Development/Social/Preventative Flashcards
T/F First born children speak later than subsequent children
F - First born children speak earlier
T/F Girls speak earlier than boys
True
T/F Twins speak earlier than singletons
F - Twins speak later
T/F Tongue tie and cleft palate are risk factors for speech delay
F - they may affect speech QUALITY though
A 4 year old should be able to give their home address T/F
F that is more typical of a 5 year old
Note: 5 years old should also be able to draw a triangle, dress and undress unaided and write their name and make good cuts with scissors
At what age would you expect a child to have a 100 word vocab?
3 yrs
Note: think 3 digits 3 yr old should also speak in 3-4 word phrases Match 2 colors Copy a circle Jump Ride a tricycle Build a tower of 9 blocks
In a pt with macrocephaly and a strong family history when is reassurance and no further work up appropriate
Only if none of the following: neurodevelopmental abnormalities; abnormal growth velocity or macrocephaly >3 sd above average
Causes of toe walking?
Prematurity Unilateral hip dislocation Duchenne MD Spastic CP Spinal tumors
UA should be performed in all children that present with nocturnal enuresis T/F
F - Do not perform urinalysis routinely in children and young people with bedwetting, unless any of the following apply:
- bedwetting started in the last few days or weeks
- there are daytime symptoms
- there are any signs of ill health
- there is a history, symptoms or signs suggestive of urinary tract infection
- there is a history, symptoms or signs suggestive of diabetes mellitus.
Waking or lifting children and young people with bedwetting, at regular times or randomly, will promote long‑term dryness. T/F
False
First‑line treatment to children and young people whose bedwetting has not responded to advice on fluids, toileting or an appropriate reward system
Alarm
Desmopressin is indicated for use in those who have daytime urinary wetting only T/F
F
But it can be used in patients who have both daytime and nocturnal enuresis
Desmopressin use is CI in those with sickle cell disease T/F
F - but it must be stopped during times of crisis
Desmopressin can be used for nocturnal enuresis for those > 7 yrs only T/F
F - can consider in those 5-7 yrs
Roughly how many newborns will have hearing loss?
1-2 in 1,000
Note: this number increases to 1 in 100 if they have spent at least 48 hours in special care
Emotional deprivation is a known cause of speech delay T/F
T
Other known causes: any type of learning disability, hearing defects, CP, autism, developmental expressive aphasia
When does the Morro reflex disappear?
Around 4 months, persistence past 6 months is always abnormal
When does the palmar reflex disappear?
Around 3 months
Which is the last of the postural reflexes to develop?
Parachute reflex . Develops around 9 months, around the time the baby is learning to balance and sit unsupported.
At what age should a child be able to write their name?
5 yrs
At what age should a child with a squint be referred for work up?
Over 6 months old. However can wait up to 18 month if transient and only lasting a few seconds
By what age would a neat pincer grasp be demonstrated?
By 12 months
Building a tower of 3-4 cubes and following a one step command - what age?
By 18 months
In a patient with nocturnal enuresis and only a partial response to desmopressin the next medication is imipramine T/F
F - imipramine is used for this; but first should try to add an anticholingeric.
Note: anticholinergic should not be used for those with nocturnal enuresis without daytime wetting and it should not be combined with tricyclic therapy.
A children should be referred for a hearing test if they have no single words by what age? And no intelligible speech by what age?
18 month for single word
3 yrs for intelligible speech
Other indications: parental concern, strong family history of congenital deafness or bacterial meningitis
What age should a child be able to copy a circle
3 yrs
What age should a child be able to count to 10?
4 yrs
Also should be able to copy a cross, draw a person with 3 parts and stand on one foot well
Menstrual cycle which comes first follicular phase or luteal?
Follicular (d 1-14)
During the follicular phase of the menstrual cycle there is an increase in oestrogen what does this lead to?
Increase in LHRH and decrease in FSHRH
At what age would a child be expected to fix and follow through 90 degrees in horizontal field?
6 weeks
Also: startle to loud noises and smile (but not social)
At what age would a child be expected to fix and follow in vertical and horizontal field?
12 - 16 weeks
A 2 yr old would usually share their toys and play with others? T/F
F - this would be more typical of a 4 yr old
A 2 yr old would play alone, “alongside” other children but not with them
At what age can a child draw a diamond?
7 yrs
A 7 yr old can also write their full name, and write the numbers up to 9
At what age can a child draw a person with defined features, such as hands and feet
8 yrs
At what age can a child write their first name?
6 yrs
Should also be able to draw a slanted rectangle
When should a child start to show hand preference?
18 months
When do the first teeth usually erupt in children?
Around 6 months
At what age should a child pull to sit?
6 months
Note: also transferring objects from hand to hand, follow objects with eyes, rolling front to back, babble and laugh, recognise parental voices
At what age should a child pivot to reach objects?
9 months
Note: also finger feed
At what age should a child walk up stairs with support?
16-18 months
Note: without support is 24 months
At what age should a child be able to bounce and catch a ball?
5 yrs
At what age should a child be able to pull and push large wheeled toys?
2 yrs
Note: should also be able to squat to play with toys on the floor
At what age should a child be able to run on tip toes?
3 years
Up until what age is separation anxiety normal?
