Community Pediatrics Flashcards
Definition of community pediatrics
the practice of promoting and integrating the positive social, cultural, and environmental influences on children’s health as well as addressing potential negative effects that deter optimal child health and development within a community
Goals of the routine well child visit
- Provide surveillance of growth and development
- Conduct age-appropriate evidence based screening
- Administer immunizations
- Provide anticipatory guidance
- Address parental concerns.
What are the factors that influence health outcomes, and how is the percentage distribution ?
Social , environmental and behavioral influence 50-60% of health outcomes
Genetic factors influence 30%
Health care system only 10%
What is the definition of SDH? What are these?
conditions in which people are born, grow, live, work and age
Economic stability Neighborhood and physical environment Education Food Community and social context Healthcare system
Adverse childhood experiences types
3 types:
- Abuse( physical, emotional, sexual)
- Neglecct ( physical and emotional)
- Household dysfunction
- Mental illness
- Incarcerated relative
- Mother treated violently
- Substance abuse
- Divorce
CDC-Kaiser permanent ACE study
largest investigations of childhood abuse and neglect and household challenges and later-life health and well-being.
Found that increased ACEs would lead to:
Increased morbidity and mortality
negative outcomes: alcoholism, illicit drug use, COPD, depression, fetal death, ischemic heart disease, liver disease
ACE Pyramid
Bottom to top:
- ACE
- Disrupted Neurodevelopment
- Social, emotional, cognitive impairment
- Adoption of health risk behaviors
- Disease, disability and social problems
- Early death
What do you consider when choosing a tool for screening SDH
The goals of screening in your setting( referral sources, identifying needs, social’s context)
Format used ( paper, electronic, self administered)
Who will respond to positive results
What is advocacy
to offer pubic support for or recommend a cause or policy
ITHELLPS - Screening for social determinants of health
income and food security, transportation, housing/utilities, education, legal status/immigration, literacy, personal safety and support
Four stages of growth
fetal, infant, childhood, and pubertal.
What are the MC parameters to assess growth
weight, height (or length if the child is measured supine), and head circumference.
Which growth chart to use according to age
WHO 0-2 years
CDC >2 years
Why using WHO growth chart in children < 2 years?
- utilize growth of the breastfed infant as the norm for growth.
- The WHO standards are based on high quality data collected for children younger than aged 2 years.
There is a modified CDC version for the WHO growth charts in < 2 years
The WHO growth charts as modified by CDC use the 2nd percentile and the 98th percentile as the outer most percentile cutoff values.
The use of BMI-for-age is not recommended for children younger than aged 2 years at this time
true
Factors that affect Fetal growth
- maternal nutrition
- uterine size
- hormones (including insulin and insulin-like growth factors).
Small for gestational age (SGA) definition
birth weight is below the 10th percentile for the appropriate gestational age.
SGA is different from IUGR
IUGR describes a fetus that has not reached its growth potential
Symmetric vs. Asymmetric IUGR
Symmetric - equally small, early in utero.
chromosomal abnormalities, infections
Asymmetric- spares the head, later onset
Uteroplacental insufficiency
Malnutrition
Smoking
hypertension
large for gestational age definition (LGA)
infant whose weight is greater than the 90th percentile for gestational age.
Children with ADHD often have impaired executive function including ______ and difficulty with response inhibition and control of impulsive behaviors
forward planning
abstract reasoning
working memory
mental flexibility
Comorbidities of ADHD
Oppositional defiant disorder Conduct disorder Learning disabilities Tic disorder Depression Bipolar disorder Anxiety OCD Developmental coordination disorder Substance abuse
Etiology ADHD
unclear
catecholamine metabolism in cerebral cortex appears to play a role.
other factors that may contribute: maternal alcohol, tobacco, substance
prematurity
pre and postnatal toxin exposure
FOOD DOESNT IMPACT ADHD
Diagnosis of ADHD
NICHQ Vanderbilt Assessment - parent, teacher
>= 6 of first 9 questions= inattention, above 18 yo is 5
>= 6 of second 9 questions up to 18 = hyperactivity / above 18 is 5
Ss are present in >= 2 settings
Must impair function and interfere with quality of social, school or work functioning.
and rule out other causes
Symptoms must be present before age 12 and last at least 6 months.
