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Pediatrics BRS > Chapter 1 - Health Supervision > Flashcards

Chapter 1 - Health Supervision Flashcards

1
Q

What are the six purposes of the well child care visit?

A
  • anticipatory guidance
  • preventative measures
  • screening tests
  • early detection and treatment of symptomatic acute illness
  • prevention of disability in chronic disease
  • assessment of growth and development
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2
Q

How long after birth do we continue to assess head circumference?

A

until two years of age

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3
Q

What are rules of thumb for expected increases in weight after birth?

A
  • 0-3 months: 30g/day; regain birth weight by 2 weeks
  • 3-6 months: 20g/day
  • 6-12 months: 10g/day
  • 1-2 years: 250g/month
  • 2 years-adolescence: 2.3 kg/year
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4
Q

What are the rules of thumb for expected increases in height after birth?

A
  • 0-12 months: 25 cm/year
  • 13-24 months: 12.5 cm/year
  • 2 years-adolescence: 6.25 cm/year
  • by age 4: double birth length
  • by age 13: triple birth length
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5
Q

Failure to Thrive

A
  • describes a growth rate less than expected; concerning once a child’s weight crosses two major percentile isobars
  • weight gain is generally the most abnormal and affected before length, which is affected before head circumference
  • most often it is due to an inorganic etiology related to a disturbed patient-child bond (e.g. poor formula prep, poor feeding technique, abuse/neglect, parental immaturity, maternal depression, alcohol/drug use, martial discord, mental illness, family violence, poverty)
  • organic etiologies suggest underlying organ system pathology, infection, chromosomal disorders, or systemic illness
  • screening tests are usually not useful so labs should be guided based on the history and exam
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6
Q

List 10 inorganic causes of failure to thrive.

A
  • poor formula preparation
  • poor feeding techniques
  • child abuse or neglect
  • parental immaturity
  • maternal depression
  • alcohol or drug use
  • marital discord
  • mental illness
  • family violence
  • poverty
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7
Q

What are the four types of head growth abnormalities?

A
  • microcephaly
  • craniosynostosis
  • deformational plagiocephaly
  • macrocephaly
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8
Q

Describe the appropriate timeline for head growth.

A
  • born with head circumference 25% of adult size
  • increases to 75% of adult size by 1 year of age
  • nearly 100% of adult size by 2 years of age
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9
Q

What is cephalohematoma? Why is it clinically relevant?

A

a subperiosteal hemorrhage of the newborn cranium after a traumatic delivery, which may interfere with accurate head circumference measurements

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10
Q

What are the rules of thumb for expected increase in head circumference?

A
  • 0-2 months: 0.5 cm/week
  • 2-6 months: 0.25 cm/week
  • by 12 months: a total increase of 12 cm since birth
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11
Q

Microcephaly

A
  • defined as a head circumference more than 2-3 standard deviations below mean
  • can be either congenital (associated with abnormal induction and migration of brain tissue) or acquired (caused by cerebral insult in the late third trimester, perinatal period, or first year of life)
  • congenital causes include prenatal infection, maternal exposure to drugs/toxins, chromosomal abnormality, familial microcephaly, or maternal phenylketonuria
  • acquired include late third trimester or perinatal infections, meningitis/meningoencephalitis in the first year of life, ischemic insult, metabolic derangements
  • microcephaly is always associated with a small brain, usually associated with developmental delay and; intellectual impairment, and occasionally associated with cerebral palsy or seizures
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12
Q

Macrocephaly

A
  • defined as a head circumference more than 95% expected for the age
  • unlike microcephaly, it doesn’t necessarily reflect brain size
  • may be familial (otherwise normal PE and fitting FH), related to an overgrowth syndrome (all growth parameters will be enlarged), metabolic storage disorders, neurofibromatosis, achondroplasia, hydrocephalus, or space-occupying lesions
  • split cranial sutures, bulging anterior fontanelle, irritability, and vomiting could all suggest elevated intracranial pressure and an ultrasound or CT should be used to rule out hydrocephalus
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13
Q

What is craniosynostosis and what are the major risk factors?

A
  • defined as premature closure of one or more cranial sutures, which causes an abnormal head shape
  • most cases are sporadic but risk factors include intrauterine constraint or crowding as well as metabolic abnormalities like hyperthyroidism or hypercalcemia
  • dolichocephaly/scaphocephaly is a premature closure of the sagittal suture resulting in an elongated skull
  • brachycephaly is a shortened skull due to premature closure of the coronal suture
  • trigonocephaly is an triangular-shaped head caused by premature closure fo the metric suture
  • each form is usually noted by 6 months of age and can be confirmed with skull radiographs or CT
  • surgical repair is most often indicated when cosmetic concerns are significant
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14
Q

When should cranial sutures close?

A

when brain growth stops around age 5 (90% complete by age 2)

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15
Q

When is brain growth complete?

