Community & Development Flashcards
Low risk BRUE criteria
Age > 60 days
If premature, gestational age >/= 32 weeks and CGA >/= 45 wks
First episode of BRUE
Duration < 1 min
No CPR required by trained medical provider
No concerning features on history or physical
Breath holding spell management
Reassurance
Self limited episodes
Outgrown within a few years
Screen for anemia with CBC recommended
- Spells can be worse with iron deficiency anemia
Screen for arrhythmia with ECG recommended
- Rarely presenting sign of long QT syndrome
Meds (rarely used, only if anoxic seizures that are recurrent, prolonged and not responding to other measures)
Atropine
Antiseizure meds
CPR training if severe spells s
Head shape cranio vs plagio
ears anterior = A-ok = plagio
ears posterior = bad = cranio
Tics criteria
Typically preceded by a premonitory urge
Suggestible
Suppressible - can be suppressed for varying periods of time – e.g. when deeply focused, during sleep
Distractible
Tourette disorder dx
Both multiple motor AND one or more vocal tics have been present at some time during the illness, although not necessarily concurrently
Tics may wax or wane in frequency, but have persisted for > 1 year since first tic onset
Onset before age 18 years
Persistent/provisional tic disorder
Persistent (>1yr)
Single or multiple motor or vocal tics have been present during the illness, but not both motor + vocal
May wax + wane in frequency but have persisted for > 1 year since first tic
Onset before 18 years
Provisional (<1 yr)
Single or multiple motor and/or vocal tics
Persistent for < 1 year
Onset before age 18
Tourette comorbidities
ADHD
OCD
Tic treatment meds
alpha agonist (clonidine, guanfacine)
antipsychotics
use if tics are painful or injurious or cause functional impairment or impair quality of life
treat ADHD or OCD first
CPS physical activity in toddlers recommendations
Toddlers age 1-4
- > 180 mins of any intensity per day
-
Bacteria causing dental caries
strep mutans
Cannabis withdrawal syndrome
at least two of five psychological symptoms:
Irritability
Anxiety
Depressed mood
Sleep disturbance
Appetite change
And at least one of six physical symptoms:
Abdominal pain
Shaking
Fever
Chills
Headache
Diaphoresis
craniosynostosis types
Sagittal > metopic > unilateral coronal
Sagittal: long head, bulging forehead
Lamboid willl have flat occiput similar to :(
Vaccines after HD steroids
–> inacctivated 2 weeks after stopping
–> live 4 weeks after stopping
Influenza vaccines
everyone 6 mo up should get it including pregmany women
Car seat safety
rear facing: until 2-4 yr old
Forward facing with 5 pt harness: at least 2 yo and have outgrown larg rear facing seat
Booster seat: once 18kg (40lb) and can sit straight and tall without moving
Seat belt only: must be at least 145 cm ( 4’9) - usually age 9-12
Colic
-normal crying
-colic criteria
normal crying
2 weeks 1-2 hr
peak 2-3 hr at 6-8 weeks
less than 1 hr by 12 weeks
Rome criteria for colic:
- Infant < 4 months of age
- Paroxysms of fussiness/crying that starts/stops without obvious cause
- >3h/day, >3day/week, for >1 week
- Otherwise well
red flags
- apneic
- cyanosis
- resp distress
- vomiting
- bloody stools
- fever
Enuresis
- decide if they have lower urinary tracts symptoms or not to determine overactive bladder vs. dysfunctional voiding vs. lower tract obstruction
alarm therapy if 2x a week but don’t use if nightly
DDAVP - used for nocturnal polyuria with normal daytime bladder capacity
- anticholinergics for bladder overactivity, need to refer to urology
- don’t use tricyclics
- mirabegron refer to urology to use; used to treat overactive bladder
Screening for STIs
annual G/C if sexually active < age 25 yo
- First catch urine for chlamydia and gonorrhea (small volume)
- Pharyngeal swab if oral sex
- anal swab if anal receptive intercourse
Annual serology for HIV and syphilis if >15 yo or high risk
Hepatitis B/A/C serology if sexually active with unclear immunization hx or high risk bevahiour or partner
Rome III Criteria for functional constipation
Rome III Criteria 2 or more of:
2 or less BM per week
1+ episode of incontinence per week (2dary)
Hx of excessive stool retention (volitional, posturing)
Hx of painful or hard bowel movements
Large fecal mass in the rectum
Hx of large-diameter stools that may obstruct the toilet
If <4 year developmental age:
2+ above for 1 month+
If >4 year developmental age:
Cannot also fulfill IBS criteria
2+ above for 2 months+
constipation red flags
History: 🚩
Onset <1mo age
Delayed meconium >48h
Ribbon stool
Blood in stool without fissure
Resp problems (CF)
Bilious emesis
Family history: celiac, thyroid, MEN2b
Exam: 🚩
Poor growth
Lumbosacral anomalies: tuft, dimple, deviated cleft
Abnormal lower extremity tone/gait/reflexes
Absent anal or cremasteric reflex
Abnormal anus position
Abnormal thyroid gland
Severe abdo distension
Perianal fissure
Anal scars
Extreme fear during anal examination (sex assault)
