class 6: peds Flashcards
what is APGAR Score
a clinical assessment that evaluates a newborn’s health shortly after birth
what are the 5 categories of the APGAR score
apperence
pulse
grimace
activity
respiration
appearance - 0
blue
appearance - 1
blue extremities
appearance - 2
no blue
pulse - 0
absent
pulse - 1
<100
pulse - 2
100 -140
grimace - 0
no response
grimace - 1
grimace
grimace - 2
cry or withdrawal
activity (muscle tone) - 0
flaccid
activity (muscle tone) - 1
some flexion
activity (muscle tone) - 2
active motion in the muscles
respiration - 0
absent
respiration - 1
cry
hypoventilationn
respiration - 2
strong cry
when is APGAR checked
1 min
no normal - 5 mins
not normal - 10 min
Month 3
● Prone on elbows
● Can lift head in prone
● Belly crawl (3-9 mo)
what is normal on APGAR
8-10
Months 3 - 4
● Supine to sidelying
Months 5 - 6
● Prone to supine
● Pull to sit without head lag
● Sitting with UE support
● Feet to mouth
Months 6 - 7
● Supine to prone
● Quadruped
● Independent ring
sitting
● Transfers objects
between hands
● Trunk rotation in
sitting
Months 9-10
● Quadruped creeping
● Cruises to sideways
● Plantigrade, pulls to stand
● Improving grasping skills,
pincer, three jaw chuck
(10 mo)
Months 10 - 15
● Begins to walk unassisted
● Transitions in and out of
squatting (10 mo)
● Controls grasp AND
release
● Stacks two cubes
Crawling
army crawl, on belly
Creeping-
quadruped
poem for children
3 I lift my head,
4 lay on my side,
5 prone to supine,
And at 6 I sit upright.
7 quadruped,
At 8, can’t wait to cruise (9).
Creep, cruise, and stand alone at 9,
Then walk and stack two cubes.
Integrated:
When the reflex disappears to allow for normal development
Persistent:
A reflex that has not integrated and indicative of central nervous
system (CNS) dysfunction
onset of flexor withdrawl
28 weeks gestation
what is the stimulus for flexor withdrawl
Noxious stimulus (pinprick) to
sole of foot
integrated of flexor withdrawl
1-2 months
what is the normal response to flexor withdrawl
Toes extend, foot dorsiflexes, LE
flexes uncontrollably
onset of Crossed Extension
28 weeks gestation
intrgration of Crossed Extension
1-2 months
Crossed Extension stimulation
Noxious stimulus to ball of foot
of LE fixed in extension
onset Rooting
28 weeks gestation
Crossed Extension response
Opposite LE flexes, then adducts
and extends
intregrated rooting
3 months
rooting stimulus
Stroking the side of baby’s
cheek
rooting response
Head turns toward stimulus and
mouth opens
Traction onset
28 weeks’ gestation
Traction intregration
2-5 months
traction stimulus
Grasp forearm and pull up from
supine into sitting position
traction response
Grasp and total flexion of the UE
what is onset of Asymmetrical Tonic Neck
(ATNR)
birth
when is integration of Asymmetrical Tonic Neck
(ATNR)
4-6 months
Asymmetrical Tonic Neck
(ATNR) stimulus
Rotation of the head to one side
Asymmetrical Tonic Neck
(ATNR) response
Flexion of skull limbs, extension of
the jaw limbs, “bow and arrow”
posture
do you have reflex before cortex input
yes
Palmar Grasp onset
birth
Palmar Grasp intergated
4-6 months
what comes first in childeren general movement or localized movement
generalized big movement
Palmar Grasp stimulus
Maintained pressure to palm
of hand
Palmar Grasp response
Maintained flexion of fingers
do infants have flexore or extensor tone first
flexor tone - this is seen when babies are on their back (first)
extensor tone is seen when babies start to move against gravity
Moro onset
28 weeks gestation
MORO intregrated
5-6 months
to babies develope in caudal to cephalic development or the other way
cephalic to caudal
babies develop more control in their upper body before their lower body
do babies develope proximal or distally first
proximal to distal
what does cephalic mean
head
what does caudal
tail
what is the stimulus for MORO reflex
Drop patient backward from
sitting position
what is the response for the moro reflex
Extension, abduction of UEs, hand
opening and crying followed by flexion,
adduction of arms across chest
Symmetrical Tonic
Labyrinthine (TLR / STLR) onset
birth
TLR/ALTR Integrated:
6 months
when do we start to see belly crawl
3-9 months
Symmetrical Tonic
Labyrinthine (TLR / STLR) stimulus
Prone or supine position
Symmetrical Tonic
Labyrinthine (TLR / STLR) response
Prone: increased flexor tone of all limbs
Supine: increased extensor tone of all
limbs
Positive Supporting onset
birth
Positive Supporting intrgrated
6 months
Positive Supporting stimulus
Contact to the ball of the
foot in upright standing
position
Positive Supporting response
Rigid extension (co-contraction) of the LEs
Plantar Grasp onset
28 weeks
plantar grasp intregrated
9 months
plantar grasp stimulus
Maintained pressure to
ball of foot under toes
plantar grasp response
Maintained flexion of toes
Symmetrical tonic
neck (STNR) stimulus
Flexion or extension of
the head
Symmetrical tonic
neck (STNR) response - head flexion
flexion of UEs,
extension of LEs
Symmetrical tonic
neck (STNR) response - head extension
extension of UEs,
flexion of LEs
what can a baby start s to creep
9-10 months
when can a baby start to walk unassisted
10-15 months
Classification of Cerebral Palsy - Spastic:
Velocity dependent resistance of a muscle to stretch
̶Synergy patterns, contractures, crouched gait, toe walking
Classification of Cerebral Palsy: Ataxia
Disorder of coordination, force, and timing, associated with
cerebellar involvement
̶Floppy baby/low tone, tremor, poor balance, wide BOS, nystagmus
Classification of Cerebral Palsy-
Dyskinetic:
Disorder of basal ganglia, characterized by involuntary
movements that are slow and writhing
̶Poor stability, hand tremor, fluctuating tone, hypo becomes hyper
Gross Motor Classification of CP - level 1
Patient will walk without restrictions but will have limitations in more
advanced gross motor skills.
