Deck 1 Flashcards
developmental quotient is calculated how?
developmental age/chronologic age
what is normal developmental quotient?
> 85 is normal, less than 70 is abnormal
primitive reflexes
present at birht
example of primitive reflec
moro reflex
when do primitive reflexes disappear?
3-6 months of age
what should you be concerned about if primitive reflexes stay?
CNS injuries
postural reaction
acquired (not present at birth)
example of postural reflex
parachute reaction
delayed development of postural reactions should make you concerned for what?
cns damage
fine motor skills progress from prox to distal or vice versa?
prox to distal
gross motor milestone at birth
turn head side to side
gross motor milestone at 2 months
lift head when lying prone; head lag when pulled from supine position
gross motor milestone at 4 months
rolls over; no head lag when pulled from supine position; pushes chest up with arms
gross motor milestone at 6 months
sits alone, leads with head when pulled from supine position
gross motor milestone at 9 months
pulls to stand; cruises
gross motor milestone at 12 months
walks
four primitive reflexes
moro, hand grasp, atonic neck reflex (fencer); rooting
two postural reactions
head righting, parachute
moro reflex- what is it, when does it appear and when does it disappear
appears at birth and disappears at 3 months
hand grasp
appears at birth and disappears at 1-3 months
atonic neck (fencer) reflex
appears at 2-4 weeks and disappears at 6 months
rooting reflex
appears at birth and disappears at 6 months
head righting
ability to keep head vertical despite body being tilted; appears at 4-6 months and persists
parachute
8-9 months appears and then persists
fine motor milestone at birth
keeps hands tightly fisted
fine motor milestone 3-4 months
brings hands together to midline and then to mouth
fine motor milestone at 4-5 months
reaches for objects
fine motor milestone at 6-7 months
rakes object with whole hand; transfers object from hand to hand
fine motor milestone at 9 months
uses immature pincer (bt thumb and index finger)
fine motor milestone 12 months
uses mature pincer (bt thumb and tip of index finger)
when does the infant learn to use objects as tools (building blocks)?
during the second year of life
what is often the earlies sign of neuromotor problems?
persistent fisting beyond 3 months of age
what would early rolling over, early pulling to a stand instead of sitting, persistent toe walking indicate?
spasticity
early hand dominance
before 18 months of age
what can early hand dominance tell us?
sign of weakness of the opposite upper extremity associated with hemiparesis
when is optimal language development?
first two years of life
what are the periods of speech development?
prespeech (0-10 months); naming (10-18 months); word combination (18-24 months)
when, relative to when they say their first word, are infants able to combine words?
6-8 months after their first word
basic language milestone at birth
attunes to human voice; develops differential recognition of parents’ voices
basic language milestone at 2-3 months
cooing, musical sounds
basic language milestone at 6 months
babbling (ba-ba-ba, da-da-da)
basic language milestone at 9-12 months
jargoning, begins using mama, dada (nonspecific)
basic language milestone at 12 months
1-3 words, mama and dada (specific)
basic language milestone at 18 months
20-50 words; beginning to use two word phrases
basic language at 2 years
two word telegraphic sentences (mommy come); 25-50% of child’s speech should be intelligible
basic language milestone at 3 years
three word sentense; 75% intelligible
when is the “sensorimotor period”?
birth to age 2
when is functional play (using a toy telephone as a telephone), i.e. recognizing objects and associates them with their function
begins at 1 year
when does imaginitive play begin
24-30 months
when does concrete thinking start?
preschool
when does abstract thinking start?
adolescence
when does object permanence develop
9 months, think sep anxiety at this time too
when does separation anxiety develop?
6-18 months
when does cause and effect develop?
9-15 monhs
when is parallel play? Social play?
parallel during first 2 years and social at about 3 years
cerebral palsy
injury to the brain during development, such that motor function is primarily affected; intelligence can be normal or can not be; lots of other associated things like seizures, cognitive deficits, mental retardation, learning disabilities, sensory loss, and visual and auditory d
what is prevalence of cerebral palsy?