Diagnosis of ADHD by DMS-V Inattention dimension:
- Careless mistakes
- Difficulty sustaining attention
- Seems not to listen
- Fails to finish tasks
- Difficulty organizing
- Avoids tasks that require sustained attention
- Loses things
- Easily distracted
- Forgetful
Hyperactivity/Impulsivity dimension
Diagnosis of ADHD by DMS-V Hyperactivity/Impulsivity dimension
- Fidgety
- Unable to stay seated
- Moves excessively ( restless)
- Difficulty engaging in leisure activity quietly
- “On the go”
- “Talks excessively
- Blurts answers before questions are complete
- Difficulty awaiting turn
- Interrupts or intrudes others
In ADHD at what age does hyperactivity/impulsivity usually starts? at which age does it peak?
starts 4 years
peaks 7-8 years
In ADHD at what age does inattention becomes more apparent?
8-9 years
3 types of ADHD
- Combined presentation- inattention and hyperactivity-impulsivity were present for the past 6 months.
- Predominantly inattentive presentation- more inattentive, were present for the past 6 months
- Predominantly hyperactive-impulsive presentation- were present for the past 6 months
Differential Dx of ADHD
Sympathomimetic toxidrome hyperthyroidism absence seizure anxiety depression lead toxicity OSA (assess freq snore,breath pauses, RF) intellectual disability ( fetal alcohol syndrome, fragile X syndrome( Learning disabilities ( dyslexia) restless leg syndrome
Dyslexia
difficulty reading due to problems identifying speech sounds and learning how they relate to letters and words
MOA methylphenidate
inhibits dopamine and norepinephrine reuptake
If ss of ADHD arise suddenly suspect..
head trauma physical or sexual abuse neurodegenerative disorders mood or anxiety disorders substance abuse major psychological stress in the family or school
CRAFFT questionaire
Substance abuse
Car, Relax, Alone, Forget, Friends, Trouble
1.Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
2. Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
3. Do you ever use alcohol or drugs while you are by yourself, or ALONE?
4. Do you ever FORGET things you did while using alcohol or drugs?
5. Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
6. Have you ever gotten into TROUBLE while you were using alcohol or drugs?
CRAFFT Scoring: Each “yes” response in Part B scores 1 point.
A total score of 2 or higher is a positive screen, indicating a need for additional assessment.
Advocacy and support group for AHDH
CHADD= Children and adults with ADHD disorder
Any child who meets the criteria for ADHD should be considered a child/youth with special health care needs
True
Treatment of ADHD
- Preschool age ->behavioral therapy
* School age ->behavioral therapy + trial stimulants
Drug of choice for ADHD
Ohter drugs
Methylphenidate ( Stimulant)
Mixed amphetamine salts (Adderall)
Dextroamphetamine
Lisdexamfetamine
Dexmethylphenidate
Atomoxetine
ER guanfacine
ER clonidine
What to order before prescribing methylphenidate for ADHD?
Good PE
Evaluate if ECG is needed- this is based on physician suspicion and is not mandatory.
history of cardiac ss
cardiac family history- arrhythmias, sudden death, deathh young age.
Should treatment of ADHD be withheld if an ECG is not done?
NO, doing an ECG is not mandatory and depends on physicians judgement.
Give med for ADHD in patient with congenital heart disease?
reasonable in congenital heart disease that is either unrepaired or repaired, but without current hemodynamic or arrhythmic concerns.
Which ADHD meds increase and decrease BP and HR?
Increase: methylphenidate, amphetamine, atomoxetine
Decrese: guanfacine, clonidine
Which ADHD meds cause ECG changes?
None of the common ones.
The two meds non-FDA approved that can alter ECG:
Bupropion
Desipramine, imipramine.
Stimulant medications for ADHD can be effectively titrated every _____
3-7 days. done with the prescription note
Then face-to face visit: 4 weeks
In person visits interval to PCP once ADHD meds have been started
every month until there is a consistent optimal response.
then every 3 months in the first year of tto
Subsequent visits at depend on progress, but twice per year.
In ADHD By three years after starting medication, continue to impove even if the medication has been discontinued.
TRUE
What if you gave max dose of Methylphenidate and kid still with ADHD still not improving?
Give a med from the other stimulant grouop ( amphetamine) with similar titration plan.
