CH20 primary care of well and sick infant, child, teen Flashcards
neonate
0-28 days
infancy
1st year
toddler
1-2 yrs old
preschool
3-4 years
school age
5-12 yrs
purpose of well child visit
health promotion (nutrition, safety, immunization)
-tracking growth and development (learning, social)
- parent/provider concerns (diet, sleep, dev)
how often do kids need well child visits?
- NO - best vision range 8 -12 inches or how far mom’s face from baby’s face when bby on nipple
- YES - blueish scleral tint normal first few months (if persists.. consider osteogenesis imperfect)
- yes - bright light can trigger the startle reflex
- yes - blink reflex
term pregnancy in weeks
37 weeks (lungs are mature now) - 41 weeks + 6 days
in 2 week old
A correct.
B: high pitch betterr
C: will react
D: well developed sense of smell (thats why holding a baby is important bc it’ll imprint who holds them and is more comfortable with familiar smell)
“Ag”= always growing
-mom has hep B
-D! without intervention, 40% of HBV exposed newborns develop chronic HBV
persistent neonatal reflexes causes..
need further eval!!
walking reflex
walking motion made with legs and feet when held upright
appears for first 3-4 months, then reappears 12-24 months
rooting reflex
turning head and sucking when cheek stroked
no longer seen by 4 months
moro reflex
aka startle reflex
Throwing out arms and legs followed by pulling them
back to the body following a sudden movement or loud noise.
-no longer seen by 6 months
palmar grasp
-Grasping of an object when placed in the palm
-No longer seen by 7 months
babinski reflex
Stroking the sole of the foot elicits fanning of the
toes.
No longer seen by 6 months.
(adults don’t do this)
best time = earliest u can detect a problem
A! test before baby goes home.
for D, AOM has weeks/ mo of fluid in middle ear so screening will be abnormal (test will not influence treatment plan)
B. face up!
NO soft bumper, nothing in the crib! no positional wedges
“back to sleep, tummy to play”
SIDS
sudden infant death syndrome
need supervised awake “tummy time” to minimize development of positional plagiocephaly
when should tummy time start?
-start asap post birth, building up slowly for a total of 30 mins per day until such time as child easily turns tummy-to-back, back-totummy without assistance, usually by around age 6 months.
ALWAYS SUPERVISE TUMMY TIME!
SIDS recommendations
Back to sleep for every sleep
* firm sleep surface.
* Room-sharing without bed-sharing for the first 6 months is recommended, ideally for 1 year.
* NO soft objects and loose bedding in crib.
* Do not let child fall asleep on nursing pillows or pillow-like lounging pads.
* Never place baby to sleep on a couch, sofa, or armchair.
* Swaddling the baby is fine.
* Pregnant women should receive regular prenatal care.
* Avoid smoke exposure during pregnancy and after birth.
* Avoid alcohol and intoxicating drug use during pregnancy and after birth.
* Breastfeeding is recommended.
* pacifier at nap time and bedtime to reduce SIDS
* Avoid infant overheating.
* Do not use home cardiorespiratory monitors as a strategy for reducing the risk of SIDS.
* Expand the national campaign to reduce the risk of SIDS to include a major focus on the
safe sleep environment and ways to reduce the risk of all sleep-related infant deaths,
including SIDS, suffocation, and other accidental deaths; pediatricians, family physicians,
and other primary care providers should actively participate in this campaign.
stomach size of first 30 days of life (DOL)
cherry to unshelled walnut by day 1
day 7: apricot
day 30: large egg
in womb, only liquid that they can hold and stomach gradually learns to fill and empty
when can u start introducing foods to infants?
no food sooner than 4 months, continue breast feeding
must be exclusively BF for 1st 6 months and continue for 1 year or longer (or infant formula)
feeding frequencies for
neonate
2 months
4 months
6 months
breastfeeding basics
NO clicking (latch isn’t adequate)
D! should be back up by 2 weeks
BF babies make lots of small stools a day (normal) but infant with formula has firmer stools
C ! something is going well if bb has good weight gain.
No Fluroide supplements for the 1st 6 months of life!