A

90% by age 2 and complete by age 5

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16
Q

Plagiocephaly

A
  • an asymmetry of the infant head not associated with premature suture closure
  • the most common form is positional plagiocephaly associated with flattening of the occiput and prominence of the ipsilateral frontal area (think parallelogram)
  • may be associated with congenital muscular torticollis or extended periods spent on the child’s back (recommended to prevent SIDS)
  • managed with reposition of the head during sleep, helmet therapy, and increased timed in the prone position when awake
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17
Q

What is the protocol for a newborn born to a hepatitis B-positive mother?

A

provide HepB vaccination and HBV immune globulin at birth

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18
Q

Describe the composition of the hepatitis B vaccine and it’s recommended schedule of administration.

A
  • a recombinant vaccine with particles of surface antigen

- recommended as a three-shot series within the first year of life

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19
Q

Describe the composition of the DTaP/dT vaccine and it’s recommended schedule of administration.

A
  • DTaP is an inactivated vaccine with acellular Bordetella pertussis (in contrast to DTP), diphtheria toxoid, and tetanus toxoid
  • DTaP is recommended at 2, 4, and 6 months with boosters at 12-18 months and 4-6 years
  • dT is an inactivated vaccine with 1/10th the dose of diphtheria toxoid
  • dT is used for children age 7 and over and is specifically recommended at age 11-12 as well as every ten years after
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20
Q

What are the major advantages and disadvantages of the oral polio vaccination?

A
  • it induces an IgA-based response
  • it is excreted in the stool, potentially infecting and thus immunizing close contacts
  • however, it has the possibility of vaccine-related polio
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21
Q

Describe the recommended schedule and form of polio vaccination.

A
  • only the inactivated form is recommended in the US

- given at 2 and 4 months with boosters at 6-18 months and 4-6 years

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22
Q

Describe the composition of the H. influenzae, type B vaccine and it’s recommended schedule of administration.

A
  • polysaccharide linked to either diphtheria or tetanus toxoid
  • recommended at either 2, 4, and 6 months with a booster at 12-15 months or at 2, 4, and 12 months, depending on the type of vaccine conjugate
23
Q

Describe the composition of the MMR vaccine and it’s recommended schedule of administration.

A
  • a live attenuated vaccine

- recommended at 12-15 months with a booster at either4-6 years or 11-12 years of age

24
Q

Describe the composition of the varicella vaccine and it’s recommended schedule of administration.

A
  • a live attenuated vaccine

- recommended at 12-18 months

25
Q

Describe the composition of the Hep A vaccine and it’s recommended schedule of administration.

A
  • an inactivated vaccine

- recommended at 2 years of age or older with a booster 6 months later for high risk individuals

26
Q

Describe the composition of the Pneumovax vaccine and it’s recommended schedule of administration.

A
  • polysaccharide capsular antigens from 23 pneumococcal serotypes
  • used primarily for older children and adults at high risk for pneumococcal disease (e.g. patients with SCD, chronic liver disease, nephrotic syndrome, or asplenia)
27
Q

Describe the composition of the Prevnar vaccine and it’s recommended schedule of administration.

A
  • inactivated vaccine

- recommended at 2, 4, and 6 months with a booster at 12-15 months

28
Q

Why do the MMR and varicella vaccines have the potential for a delayed rash and fever seen 1-2 weeks after immunization?

A

because the rash and fever are seen after the incubation period of the virus

29
Q

What are the three important vaccination mnemonics?

A
  • May You Be Vivacious (live vaccinations)
  • RIP Always (killed vaccinations)
  • To Be Heal Rapidly (passive immunization)
30
Q

Name five contraindications to immunization.

A

1) anaphylaxis to a vaccine or its constituents
2) encephalopathy within 7 days of DTaP vaccine
3) those with existing neurologic disorders should not receive DTaP until it is stabilized
4) immunodeficiency (including household contacts of immunodeficient patients in the case of oral polio vaccine)
5) pregnancy

31
Q

Although not contraindications for vaccination, caution should be used under what circumstances?

A
  • existing moderate to severe illness with or without fever
  • temp of 40.5 within 2 days, shock-like state within 2 days, seizures within 3 days, persistent or inconsolable crying lasting more than three hours within 2 days of prior DTaP vaccination
32
Q

Why is universal newborn hearing screening before hospital discharge recommended?

A

because moderate-to-profound hearing loss in early infancy is associated with impaired language development and early detection with intervention may improve language acquisition

33
Q

What are two methods for hearing screening in newborns? How do they compare?

A
  • brainstem auditory evoked response measures EEG waves in response to clicks and is the more accurate but more expensive
  • evoked otoacoustic emission measures sounds generated by normal cochlear hair cells; this is cheaper and requires less operator training but may be affected by debris or fluid in the external or middle ear
34
Q

How does Pneumovax compare to Prevnar?