Is likely that they improve
Atomoxetine black box warning
Suicidal ideation
MOA Atomoxetine
selective NE reuptake inhibitor
max response in 4-6 hours
Time of medication response in atomoxetine vs. alpha adrenergic agonists for ADHD?
atomoxetine : max response in 4-6 weeks
alpha adrenergic agonists : 2-4 weeks.
WHILE METHYLPHENIDATE IS LONGER.
AE Atomoxetine
GI symptoms Sedation early in treatment ( so prescribe half dose initially 0.5 mg/kg) appetite suppression tics headache weight loss hepatitis (rare)
Black box warning: suicidal ideation
AE alpha adrenergic agonists
somnolence
Duration of behavioral therapy
12-14 months
Which is the only FDA med approved for ADHD in children?
Dextroamphetamine,
But because there is more evidence with methylphenidate we use this one as first line.
Before prescribing ADHD med in adolescents what should you consider
substance abuse. Stop this before starting ADHD med
effect size calculation
(Treatment mean-control mean)/control SD
AE ADHD stimulants
appetite loss abdominal pain headache sleep disturbance increased BP and HR Potential to exacerbate tics - although in some improve hallucinations ( uncommon) in preschoolers: mood liability and dysphoria
** decrease growth velocity (1-2 cm) particularly if higher and more consistently doses.(effects diminished by 3rd year of tto)
Lisdexamphetamine (Vyvanse)
prodrug of dextroamphetamine
so less abusive potenital.
TIC disorders are NOT a contraindication of ADHD stimulant medications
TRUE
What to monitor in follow-up appointment of child with ADHD that has started treatment?
BP, HR Appetite weight sleep counsel about risks of substance abuse
PHQ-9 FOR DEPRESSION SCORE
Total Score Depression Severity 0-4 No or Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression
Indications to admit newborn to ICU
Birth weight < 2 kg
Gestational age< 37
Inability to PO feed
Any baby who requires IVF or IV med other than ampi/genta
Any baby who is undergoing treatment for infection > 48 hrs
Any baby who received CPR and/epi during initial resuscitation or requires O2 > 60 min after birth
Any baby with thermal instability or requires thermal support
Any baby with pneumothorax; congenital heart disease that requires ongoing observation
Why Vit K is low in newborns?
Coagulation --2,7,9,10 20% of adult vit K concentration due to: poor placental transfer Immature liver with low stores Uncolonized intestine Low vit K content in breast milk.
Why we care about vit K in newborns?
Coagulation –2,7,9,10
Bleeding:
Early onset: 0-2 weeks of age
Late onset 2-12 weeks of age
manifestations may be mild: skin bruising, bleeding at umbilicus or circumcision
Severe: intestinal bleeding and fatal intracranial hemorrhage
RR for developing late VKDB is 81x among infants who do not receive IM vit K vs those who doesnt
Vit K IM vs PO
IM has been shown to prevent both early and late forms of VKDeep bleeding ( CNS, intenstine).
PO prevents early VKBD but not late, which is the most scary.
IM Vit K dose
0.5-1 mg
Dose and why do you apply Erythromycin in babies?
0.5% ophtalmic ointment within 1st hour to all babies ( including C section)
Newborns born to mom with clinical gonorrhea?
IV or IM
Asymptomatic- still at risk : single dose of ceftriaxone (25 to 50 mg/kg, up to a total dose of 125 mg IM/IV) or cefotaxime (if available; 100 mg/kg, administered IV or IM) and should be evaluated for chlamydial infection
If disseminated disease:
Treatment of disseminated infection consists of ceftriaxone (25 to 50 mg/kg per dose once daily intravenously [IV] or intramuscularly) [1,2]. The duration of treatment is 7 days for septicemia, arthritis, or scalp abscess and 10 to 14 days for meningitis [1].