D
Pump and dump is rarely the answer
alcohol can pass the blood brain barrier so it can def get into the breast milk
good latch has
no clicking sound, bbys checks are round and no dimples
D!
physiologic jaundice is BEYOND 12 hours of life
hyperbilirubinemia in the newborn
immature intestinal tract can’t reduce bilirubin to urobilirubin for excretion
bilirubin types
- direct (conjugated) bilirubin: Hemolyzed RBC ABLE to be excreted;
elevated because: Sepsis, intrauterine infection, severe hemolytic
disease, biliary atresia, giant cell hepatitis, cystic fibrosis,
galactosemia, alpha-antitrypsin deficiency - indirect (unconjugated) bilirubin: Hemolyzed RBC NOT able to be
excreted; bc of positive Coombs test (Blood groups Rh,
ABO incompatibility)
onset of jaundice less than 24 hours of life…
PATHOLOGIC jaundice (less common)
- metabolic disorders
- hemolytic disorders
- sepsis
- others
risk factors for pathologic jaundice
Underlying illness
Delayed initiation of breastfeeding
Insufficient frequency and ingestion of breastmilk
Giving water before or in addition to breastfeeding
Delayed meconium elimination
Pathologic jaundice intervention
treat underlying illness (if present)
-adequatte fluid intake
-phototherapy if total serum bilirubin > 25 mg/dL
jaundice that occurs 24 hrs to 2 weeks..
PHYSIOLOGIC JAUNDICE (no liver disease; more common)
-within 4-5 day of life
- breast milk jaundice (usul after 1 week)
where does jaundice in the newborn usually start?
starts in face and then makes its way down to body
risk factors for physiologic jaundice
breastfeeding (can inhibit bilirubin excretion)
>10% weight loss
insuff freq or ingesting of BM
genetics
early hospital discharge
physiologic jaundice intervention
-hydrate/intake
-phototherapy if total bili > 25 mg/dL
galactorrhea
breast milk production when NOT lactating
-found in 5% of all healthy NBs REGARDLESS of gender
-DON’T remove the milk from breast bc it’ll stimulate more. body will naturally get rid of it
came on day 10 of life so wont be from chemoprophylaxis that was given day 0 of life
chemosis: conjunctival edema
answer: B: sx’s come 5-14 days post exposure, chemosis common. prevention with maternal C trachomatis screening
-NB prophylaxis prevents GC but NOT chlamydial conjunct
common to see baby breast engorgement onset day 3-4 day of life to 2 week with galactorrhea
and will resolve within 2 months of life
answer:D
gonococcal conjunctivitis in NB
incubation period after exposure 2-7 days
ocular chemoprophylaxis at birth with erythromycin ophthalmic ointment or silver nitrate minimizes risk
neonatal adenovirus infection
causative org of viral conjunctivitis
EXCESSIVE tearing, mildly red conjuntiva
URI symptoms (cough, red throat etc)
chlamydial conjunctivitis treatment in NB
confirm with culture
tx: ORAL erythromycin x 2 weeks d/t pneumonia risk
if eyes are contaminated then respiratory tract is contaminated
at 2 months old…
fall prevention education
at 4 months…
at 6 months
-rolling from tummy to back (supervised tummy time is not really needed anymore)
at 6-8 months of age
baby recognized body as 1 whole
by 12 months/1 year…
stands tall and walk on 2 legs
varies - 12-16 months in other ethnicities
by 18 months
can name single word objects
say no a lot “like an 18 year old”
acts like an 18 year old by copying words like adults do
by 2 years old..
follows 2 step commands (pick up a spoon and give it to me)
can walk up to 2nd floor (with help)
builds a 2 block tower with ease
by 3 years old..
tricycle..3 wheels 3 years
by 4 years old..
D
separation anxiety starts 7-8 months
when do you expect to see lower and upper central incisors in a baby?
lower: 6-10 months
upper: 8-12 months
get concern at age 1 and had NO teeth at all.