Gross Motor Classification of CP - level 2
Patient will walk without assistive device with limitations in walking
outdoors and in the community.
Gross Motor Classification of CP - level 3
Patient will walk with assistive device with limitations in walking
outdoors and in the community.
Gross Motor Classification of CP - level 4
Patient self mobility will be severely limited; children are transported
or use power mobility outdoors and in the community.
Gross Motor Classification of CP - level 5
Patient self mobility will be severely limited, even with the use of
assistive technology, requires caregiver.
what is Plagiocephaly
when a baby develops a flat spot on one side of the head or the whole back of the head.
what is Plagiocephaly 2/2
Results from prolonged asymmetrical
pressure on the premature skull
with Plagiocephaly what does we see at the back of the head
Occipitoparietal flattening and contralateral occipital bossing
with Plagiocephaly what do we see at the front of the head
Ipsilateral frontal bossing and anterior displacement of the ear
what is Torticollis?
torticollis occurs when your baby’s neck muscles cause their head to twist and tilt to one side
what is down syndrmoe 2/2
Results from presence of full or partial extra copy of the 21st
chromosome; trisomy 21
in early gait what do the babies feet look like
they are pronated
what neck movement should be avoid in children with down syndrome
- Forceful neck flexion and rotation activities should be limited due
to laxity of odontoid ligament and potential for a subluxation of
atlanto-axial joint
at what age do we want to see the babinski relfex to
12 months
baby - up
adult - down
poeple with down syndrome have decreased strength of what
Decreased quadriceps and hip abductor strength
what is Duchenne Muscular Dystrophy seen in what popiulation
X-linked recessive, inherited by boys
Dystrophin gene missing – destruction of muscles’ cells
what are the intervention for Duchenne Muscular Dystrophy
- Maintain mobility as long as possible
- Maintain joint ROM with active/passive
- DO NOT OVER FATIGUE
what is athetosis
slow writhing movements
what is graves disease
n autoimmune disorder that causes the thyroid gland to produce too much thyroid hormone, leading to hyperthyroidism
bluging eyes
what is Scheuermann Disease
a condition affecting the upper back (thoricic) that makes it rounded so it looks hunched over.
what pop is Scheuermann Disease seen in
male teens
exam finding with Scheuermann Disease
Schmorl’s Nodes and angled/wedged t/s
* Pain with thoracic extension and rotation
- Aggravation with long periods of standing/sitting or physical activity
- Increased thoracic kyphosis & lumbar lordotic curve
what muscle is effected in torticollis
the SCM
what is the intervention for Scheuermann Disease
The Schroth Method, stretch pecs, strengthen thoracic
extensors and scapular stabilizers
what do we name the torticollis for
the side the SCM impacted
what side do we name Plagiocephaly for
the flat side
what is the position that we hold the baby in to fix torticollis
football hold
ear down on the side that is effected to get a stretch in this area
Erb’s palsy is effecting what nerve roots
c5 - c6
Erb’s palsy - MOI
Stretching head downward
during birth
Erb’s palsy - loss of movement
Loss of abduction and
lateral rotation of the shoulder
Erb’s palsy - deformity
Waiter’s tip
deformity
Klumpke’s palsy - effecting what nerve root levels
C8-T1
Klumpke’s palsy - MOI
Stretching of arm
overhead
during birth
Klumpke’s palsy - loss of movement
Paralysis of the
intrinsic of the
hand
Klumpke’s palsy - deformity
Claw hand
what is one of our first treatment for plageocephly
tummy time
helment - 23 hours a day (all times)
what is cerebral palsy
Cerebral palsy is a group of conditions that affect movement and posture.
It’s caused by damage that occurs to the developing brain, most often before birth
are patient with duchennes muscle dystrophy hyper or hypotonic
normally hypotonic
what is gower’s sign
seen with duchennes muscle dystrophy
quad postion and then walking up you leg to assume standing position
what are scholres nodes
end plates cracks
bulge (protrusion) of the jelly-like contents of the vertebral disc into the growth cartilage of bone (vertebra) above or below the disc