Gonoccocal conjunctivitis
2-5 days
purulent conjunctivitis, with profuse exudate and swelling of the eye
if untreated: ulceration, scarring, and blindness
Dx: Thayer-Martin medium gram stain + evaluation for chlamydia
TTO single dose of ceftriaxone (25 to 50 mg/kg, not to exceed 125 mg, intravenously or intramuscularly)
Why ceftriaxone should be cautiously used in hyperbilirubinemia and Ca containing IV fluids?
since it displaces bilirubin from albumin and may increase the risk of encephalopathy
- and it should be avoided in neonates receiving calcium-containing IV fluids including parenteral nutrition (due to risk of precipitation)
Idiopathic orbital inflammation
lacrimal glandextraocular musclesanterior orbitorbital apexdiffuse inflammation through the orbit
Idiopathic orbital inflammation presentation ( 5 signs)
Young adults , W>Mpalpable massmotility restrictionswollen- worse in morning, decreases in afternoon.proptosis increased orbital pressureIS LOCALIZED, NOT OFTEN WITH CONSTITUTIONAL SSPT MAY OR NOT PRESENT WITH DECREASED VISUAL ACUITY DEPENDING ON THE LOCATION
Idiopathic orbital inflammation presents in patients that also have
Otitis mediaSinusitisUpper respiratiory infectionsImmune related diseases: Crohns, myastenia, Ankylosing spondylitis
Diagnosis and treatment of Idiopathic orbital inflammation
Imaging- helps differentiate orbital cellulitis, malignancyBiopsy- eosinophils, plasma cells, lymphocytesTreatment : steroids ( Dexamethasone)
What is IgG4 Related disease
IgG4 plasma cell disorder with multiorgan compromise. Pancreatitis of unknown originSclerosing cholangitisBilateral salivary or lacrimal glandorbital pseudotumor or proptosis
Diagnosis and tto of IgG4 Related disease
Dx: core needle biopsySerum IgG4 levels Quantity of PlasmablastsTto: steroids.
Complications ankyloglossia
Difficulty breastfeeding Speech dificulty - tdzs r, l. Poor oral hygiene: difficulty moving food in the mouth away from the teeth or cheeksswallowing, kissing.
Procedure to remove ankyloglossia
Frenotomy early in newborn nursery or outpatient baby may feel little discomfort- arent many nerve endings in the frenulum. Local anesthesia may be usedFrenuloplasty - if the frenulum is to thick. general anesthesia . wound closed with stitches, and they disolve as the tongue heals. risks: minor bleeding , infection, scarring
What is milia and what do we do?
Skin newborn: white papules caused by retention of keratin and sebaceous material in the pilaceous follicles. They are frequently found on the nose and cheeks and resolve in the first few weeks of life
Miliaria - what is it, why, what do we do
Also called heat rashis a transient cutaneous eruption in newborns due to obstruction of sweat ducts.face, neck, body and under armsin summer and fue to overdressing baby.
Congenital dermal melanocytosis
blue-gray, pigmented macule or patch with indefinite borders, although it can also be greenish-blue or brownThe most common location is the sacral-gluteal region, followed by the shouldersCause:delayed disappearance of dermal melanocytes.completely benign and usually fades during the first or second year of lifeBy 6 -10 years disappeared3 %remain into adulthood,
Molding
slighlty cone-shaped due to the passage through the birth canalEven babies in c-sectionhead rounds during the first days
Caput succedaneum
edematous swelling of the scalp above the periosteum that presents at birth after prolonged engagement of the fetal head in the birth canal or after vacuum extraction .with poorly defined marginsComplications: halo scalp ring and erosive and necrotic lesions resulting in long-term scarring and alopecia.
Halo scalp ring is a complication of …
caput succedaneumHalo scalp ring:area of alopecia that develops in some infants with caput succedaneumAlopecia resolves over a period of months to years but can be permanent
layers head to identify birth injuries
ScalpGaleal aponeurosisSubgaleal spacePeriostiumSkullDura
Cephalohematoma
swelling of the scalp that does not cross suture lines due to a subperiosteal hematoma.instrumented delivery.Complications: calcification or ossification, infection, and sepsis, hyperbilirrubinemia
Nevus simplex prognosiswhen does it fade?disorders?location?
BLANCHABLE LESIONSgenerally fades within one to two years, although lesions on the back of the neck may persist unchanged with little consequencemay be associated with extracutaneous disorders such as spinal dysraphism, Beckwith-Wiedemann syndrome, macrocephaly-capillary malformation syndrome, or other conditionsIf lumbosacral imaging studies to evaluate for underlying spinal dysraphism - when another lumbosacral abnormality such as a dermal sinus or pit, lipoma, patch of hypertrichosis, or deviated gluteal cleft is present
Port-wine stains or nevus flammeus
low-flow vascular malformations of dermal capillaries and postcapillary venules.BLANCHABLElocated anywhere on the body, typically with a unilateral or segmental distribution that respects the midlinedo not regress, but grow in proportion to the child’s growth and become thicker and darker in color during adulthood.