0.2-0.5%
How do you dx cerebral palsy?
repeated neurodevelopmental exams showing increased tone or spasticity, hypotonia, asym reflexes or movement disorder, or abnormal patterns in disappearance of reflexes or emergence of postural responsess
two types of cerebral palsy
spastic, extrapyramidal,
spastic diplegia cerebral palsy
one of the three types of spastic cerebral palsy; involves the lower extremities more than the upper extremities or face
maternal risk factors for cerebral palsy
multiple gestation, preterm labor
prenatal risk factors for cerebral palsy
intrauterine growth retardation, congenital malformatios, TORCH infections
extrapyramidal cerebral palsy
patients have trouble controlling the face, trunk, extremities, often writhing. Signif oral motor involvement occurs
mental retardation
significant subaverage intellectual functioning in adaptive behavior; it is manifested before 18 yo
scissoring may be a sign of what?
spastic diplegia
early hand dominance can be a sign of what?
spastic hemiplegia
extrapyramidal
involuntary reflexes
athetoid movements
slow involuntary convoluted writhing movements; seen in extrapyramidal cerebral palsy
kernicterus
bilirubin-induced brain dysfunction;
mild retardation IQ
55-69
moderate retardation
40-54
severe retardatn
25-39
profound mental retardation
less than 25
the most common cause of learning disability
idiopathic
pervasive developmental disorder
spectrum of disabilities affecting multiple developmental areas, with a wide range of severity
what is the prototypical pervasive developmental disorder (PDD)
autism
when is onset for autism
prior to 3 years
echolalia
repetitive words and phrases, seen in kids with autism
difference between autism and aspergers
autism is more severe; in aspergers you don’t see signif language delay
how heritable is ADHD?
30-50% of affected chilren have a first degree relative with ADHD
etiology of ADHD
abnormalities in neurotransmitter function (dopamine and norepi)
when must ADHD start?
before age 7
stimulants used for ADHD
methylphenidate (Ritalin) and amphetamines (Adderall)
what are the nonstimulant (second line) treatments for ADHD?
tricyclic antidepressants and adrenergic agonists like clonidine
effect of methylphenidata (ritalin) on growth stature
may decrease growth velocity but ultimately stature is not affected
prevalence of hearing loss in newborns
1/600
when should intervention occur for hearing impaired child
before 6 months of age
most common cause of hearing impairment
genetic causes account for 80% and 80%of those are recessive
why should creatinine level be checked in kids born deaf?
there is an association between hearing loss and kidney problems; Alport disease
what imaging can be useful in dx deaf kids?
CT scan of the ear
primary cause of blindness worldwide?
chlamydia trachomadas
what are two other causes of blindness in kids?
retinopathy or prematurity, congenital cataracts
definition of colic
crying that lasts greater than 3 hours per days and occurs at least 3 days per week
when does colic usually start age-wise?
starts at 2 weeks and resolves by 4 months
definition of enuresis
urinary incont beyond the age when the child is developmentally capable of continence
secondary enuresis
enuresis after 6 months of being dry
nocturnal enuresis
there’s actually a gene on chrom 13
treatments for nocturnal enuresis
behavioral modification, alarms, and pharmacotherapy
two typs of meds that are used (but only with behavioral mod and alarms)
desmopressin acetate (DDAVP) decreases urine volume but relapse common after stopping med; tricylcic antidepressants (imipramine) but don’t work that well
side effect of tricyclic antidepressants
fatal cardiac dysrhythmia with overdose
management of diurnal enuresis
bladder stretching exercises, timed voiding, treatment of coexisting constipation
when do most infants sleep through the night?
3 months of age- defined as 5 hours after midnight
what stage of sleep do nightmares occur in?
REM
what stage do night terrors occur in?
stage 4, non-REM sleep
difference between nightmares and nightterrors?
the child awakes glassy eyed and does not remember night terrors the next day.
temper tantrums are common at what age
between 1 y and 3 y
when are breath holding spells (involuntary, harmless) typically seen?
start between 6 and 18 months and disappear by 5 years of age
bowel control age range
16-48 months (1-4 years)
bladder control age range
18-60 months (1.5-5 years)
length of the growth spurt
2-3 years
what percent of adult weight and what percent of adult height are gained during growth spurt?
