child trying to achieve autonomy but thwarted

Management: provide choices, minimize “no,” distraction

A

Temper tantrums

107
Q

Occurs during expiration (falls silent)

0.1-5% of healthy children from ages 6 month to 6 years

Often in response to anger or mild injury

Rarely leads to unconsciousness, asystole or seizures

A

Breath-holding spells

what the hec… kids a weird hahaha
breathe child breathe

108
Q

Don’t calculate kids BMI before age of :

A

2

Sasha: Module 12 Pediatrics (4 decks)

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