PUFFY EYELIDS IN NEWBORN
pressure on the face during delivery
why baby sneeze
frequently to clear their nosesNasal congestion is common
When does hydrocele disappear?
6-12 months to disappear completelycheck for signs of:increased sizehernia
Erections are common in newborn boys and often caused by full bladder
True
If undescended testicle, when should I spect to come down?
1st year, otherwise referral to surgery
Is it normal that the baby’s feet are turned in, out or up, or for legs to appear bowed?
Yes, is caused by newborn;s cramped position in the uterusAs long as they are flexible and can move no concerns.
Comfort measures when baby cries
see if hungry, diaper change or too cold or hot.Try talking or singing in a soothing voice or trying a shh sound.Hold you him closely and in different positionsTry rocking or swaying in a rhythmic motionDim lights, reduce noiseWarm bathWhite noisePacifierSwaddle baby in a blanket
How many bowel movements in breastfed vs. formula
breastfeeding: 3-4formula 1-3
Idiopathic orbital inflammation
lacrimal glandextraocular musclesanterior orbitorbital apexdiffuse inflammation through the orbit
Idiopathic orbital inflammation presentation ( 5 signs)
Young adults , W>Mpalpable massmotility restrictionswollen- worse in morning, decreases in afternoon.proptosis increased orbital pressureIS LOCALIZED, NOT OFTEN WITH CONSTITUTIONAL SSPT MAY OR NOT PRESENT WITH DECREASED VISUAL ACUITY DEPENDING ON THE LOCATION
Idiopathic orbital inflammation presents in patients that also have
Otitis mediaSinusitisUpper respiratiory infectionsImmune related diseases: Crohns, myastenia, Ankylosing spondylitis
Diagnosis and treatment of Idiopathic orbital inflammation
Imaging- helps differentiate orbital cellulitis, malignancyBiopsy- eosinophils, plasma cells, lymphocytesTreatment : steroids ( Dexamethasone)
What is IgG4 Related disease
IgG4 plasma cell disorder with multiorgan compromise. Pancreatitis of unknown originSclerosing cholangitisBilateral salivary or lacrimal glandorbital pseudotumor or proptosis
Diagnosis and tto of IgG4 Related disease
Dx: core needle biopsySerum IgG4 levels Quantity of PlasmablastsTto: steroids.
Complications ankyloglossia
Difficulty breastfeeding Speech dificulty - tdzs r, l. Poor oral hygiene: difficulty moving food in the mouth away from the teeth or cheeksswallowing, kissing.
Procedure to remove ankyloglossia
Frenotomy early in newborn nursery or outpatient baby may feel little discomfort- arent many nerve endings in the frenulum. Local anesthesia may be usedFrenuloplasty - if the frenulum is to thick. general anesthesia . wound closed with stitches, and they disolve as the tongue heals. risks: minor bleeding , infection, scarring
What is milia and what do we do?
Skin newborn: white papules caused by retention of keratin and sebaceous material in the pilaceous follicles. They are frequently found on the nose and cheeks and resolve in the first few weeks of life
Miliaria - what is it, why, what do we do
Also called heat rashis a transient cutaneous eruption in newborns due to obstruction of sweat ducts.face, neck, body and under armsin summer and fue to overdressing baby.
Congenital dermal melanocytosis
blue-gray, pigmented macule or patch with indefinite borders, although it can also be greenish-blue or brownThe most common location is the sacral-gluteal region, followed by the shouldersCause:delayed disappearance of dermal melanocytes.completely benign and usually fades during the first or second year of lifeBy 6 -10 years disappeared3 %remain into adulthood,
Molding
slighlty cone-shaped due to the passage through the birth canalEven babies in c-sectionhead rounds during the first days
Caput succedaneum
edematous swelling of the scalp above the periosteum that presents at birth after prolonged engagement of the fetal head in the birth canal or after vacuum extraction .with poorly defined marginsComplications: halo scalp ring and erosive and necrotic lesions resulting in long-term scarring and alopecia.