50% of weight and 25% of height
first sign of puberty in males?
testicular enlargement, between 11 and 12 years
what does HEADSS stand for?
home, education/employment, activities, drugs, sex, suicide/depression
leading causes of death for adolescents
unintentional accidents, homicide, suicide
DSM IV criteria for depression
must have 5 out of 9: depressed or irritable mood, diminished interest in activites, weight gain or loss, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness, diminished ability to concentrate, recurrent thoughts of death or suicide
what is dysthymic disorder?
milder sx than depression that last at least 1 year; 2 out of 5 sx: poor appetite or overeating, insomnia or hypersomnia, diminished energy, difficulty concentration, feelings of hopelessness
definition of problem drinking
6 or more episdoes a year of being intox OR having problems (like missing school) associated with the drinking
binge drinking
5 or more drinks in one sitting
CAGE questionaire
felt like you had to cut down? Have others annoyed you by criticizing your drinking? Have you felt guilty about drinking? Have you ever had a drink first thing in the morning (eye opener)/
definition of obesity
weight greater than 20% over ideal body weight; BMI greater than 95% for age and sex;
tibia vara
bowlegs
weight cut off for anorexia
must be >15% lower than ideal body weight
another criterion for anorexia
absence of 3 consec menstrual cycles
what percent of kids are sexually actve by the end of hs?
half
most common cause of vaginitis
BV
other causes of vaginitis
trichomonas, candida
partners should be treated if what is the cause of vaginitis?
trichomonas, not BV or candida
causes of urethritis (which is more common in males)
gonoccocus or non-gonoccoccal (chlamydia, usually, or HSV or trichomonas)
presumptive dx of urethritis
mucupurulent urethral discharge, greater than 5 wbcs per hpf on gram stain of urethral secretions, greater than 10 wbcs per hpf on first void urine specimen, pos leukocyte esterase
what percent of male adolescence get gynecomastia at some point?
60%
management of gynecomastia?
reassurance. Usually resolves within 12-15 months
what is most common cause of acute painful scrotal swelling?
torsion of spermatic cord
clinical findings in torsion of spermatic cord
pain, n/v, swollen tender testicle, absent cremasteric reflex on the affected side,
lab studies to confirm torsion of spermatic cord
decreased uptake on 99m pertechnetate radionuclide scan or absent pulsations on doppler u/s of the scrotum
management of torsion
surgical detorsion and fixation of both testes within the scrotum,
when must sugery be done?
within 6 hours- it’s an emergency! Otherwise you lose testicular function
pain of tosion of testicular appendage can mimic spermatic cord torsion. How can you tell them apart?
testicular appendage torsion has a blue dot sign which is the twisted appendage visible through the skin of the scrotum
what do doppler and radionuc scans show?
normal or incr flow or uptake
management of testicular appendage torsion
rest and analgesia; usuallyresolves within 2-12 days
epidydimitis caused by what organisms
g/c
dx of epididymitis
u/a shows incr WBC and also pos culture of urethral discharge; doppler shows increased flow and radio scan shows increased uptake
cryptochordism
testes fail to descend; associated with high chance of malignancy
dx of painless scrotal masses
doppler u/x of the scrotum; eval for serum tumor markers hcg and afp; eval for distant mets
indirect inguinal hernia
the processeus vaginalis fails to obliterate; this results in a defect in the abdominal wall that allows bowel to extend through the internal inguinal ring
what does indirect inguinal hernia look like?
painless inguinal swelling
hydrocele
collection of fluid within the tunica vaginalis
what does hydrocele look like on testicular exam?
