Case 2 - Infant WCC Flashcards by Joseph Canarie

AAP mandates dev screening at?

9, 18 and 30 months

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AAP recommends autism screening at?

18 mos and 24 mos

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Skeleton of a WCC

1) Interval/birth hx, 2) Development Screen, 3) Growth chart, 4) Diet Hx, 5) Social hx/HEADSS, 6) PE, 7) Anticipatory Guidance, 8) Immunizations

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Components of a birth history?

1) Antenatal complications? 2) HIV/RPR/HepB/GBS? 3) Deliv date/term? 4) Deliv route? 5)Deliv wt? 6) Hearing test?

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No cows milk until what age? Why?

12 months of age; Infants do not tolerate the protein mixture of unaltered cow’s milk and may develop colitis,
causing microscopic bleeding and gradually worsening anemia.

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How do you mix powdered formula?

2 scoops of the powder are mixed with 4 ounces water

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Calorie reqs for term 1-2 mo infants? Premie? VLBW?

TERM: 100 to 120 cal/kg/day PREMIE: 115 to 130 cal/kg/day VLBW: up to 150 cal/kg/day

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What’s the average daily weight gain for a term infant?

The average daily weight gain for a term infant is 20 to 30 grams.

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Primitive reflexes and age by which they should extinguish?

Palmar grasp (2-3m/o), ATNR (6m/o), Plantar grasp (8m/o), Babs (1-2 y/o),

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ATNR?

Asymmetric Tonic Neck Reflex (a.k.a. fencing reflex): turn baby’s head to one side and ipsi extremities extend while contra flex

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AAP rec for Vit D supplementation?

breastfed babies should get 400 IU/day via drops

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Car seat for < 2 y/o?

Under 2 years of age (and not over the manufacturer’s weight or height requirement for seat): Rear-facing car safety seat, restrained in the rear seat.

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Car seat for 2 - 4 y/o’s?

Between 2 years and 4 years of age: Forward-facing car safety seat, restrained in the rear seat.

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Car seat for 4 to 8 y/o’s?

Between 4 years and 8 years of age: Belt-positioning booster seat, restrained in the rear seat.

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Car seat for 8 to 13 y/o’s?

Over 8 years of age: Lap-and-shoulder seat belts for all who have outgrown booster seats, restrained in the rear seat.

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Car seat for >13+ years old?

13 years of age and older: Lap-and-shoulder seat belt, rear or front seat.

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What’s Prevnar?

PCV 13

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What’s Pentacel?

DTaP-IPV-Hib combined

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What’s in Pediarix IM?

DTaP, HepB, and IPV

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Shots at birth?

Hep B #1

Shots at 2mo visit?

Hep B #2 (can be at 1-2 mo), Rota #1, DTap #1, Hib #1, PCV #1, IPV #1 (Pentacel, Prevnar, Heb B and PO Rotarix)

Shots at 4mo visit?

Rota #2 (Last dose if Rotarix, 2/3 if RotaTeq), DTaP #2, Hib #2 (Done if Pentacel, others 2/3 for others), PCV #2, IPV #2 (Pentacel, Prevnar and PO Rotarix)

Shots at 6mo visit?

Rota #3 (if RotaTeq, already done if had 2 Rotarix), Heb B #3 (can be 6-9mo range), DTaP #3, Hib #3 (if certain types, done), PCV #3, IPV #3, IM Flu (Pediarix, Prevnar and Flu)

Shots at 12mo visit?

Hep B #3, Hib #3/4, PCV #4, IPV #3, MMR #1, Var #1, Hep A #1, IM Flu PRN

Shots at 15-18mo?

DTaP #4, Hep A #2 (2 doses between 12 and 23 mo), IM flu PRN, MCV if high risk

By what ages should an infant double and triple his or her birth weight?

Double BW by 4-5mo and triple by 12mo

White spots on fundo exam is called?

leukocoria

DDx for absence of red reflex?

congenital cataracts, glaucoma, Rb, chorioretinitis

Have Jeremy quiz me on developmental milestones.

Please

Toddler proofing 101

stairs, meds/cleaners, outlets, 1-800-222-1222, cabinet locks

Sleeping anticip guidance for 6mo?

2 naps per day and, by 4-6mos, should be sleeping through the night

Calorie reqs for 9 mo infants?

100 cal/kg/day for appropriate growth; about 75% of the calories still come from breast milk or formula (for most children, about 24 ounces per day)

Ddx for RUQ abdominal mass in a 9mo infant?

Hepatic malig, hydro, neuroblastoma, nephroblastoma (Wilms' tumor), teratoma (note, poo usually on L side)

ROS/exam for RUQ abd mass?

pallor?, HSM?, jaundice?, G&D?, LNs? abd pain/n/v?

Initial w/u for RUQ mass in infant?

CBC, urine VMA/HVA (catecholamine breakdown prods of neuroblastoma), abd u/s & CXR (consider KUB +/- abd CT)

If infants are doing both BF and formula, they need at least __ oz of formula to get their RDA of Vit D without supplementation?

32oz

How many childhood doses do we give of DTaP and when are they given?

5 @ 2mo, 4mo, 6mo, 15-18mo and 4-6yo

How many childhood doses do we give of IPV and when are they given?

4 doses @2mo, 4mo, 6-18mo and 4-6yo; administer the final dose at or after age 4 years and at least 6 months after the previous dose.

How many childhood doses do we give of Hib and when are they given?

3 or 4 doses (depends on brand); usual 4-dose Pentacel/ActHIB/Hiberix schedule is at 2, 4, 6, 12–15 months

How many childhood doses do we give of MMR and when are they given?

2-dose series at 12–15 months, 4–6 years | Dose #2 may be administered as early as 4 weeks after dose 1.

How many childhood doses do we give of PCV13 and when are they given?

4-dose series at 2, 4, 6, 12–15 months

How many childhood doses do we give of Varicella and when are they given?

2-dose series at 12–15 months, 4–6 years Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted).

How many childhood doses do we give of Rotavirus and when are they given?

2 or 3 (depends on brand): - Rotarix: 2-dose series at 2 and 4 months - RotaTeq: 3-dose series at 2, 4, and 6 months * *If any dose in the series is either RotaTeq or unknown, default to 3-dose series.

How many childhood doses do we give of HepA and when are they given?

2-dose series (minimum interval: 6 months) beginning at age of 12 months

How many childhood doses do we give of HepB and when are they given??

3-dose series at 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks) Infants who did not receive a birth dose should begin the series as soon as feasible

What is the most common neoplasm of infancy? How does it present?

Neuroblastoma (>1/2 pts present < 2y/o). • tumor may present as a painless mass in the neck, chest, or abd; fever, pallor & wt loss also common • may also appear chronically ill and may have bone pain from mets • can be asymptomatic

How does teratoma present?

very rare, esp in kids; p/w painless abd mass w/o other sx or it may cause pressure effects on neighboring structures resulting in abd or back pain, nausea, vomiting, constipation, and/or urinary tract symptoms.

How does Wilm's Tumor (nephroblastoma) present?

asx RUQ abd mass in median age 3 y/o w/o LAN or jaundice & nl growth/dev. • often discovered by parents or on routine exam • generally smooth; rarely cross midline • Assoc'd sx occur in 50% of pts: abd pain, vomit +/- HTN