Halo scalp ring is a complication of …
caput succedaneumHalo scalp ring:area of alopecia that develops in some infants with caput succedaneumAlopecia resolves over a period of months to years but can be permanent
layers head to identify birth injuries
ScalpGaleal aponeurosisSubgaleal spacePeriostiumSkullDura
Cephalohematoma
swelling of the scalp that does not cross suture lines due to a subperiosteal hematoma.instrumented delivery.Complications: calcification or ossification, infection, and sepsis, hyperbilirrubinemia
Nevus simplex prognosiswhen does it fade?disorders?location?
BLANCHABLE LESIONSgenerally fades within one to two years, although lesions on the back of the neck may persist unchanged with little consequencemay be associated with extracutaneous disorders such as spinal dysraphism, Beckwith-Wiedemann syndrome, macrocephaly-capillary malformation syndrome, or other conditionsIf lumbosacral imaging studies to evaluate for underlying spinal dysraphism - when another lumbosacral abnormality such as a dermal sinus or pit, lipoma, patch of hypertrichosis, or deviated gluteal cleft is present
Port-wine stains or nevus flammeus
low-flow vascular malformations of dermal capillaries and postcapillary venules.BLANCHABLElocated anywhere on the body, typically with a unilateral or segmental distribution that respects the midlinedo not regress, but grow in proportion to the child’s growth and become thicker and darker in color during adulthood.
PUFFY EYELIDS IN NEWBORN
pressure on the face during delivery
why baby sneeze
frequently to clear their nosesNasal congestion is common
When does hydrocele disappear?
6-12 months to disappear completelycheck for signs of:increased sizehernia
Erections are common in newborn boys and often caused by full bladder
True
If undescended testicle, when should I spect to come down?
1st year, otherwise referral to surgery
Is it normal that the baby’s feet are turned in, out or up, or for legs to appear bowed?
Yes, is caused by newborn;s cramped position in the uterusAs long as they are flexible and can move no concerns.
Comfort measures when baby cries
see if hungry, diaper change or too cold or hot.Try talking or singing in a soothing voice or trying a shh sound.Hold you him closely and in different positionsTry rocking or swaying in a rhythmic motionDim lights, reduce noiseWarm bathWhite noisePacifierSwaddle baby in a blanket
How many bowel movements in breastfed vs. formula
breastfeeding: 3-4formula 1-3
Idiopathic orbital inflammation
lacrimal glandextraocular musclesanterior orbitorbital apexdiffuse inflammation through the orbit
Idiopathic orbital inflammation presentation ( 5 signs)
Young adults , W>Mpalpable massmotility restrictionswollen- worse in morning, decreases in afternoon.proptosis increased orbital pressureIS LOCALIZED, NOT OFTEN WITH CONSTITUTIONAL SSPT MAY OR NOT PRESENT WITH DECREASED VISUAL ACUITY DEPENDING ON THE LOCATION
Idiopathic orbital inflammation presents in patients that also have
Otitis mediaSinusitisUpper respiratiory infectionsImmune related diseases: Crohns, myastenia, Ankylosing spondylitis
Diagnosis and treatment of Idiopathic orbital inflammation
Imaging- helps differentiate orbital cellulitis, malignancyBiopsy- eosinophils, plasma cells, lymphocytesTreatment : steroids ( Dexamethasone)
What is IgG4 Related disease
IgG4 plasma cell disorder with multiorgan compromise. Pancreatitis of unknown originSclerosing cholangitisBilateral salivary or lacrimal glandorbital pseudotumor or proptosis
Diagnosis and tto of IgG4 Related disease
Dx: core needle biopsySerum IgG4 levels Quantity of PlasmablastsTto: steroids.
Complications ankyloglossia
Difficulty breastfeeding Speech dificulty - tdzs r, l. Poor oral hygiene: difficulty moving food in the mouth away from the teeth or cheeksswallowing, kissing.
Procedure to remove ankyloglossia
Frenotomy early in newborn nursery or outpatient baby may feel little discomfort- arent many nerve endings in the frenulum. Local anesthesia may be usedFrenuloplasty - if the frenulum is to thick. general anesthesia . wound closed with stitches, and they disolve as the tongue heals. risks: minor bleeding , infection, scarring
What is milia and what do we do?