A
  • pneumovax covers 23 serotypes while prevnar covers only 7
  • since pneumovax is based on polysaccharide capsular antigens, prevnar is more immunogenic and efficacious
  • this is why prevnar is recommended for younger individuals (less than 2 years old)
35
Q

Most states perform newborn screening for what five diseases?

A
  • congenital hypothyroidism
  • phenylketonuria
  • galactosemia
  • sickle cell anemia and other hemoglobinopathies
  • congenital adrenal hyperplasia
36
Q

What is the recommendation for cholesterol and lipid screening in newborns?

A
  • screening is recommended for children over two years old who have a family history of hyperlipidemia, hypercholesterolemia, or early myocardial infarction
  • specifically, cholesterol screening in those with a history of hypercholesterolemia
  • and fasting lipid panel in those with parents or grandparents who have a history of cardiovascular disease or sudden death before age 55
37
Q

Iron-Deficiency Anemia Screening in Infants

A
  • IDA occurs most commonly in children less than 6, with incidence peaking between 9 to 15 months
  • risk factors include prematurity, low birth weight, early introduction of cow’s milk before 9 months age, dietary insufficiency, low socioeconomic status
  • universal screening of hemoglobin levels is recommended between 9 to 15 months of age and between 4 and 6 years of age
38
Q

For which children is a PPD screening recommended?

A

those who…

  • have contact with persons who have confirmed disease
  • those in contact with high-risk groups
  • those with radiographic evidence
  • those with HIV
  • those from, with history of travel to, or contact with indigenous persons from endemic areas
  • those who reside in high prevalence areas
39
Q

What is the medical recommendation regarding circumcision?

A

circumcision isn’t recommended on the basis of any medical grounds by the American Academy of Pediatrics

40
Q

What are the benefits of circumcision? Under what circumstances does circumcision become medically necessary?

A
  • may slightly decrease the risk of penile cancer and cervical cancer in partners
  • UTIs are ten times less likely in uncircumcised male infants
  • may be required in those with phimosis, paraphimosis, or balanitis
41
Q

Phimosis

A
  • an inability to retract the foreskin

- considered normal up to age 6 but is always abnormal if ballooning of the foreskin occurs during urination

42
Q

Paraphimosis

A
  • an inability to return the retracted foreskin back to it’s normal position
  • it acts as a tourniquet and obstructs lymphatic flow, leading to edema
  • surgery is required emergently
43
Q

What is balanitis

A

an inflammation of the glands of the penis

44
Q

What are the primary complications that may be seen following circumcision? What are the contraindications to circumcision?

A
  • may be complicated by bleeding, infection, poor cosmoses, phimosis, urinary retention, and injury to the glans or urethra
  • contraindicated in those with penile abnormalities, prematurity, or a bleeding diathesis
45
Q

Describe the timeline for normal tooth eruption.

A
  • initial tooth eruption is between 3-16 months of age with the average age as 6 months
  • most often this is a lower central incisor
  • the 20 primary teeth are generally established by 2 years of age
  • secondary tooth eruption also begins with the lower central incisor between 6-8 years of age
  • there are 32 secondary teeth
46
Q

How many primary and secondary teeth are there?

A

20 and 32, respectively

47
Q

What may cause primary tooth eruption to be delayed or premature?

A
  • delayed could be familial, due to hypothyroidism, due to Down syndrome, or a result of ectodermal dysplasia
  • premature could be familial, due to hyperthyroidism, or the result of growth hormone excess
48
Q

Describe the course of dental hygiene in infants.

A
  • tooth brushing should begin as soon as teeth erupt, starting with a moist washcloth or gauze pad
  • use a soft toothbrush as soon as it is tolerated
  • once children are able to assist, a fluoride toothpaste may be used
  • use dental floss once tight contact exists between teeth
49
Q

What is fluorosis?

A

an excess of fluoride, which affects permanent teeth, but only in a cosmetic way

50
Q

What are natal and neonatal teeth?

A

natal are those present at birth and neonatal are those that emerge during the first month of life

51
Q

How should natal and neonatal teeth be managed?

A

they don’t require intervention unless they are hyper mobile, cause difficulty breastfeeding, or cause trauma to the infant’s lip or tongue

52
Q

Nursing/Bottle Caries

A
  • most often seen in children 24-30 months of age
  • associated with a history of falling asleep with a nipple in the mouth
  • any liquid other than water retained around the teeth can promote bacteria growth and caries
  • Strep mutans is the most common bacterial agent involved
  • maxillary incisors, canines, and primary first molars are affected before lower teeth because the lower teeth are covered by the tongue
53
Q

Permanent Tooth Avulsion

A
  • a tooth that has been traumatically avulsed may be re-implanted
  • extra oral time is the most important factor affecting the prognosis but it can also be improved by storing the tooth in liquids, especially milk in the interim
  • gently rinse the tooth with saline, place it back into the sock, and refer the patient to a dentist

Pediatrics BRS (20 decks)

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