Case 2 Flashcards
What may be the cause of an symptomatic abdominal mass at a 9 mo visit?
Neuroblastoma
Assessment of Development at a Well-Child Visit:
- May be assessed using one of several developmental screening tests (eg, the Parents’ Evaluation of Developmental Status (PEDS), Ages and Stage, or the Denver II Developmental Screening Test).
- The American Academy of Pediatrics (AAP) mandates developmental screening at 9 mo, 18 mo, and 30 mo checkups.
- Specific autism screening is recommended at 18 mo and age 2 yr
- Many offices do developmental screening at every health maintenance visit, especially if the office takes care of children that have been medically underserved.
- Tests may involve parental reports and/or examination in the office.
Breast milk:
Preferred source of nutrition for most babies.
Formula:
Commercial formulas provide complete nutrition for those babies whose mothers are unable or unwilling to breastfeed. Available formulas include those made with:
1. Cows milk protein
2. Soy protein
3. Hydrolyzed cows milk protein
There are also specialized formulas that provide protein in the form of simple amino acids (the true elemental formulas)
Preparing formula:
- Ready to feed formula: Baby is fed directly from the bottle
- Powder: 2 scoops of the powder are mixed with 4 oz water
- Formula concentrate: ratio is 1 part concentrate to 1 part water
There is no need to give an infant extra bottles containing water only, because formula or breast milk fulfills maintenance fluid requirements.
Transition to Regular Cow’s Milk:
It is important never to give regular cow’s milk until 12 mo of age. Infants do not tolerate the protein mixture of unaltered cows milk and may develop colitis, causing microscopic bleeding and gradually worsening anemia.
When are babies expected regain their birth weight?
As early as 1 week of age, but definitely by 2 weeks of age.
What is the caloric requirement of most healthy term babies in the first 1 to 2 months of life?
100 cal/kg/day
Adequate growth for a term infant:
Requires approximately 100 to 120 cal/kg/day. The average daily wt. gain for a term infant is 20 to 30 grams.
What calorie intake do preterm infants require?
115 to 130 cal/kg/day
What calorie intake do VLBW (very low birth weight) infants require?
Up to 150 cal/kg/day.
When does the moro reflex disappear?
4 months
What can the moro reflex be used to detect?
Peripheral problems such as congenital musculoskeletal abnormalities or neural plexus injuries.
What is the PEDS screening tool?
A developmental screening test used by pediatricians. This tool is (1) Evidence-based (2) Used for children between 0 and 8 years of age (3) Able to be performed at all well-child visits (4) Used to identify those children who may have developmental delay and who may need a more formal evaluation. Parents are asked to answer ten Qs on the PEDS response form. The questions elicit parents’ perspectives on their child for each developmental domain.
What developmental milestones should a 2 mo old infant reach?
- Gross motor - head up 45deg (50-90percent), lift head (90percent)
- Fine motor - follow past midline (50-90percent), follow to midline (90percent)
- Cognitive, linguistic, and communication - laugh (50-90percent), vocalize (90percent)
- Social-Emotional - smile spontaneously (50-90percent), smile responsively (90percent)
What developmental milestones should a 4 mo old infant reach?
- Gross motor - Roll over (50-90percent), Sit - head steady (90percent)
- Fine motor - follow to 180deg (50-90percent), grasp rattle (90percent)
- Cognitive, linguistic, and communication - turn to rattling sound (50-90percent), laugh (90percent)
- Social-Emotional - regard own hand (90percent)
What developmental milestones should a 6 mo old infant reach?
- Gross motor - Sit - no support (50-90percent), roll over (90percent)
- Fine motor - look for dropped yarn (50-90percent), reach (90percent)
- Cognitive, linguistic, and communication - turn to voice (50-90percent), turn to rattling sound (90percent)
- Social-Emotional - feed self (50-90percent), work for toy (out of reach) (90percent)
What developmental milestones should a 9 mo old infant reach?
- Gross motor - Pull to stand (50-90percent), Stand holding on (90percent)
- Fine motor - take 2 cubes (50-90percent), pass cube (transfer) (90percent)
- Cognitive, linguistic, and communication - dada/mama, nonspecific (50-90percent), single syllables (90percent)
- Social-Emotional - wave bye-bye (50-90percent), feed self (90percent)
When can some infants be started on rice cereal with a spoon?
Age 4 months
What is the recommended daily allowance of vitamin D?
400 units per day
What is a nutritional concern with children who are exclusively breast fed?
- While there is evidence that breast milk is superior, there has been a concern that the amount of vitamin D in breast milk is not adequate. Unless an infant or child is drinking 32 ox of formula or milk a day (both of which are supplemented with vitaD already), they may not receive enough vitamin D.
- Infants and children who are exclusively or mostly breastfed therefore should be supplemented, as should infants and children drinking less than a quart per day of formula or cows milk.
- The easiest/most cost effective way to supplement is a multivitamin. Infants can use liquid vitamin drops; older children can take chewable multivitamins.
When do babies start sleeping through the night?
Usually by age 4-6 months. To help prevent SIDS, an infant should continue to be placed on her back to go to sleep.
What car seat position is most appropriate at 2 mo of age?
Middle back seat, facing rear.
Car Seat Safety Tips
Children under age 13 yo should not sit in the front seat. Car seats for children are required in all 50 states. The most effective car-seat restraint is a five-point harness, consisting of two shoulder straps, a lap belt and a crotch strap.
What vaccinations are given at the 2 mo visit?
First doses of DTaP, Hib, IPV, PCV13, RotaV and second dose of HepB.
When are the MMR and HepA vaccines given?
12 mo of age
Over the first 5 yr, every child should receive the following numbers of doses of each type of vaccine:
- DTaP (5)
- IPV (4)
- Hib (3 or 4, depending on the vaccine manufacturer)
- PCV13 (4)
- MMR (2)
- Varicella (2)
- RotaV (2 or 3, depending on the vaccine manufacturer)
- HepA (2)
- HepB (3)
Seasonal influenza vaccine:
Annual vaccination strongly recommended for all children 6 through 59 mo of age. Also strongly recommended or household contacts and caregivers of children 0 to 59 months and children and adolescents in high risk groups (asthma, lung, heart, immune system problems). Vaccine routinely recommended for all children under age 19 years.
What are some combination vaccines?
Pediarix (combines DTaP, HepB and IPV), Pentacle (combines DTaP, IPV and Hib)
What are common side effects of vaccines?
“Knots” in the skin at the injection site (which may persist for a few weeks) or fussiness and fever for 24 hours.
By what ages should an infant double or triple his or her birthweight?
Double by 4-5 mo, triple by 12 mo.