painless, soft, cystic scrotal mass that may be smaller in the morning and larger at night; dx with transillumination of the scrotum
how do you manage a hydrocele
reassurance; surgery only if very large, painful
varicocele
dilation and tortuosity of veins in the pampiniform plexus
how prevalent are varicoceles
10-20%
bag of worms
varicocele
clinical findings of varicocele
most commonly found in the left half of the scrotum; diminish in side when the patient is supine and enlarges with standing and valsalva
management of varicocele
reassurance; if painful or distended or associated with a small testicle (means diminished blood flow), refer to urologist
puberty occurs in males how much later than in females
6-12 months
gram neg intracellular diploccoci
gonorrhea
chancre (h ducrei)
painful multiple ulcers with red irreg borders and purulent discharge; ainful inguinal adenopathy; treat with oral azithromycin, erythromicin or IM ceftriaxone
if apgars arent good at 1 and 5 mins, what’s the protocol
scoring should be continued every 5 minutes until a final score of 7 is reached
apgar heart
absent, less than 100, greater than 100
apgar respiration
absent, slow/irreg, good/crying
apgar muscle tone
limp, some flexion, active motion
apgar reflex irritabilit (response to catheter in nose)
none, grimace, cough/sneeze/cry
color
blue/pale, body pink with blue extremities, completely pink
how is lanugo different among babies of different gestational ages?
lanugo covers pretermers and minimally present in term infants
how is vernix different among babies of different gestational ages
present in term infants, absent in post-term infants
acorcyanosis (cyanosis of the hands and feet)
very frequent during the first 48-72 hours and for some infants can last through the first month of life, particularly if the baby is very cold
cutis marmorata
mottling of the skin with venous prominence
when is jaundice abnormal?
within the first 24 hours of life; it is normal if seen within the first few days after birth
milia
very small cysts formed around the polosebacceous follicles; look like white papules on the nose, cheeks, forehead and chin
treatment for milia?
no, they disappear within a few weeks and do not require treatments
mongolian spots- clinical signif?
of no pathological significance
pustular melanosis
benign transient rash with small dry vesicles over a dark macular base; must be differentiated from infections like herpes and impetigo
erythema toxicum neonatorum
benign rash seen most frequently in the 72 hours after birth; erythematous macules, papules, and pustules resembling flea bites; on the trunk and extremites and face but spares the palms and soles;
how common is erythema toxicum neonatorum
about 50% of full term infants and is found much less freq in preterm infeants
erythema toxicum neonatorum lesions are filled with what?
eosinophils
treatment for erythema toxicosum neonatorum
no treatment necessary
nevus simplex
aka salmon patch or telangiectatic nevus; most common vascular lesion of infancy; pink macular lesion on the nape of the neck (“stork bite”), upper eyelids, or nasolabial region. It is transient
nevus flammeus
aka port wine stain; congenital vascular malformation composed of dilated capillary-like vessels on the face or trunk
what can you expect for nevus flammeus and increasing age
get darker with age;
what to be aware of with nevus flammeus
those located in the opthalmic branch of the trigeminal nerve (cranial nerve V-1) are associated with intracranial or spinal vascular malformations, seizures, and intracranial calcifications (sturge weber syndrome)
sturge weber syndrom
when nevus flammeus are in the opthalmic region of cranial nerve V, then they may be associated with intracranial or spinal vascular malformations, seizures, and intracranial calcifications
strawberry hemangiomas
benign proliferative vascular tumors
how common are strawberry hemangiomas
10% of infants
what should you expect with strawberry hemangiomas?
first noticed a few days after birth, grow , and then resolve by 18-24 months
which hemangiomas need attention
those that compromise the airway or vision
neonatal acne occurs in what percent of newborns?
20%
treatment for neonatal acne?
no
when does neonatal acne appear?
1-2 weeks of life (virtually never present at birth)
caput succendaneum
diffuse swelling of the soft tissue of the scalp that crosses the cranial sutures
cephalahemotomas
confined and limited by the sutures
craniotabes
soft areas of the skull with a ping pong ball feel; usually within weeks or months
what does an abnormal red reflex in a newborn indicate?
may be caused by cataracts, glaucoma, retinoblastoma, or severe chorioretinitis
choanal atresia
back of the nasal passage is blocked
Pierre Robert syndrome
micrognathia, cleft palate, glossoptosis, and obstruction of the upper airway
Beckwith-Wiedemann syndrome
a cause of LGA infants; causes hemihypertrophy, visceromegaly, macroglossia
other causes of macroglossia
hypothyroidism or mucopolysaccharidosis
meausre head circum until what age
2 year
failure to thrive
growth RATE less than expected
particular concern with FTT
weight crosses 2 percentile isobars
isolated short stature
only height is abnormal
in children with FTT, what is affected first- height or weight?
weight, then height then head circumfrence