Skin newborn: white papules caused by retention of keratin and sebaceous material in the pilaceous follicles. They are frequently found on the nose and cheeks and resolve in the first few weeks of life
Miliaria - what is it, why, what do we do
Also called heat rashis a transient cutaneous eruption in newborns due to obstruction of sweat ducts.face, neck, body and under armsin summer and fue to overdressing baby.
What is this?
Miliaria crystallina
What is this?
Milliaria rubra
What is this?
Sebaceous hyperplasiasmall (1 to 2 mm), white-yellow, smooth papules occurring most prominently on the face, particularly on the nose and upper lip, in up to one-half of normal newbornsThey gradually involute in the weeks after birth.
What is this?
Erythema toxicum neonatorumin body and diaper areacommon pustular eruption seen in term neonates within the first 1-3 daysof life that resolves spontaneously within one weekno scratch. no tto
What is this?
Neonatal cephalic pustulosis (also called neonatal acne)a pustular eruption on the head and neck of newbornsonset around 3-4 weeks of lifelast until 4-6 monthsSome studies have shown an association withMalasseziacolonization.It resolves spontaneously without scarring in a few months but may be treated with topical azole antifungal preparations or mild topical steroids to speed clearance.
What is this?
Sucking blisterssingle, noninflammatory vesicles or bullae on the wrists, hands, or fingers of newborns due to vigorous sucking in utero
What is this?
Benign cephalic histiocytosisself-healing type of non-Langerhans cell histiocytosisinfants and young children, with an average age of onset of 15 monthssmall, yellow-red or yellow-brown, asymptomatic maculesand/orpapules located mostly on the head and neck
What is this?
Cradle capscaly white or yellow patches on the scalp that may be oily or dryCause unknownnot contagious, not due to poor hygienebaby oil before washing it with mild shampoo. Dont leave oil on or it may worsen. Do not scratch it
Congenital dermal melanocytosis
blue-gray, pigmented macule or patch with indefinite borders, although it can also be greenish-blue or brownThe most common location is the sacral-gluteal region, followed by the shouldersCause:delayed disappearance of dermal melanocytes.completely benign and usually fades during the first or second year of lifeBy 6 -10 years disappeared3 %remain into adulthood,
What is this?
Cutis marmoratasymmetric, reticular mottling of the skin of the extremities and trunkvascular response to cold and usually resolves with warming.distinguished from cutis marmorata telangiectatica congenita, a vascular malformation in which the lesions do not resolve with warming PLUS HAS body and limb asymmetry, cleft palate, and glaucoma
Molding
slighlty cone-shaped due to the passage through the birth canalEven babies in c-sectionhead rounds during the first days
Caput succedaneum
edematous swelling of the scalp above the periosteum that presents at birth after prolonged engagement of the fetal head in the birth canal or after vacuum extraction .with poorly defined marginsComplications: halo scalp ring and erosive and necrotic lesions resulting in long-term scarring and alopecia.
Halo scalp ring is a complication of …
caput succedaneumHalo scalp ring:area of alopecia that develops in some infants with caput succedaneumAlopecia resolves over a period of months to years but can be permanent
layers head to identify birth injuries
ScalpGaleal aponeurosisSubgaleal spacePeriostiumSkullDura
Cephalohematoma
swelling of the scalp that does not cross suture lines due to a subperiosteal hematoma.instrumented delivery.Complications: calcification or ossification, infection, and sepsis, hyperbilirrubinemia
Nevus simplex prognosiswhen does it fade?disorders?location?
BLANCHABLE LESIONSgenerally fades within one to two years, although lesions on the back of the neck may persist unchanged with little consequencemay be associated with extracutaneous disorders such as spinal dysraphism, Beckwith-Wiedemann syndrome, macrocephaly-capillary malformation syndrome, or other conditionsIf lumbosacral imaging studies to evaluate for underlying spinal dysraphism - when another lumbosacral abnormality such as a dermal sinus or pit, lipoma, patch of hypertrichosis, or deviated gluteal cleft is present
Port-wine stains or nevus flammeus
low-flow vascular malformations of dermal capillaries and postcapillary venules.BLANCHABLElocated anywhere on the body, typically with a unilateral or segmental distribution that respects the midlinedo not regress, but grow in proportion to the child’s growth and become thicker and darker in color during adulthood.