C
starting to pull to stand is a good sign
developmental red flags in the young child
PERSISTENCE PRESCENCE of 1 or more of these warrants further evaluation:
by 6 mo: no big smiles or other warm, joyful expressions
by 9 mo: no back and forth sharing of sounds, smiles or other facial expressions
by 12 mo: no response to name, no babbling or baby talk, and/or no back and forth gestures (pointing, showing, reaching, or waving)
by 24 mo: no meaningful 2 word phrases that don’t involve imitating or repeating
C. 18-24months; formal screening earlier without red flags but can miss a sign and then another one at 18-24 for early detection and early intervention
DSM 5 autism spectrum disorder (ASD)
2 core domains:
- deficits in social-emotional behaviors, nonverbal communication behaviors, developing/maintaining/understanding relationships
restricted, repetitive patterns of behavior, interests, or activities with 2 or more present:
- stereotyped or repetitive motor movements, use of objects or speech
-insistance on sameness, inflexible adherence to routines or ritualized patterns of verbal or non verbal behavior
-highly restricted, fixated interested that are abnormal in intensity or focus
-hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of environment
sx sig impair social, job, other areas of function
C
ADHD 3 subtypes
inattentive
hyperactive/impulsive
combined
ADHD diagnosis
-sx must present before 12 yrs old
-sx must be present in at least 2 settings (home and school)
-functional interference: social, academic, extracurricular
inattentive: 5 or more, happen often:
-Fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities
Difficulty sustaining attention in tasks or play activities
Does not listen when spoken to directly
Does not follow through on instructions and fails to finish schoolwork, chores or duties
Difficulty organizing tasks and activities
Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
Loses things necessary for tasks
Easily distracted by extraneous stimuli
Forgetful in daily activities
hyperactivity-impulsivity: 5 or more often:
- Fidgets with hands or feet or squirms in seat
Leaves seat in classroom or in other situations in which remaining seated is
expected
Runs about or climbs excessively in situations when inappropriate
– Can be subjective feelings of restlessness in adults or adolescents
Difficulty playing or engaging in leisure activities quietly
Acts “on the go” or acts as if “driven by a motor”
Talks excessively
Blurts out answers before questions have been completed
Difficulty waiting turn
Interrupts or intrudes on others
when 1st molars come out or at 1 years old
if a baby is born BEFORE 40 weeks gestation and you want to perform a developmental exam, you must correct for…___
do this until?
correct for a preterm! 40 weeks - the gestation.
the gestation - current age = assess as this age
DO THIS UNTIL BABY IS 2 YEARS OLD!
40 weeks - 32 weeks = 8 weeks early/ 2 months
6 months - 2 months = 4 months
assess baby as a 4 month old baby
B! reaches “4” a toy
but in a TERM infant, it responds to its name in 6 months. if reaches for 1 hand and recognizes familiar ppl (4-6 months), babbling mamama and transfer objects hand to hand (4-6 mo), ah and oh sounds and tummy side to side is 6-8 mo
D. up until thomas is 2 years old, we’ll pull back 2 months on his developmental assessment. if he’s not walking by 12 months, bc it means he’s only at 10 months of age.
what makes the difference if kid “catches up” if they are preterm or not?
depends on neonates health at the time at birth
if he was born with mom with sever preeclampsia and got early labor, mom is ill but thomas wasn’t. baby was fine and will catch up
but if thomas had an intrauterine probably and mom is well. and preg was preterm and ended up early but take a little more time to catch up
club foot - foot turned inward with bottom facing sideways
dx at birth or prenatal ultrasound
tx: ponseti method
syndactyly - fusion of 2 or more digits (webbing of skin or bone)
tx: surgery (skin graft)
metatarsus adductus (pigeon toed)
common TRANSIENT/normal issue in new walkers
2-3 months of walking (self resolves)
-passive maniupation to check for flexible or non flexible metatarsus
tx: if persists longer than 4 mo of age, can refer to peds ortho
depends on severity, observation, stretching, passive manipulation, casting, straight last shoes, surgery
polydactyly - extra digit (hand or foot)
tx: surgery at 9-12 mo
B: lots of foreskin before 3 years old and when they grow, it’ll be easily retractable.. and make sure urine is out fine (but if it balloons out then it’s too tight)
D. hydrocele
goes away after 1 years old
non communicating hydrocele
most common
-no connection b/t abdominal cavity and sac around scrotum = fluid filled, transillluminates
non communicating hydrocele presentation and management
fluid filled scrotal sac
transilluminates, non tender, testes NORMAL
-no change in scrotal size, with position change, same at bedtime and on awakening
resolves by age 2 w/o intervention. only refer if size interferes comfort and activity
Reassurance, no risk of herniation; no special skin are needed