PUFFY EYELIDS IN NEWBORN
pressure on the face during delivery
why baby sneeze
frequently to clear their nosesNasal congestion is common
What is this?
Epstein pearlspainless, harmless cystspot usually disappear on their own
When does hydrocele disappear?
6-12 months to disappear completelycheck for signs of:increased sizehernia
Erections are common in newborn boys and often caused by full bladder
True
If undescended testicle, when should I spect to come down?
1st year, otherwise referral to surgery
Is it normal that the baby’s feet are turned in, out or up, or for legs to appear bowed?
Yes, is caused by newborn;s cramped position in the uterusAs long as they are flexible and can move no concerns.
Comfort measures when baby cries
see if hungry, diaper change or too cold or hot.Try talking or singing in a soothing voice or trying a shh sound.Hold you him closely and in different positionsTry rocking or swaying in a rhythmic motionDim lights, reduce noiseWarm bathWhite noisePacifierSwaddle baby in a blanket
How many bowel movements in breastfed vs. formula
breastfeeding: 3-4formula 1-3
Typical growth can be classified into four stages:
fetal, infant, childhood, and pubertal.
Fetal growth is influenced by
maternal nutrition, uterine size (restriction), and hormones (including insulin and insulin-like growth factors).
Disorders of fetal growth
SGA - birth weight < 10th percentile for the appropriate gestational age. Can be symmetric/asymmetric
IUGR describes a fetus that has not reached its growth potential.
LGA - > 90th percentile
most common pathology associated with LGA
gestational or pregestational diabetes
maternal obesity
overgrowth syndromes (e.g., Beckwith–Wiedemann and Sotos syndromes)
How is the infant growth
-10% weight loss within the first few days of birth that is regained (“back to birth weight”) by 2 weeks.
After birth weight is regained, infants gain an average of 20–30 grams/day during the first 3 months.
double their birthweight by 6 months and triple it by one year.
Mid-parental height formula
can be used as predictor of height in infant but may not be 100% accurate
For boys: [father’s height (cm) + mother’s height (cm) + 13]/2 or [father’s height (in) + mother’s height (in) + 5]/2
For girls: [father’s height (cm) - 13 + mother’s height (cm)]/2 or [father’s height (in) - 5 + mother’s height (in)]/2
Failure to thrive causes
inadequate nutrient intakeinadequate nutrient absorption or increased lossesincreased nutrient requirements or ineffective utilizationeating disorders
Overweight/obesity in children consider
hypothyroidism
Cushing disease
overnutrition
very tall stature differential dx
hyperthyroidism
precocious puberty
growth hormone
excess familial glucocorticoid deficiency
chromosome duplication (e.g., Klinefelter syndrome; 47, XXY)
genetic syndrome (e.g., Weaver, Marfan, or Sotos syndromes)
Macrocephaly
head size that is larger than expected for age (>98th percentile)
Causes Macrocephaly
hydrocephalus: the brain is not growing rapidly but the skull grows too large or too fast because of cerebral spinal fluid (CSF) retention
intracranial masssubdural fluid collection
megalencephaly: increased brain mass that may be benign or a result of a syndrome or systemic disorder
benign enlargement of the subarachnoid space seen on head ultrasound of normally developing infants; as the name implies, a nonpathologic cause of macrocephaly often seen in families with large heads
Domains of development
cognitive: reasoning, memory, and problem-solving skills
language: receptive and expressive communication, speech, and nonverbal communication
fine motor: movements using hands and small muscles
gross motor: movements using large muscles
social-emotional and behavioral: attachment, self-regulation, and interaction with others
age for autism screen
18 and 24 months
goal of primary prevention
prevent new disease by reducing risk factors.
fluoride varnish to reduce risk of cariesvitamin D supplementation for infants to reduce the risk of ricketsvaccinations to prevent disease
are examples of _______ prevention
primary
goal of secondary prevention
detect disease when a patient is still asymptomatic and early enough that treatment may improve prognosis. Secondary prevention is often achieved by screening
Screening tests are not diagnostic. Rather, they identify patients who need further workup, which may include further diagnostic testing.
goal of tertiary prevention
reduce the burden of an existing disease and prevent disease-related complications.