3-4 yrs of age
Note: equal in boys and girls
When should the moro reflex and the stepping reflex persist until?
Stepping about 2 months
Moro reflex until about 4 months
A child can build a tower of 9 blocks, what age would this be expected?
3 yrs
Hopping is typical of what age?
4 yrs
Enuresis is defined as bedwetting past what age?
Past 6 yrs old
A patient with an IQ of 55 is considered to have what type of intellectual disability?
Mild
Note: > 70 normal, 70-50 mild; 49-35 moderate; 34-20 severe; <20 v severe
At what age would a pt be expected to start mirroring simple facial expressions such as smiling or frowning?
4 months (16 weeks)
At what age would you expect a child to wave bye bye?
12 months
At what age would you expect a child to indicate toilet needs?
18 months
At what age would you expect a child to finger feed?
9 months
Note: also pivots to reach objects
At what age should a child be able to say their full name?
3 yrs old
Around what age should a child have understanding of object permanence?
12 months
What type of vaccines if not given on the same day must be given 4 weeks apart?
Live vaccines (eg MMR, varicella)
Note: rationale is to reduce the potential that the antibody response to the 1st vaccine will decrease the efficacy and response to the 2nd vaccine. Live vaccines can be given together on same visit.
Menactra (MenACWY- D ) should not be given before 2 yrs of age. Why?
To avoid interference with the immune response to the pneumococcal series (PCV13).
Note: this is not the same for Menveo (MenACWY - CRM)
Rolling front to back or back to front occurs first?
Front to back
Note: around 4 months
What is the average head circumference at term?
35cm ( +/- 2)
What are the first types of permanent teeth to erupt?
First permanent premolars and
Lower central incisors
In a child with a hx of egg allergy, what vaccine should be administered under direct supervision of an allergist with expertise in mgmt of allergic reactions?
Yellow fever vaccine
Note: it contains a larger amount of egg that other vaccines
Anaphylaxis after streptomycin, polymyxin B or neomycin is a contraindication to what vaccine?
IPV (inactivated polio vaccine)
When giving MMRV, as opposed to MRR and monovalent varicella, there is an increased risk of what?
Increased risk of febrile seizure
Significant refractive errors in children usually present with headache and complaining of blurred vision T/F
F - usually the children do not complain; instead their behaviour suggests the problem (eg sitting closer to TV)
Visual acuity in children reaches the adult level of 20/20 by what age?
3-5 yrs
When should an infant born at < 2000g should receive Hep B?
At one month (chronological age) or at hospital discharge - whichever comes first
Exception:
if mother is HepB positive, give within 12 hours of birth along with Hep B immunoglobulin (regardless of birthweight). Infant should be tested at 9 -12 months for Hep B.
if mother’s HepB status is unknown, give HepB vaccine within 12 hours (regardless of birth weight). If infant is < 2000g give HB immunoglobulin.
What is the max age for catch up with Rotavirus vaccine?
Max age for first dose is 14 weeks and 6 days
Max age for final dose is 8 months
Varicella vaccine is C/I in children with HIV. T/F
F - it should be considered in those with a CD4 T cell percentage > 15%
MMRV is not approved for what age group?
Not approved for children > 12 yrs
Which vaccine is NOT given to children 7 yrs or older DTap or Tdap?
DTap
Think D earlier in the alphabet so given earlier
What is the regular vaccine schedule for DTap and Tdap?
DTap at 2, 4, 6, 15-18 months and 4 -6 yrs
One dose of Tdap at age 10 - 11 yrs
Note: 5th dose of DTap not necessary if 4th dose admin at 4 yrs or older
Catch up vaccination plan for a child who has not been immunised with Dtap and is > 7 yrs old?
Tdap vaccine as one dose in the catch-up series; if additional doses needed, use tetanus and diphtheria vaccine, adult/adolescent formulation (Td).
Note: if the child is between 7-10 and receives a dose of Tdap as part of catch up they do not need the reg scheduled dose at 10-11yrs. Instead Td should be administered instead, 10 years after Tdap dose
Seizure within the past 3 days is a relative contraindication to immunisation with DTap/Tdap. T/F
True
Other relative contraindications:
-History of fever > 40.5 °C (105 °F) within 48 h after prior dose
-A shock-like condition within 2 days
- Persistent crying for more than 3 h within 2 days
Absolute contradiction: History of encephalopathy within 7 days of prior dose
A patient can receive live vaccines, even if their pregnant mother is non immune to the pathogens in question/ T/F
T - there is no risk that an immunised child will shed live virus
If a patient has been on high dose steroids how long after stopping the steroids until live vaccines can be given?
4 weeks minimum
Note: high dose
> 2mg/kg/day of pred for > 14 days
or > 20mg/day if child weights > 10 kg
At what age can a child “rake” for an object?
By 6 months
Megalencephaly: difference in presentation of metabolic vs anatomical?
Metabolic (such as liposomal storage disorder): generally normocephalic at birth with increase in head circumference during infancy
Anatomical (such as benign familial megancephaly or syndromic): macrocephalic at birth
What is the leading cause of infant mortality between 1 month and 1 yr in the US?
SIDS
What is the leading cause of infant mortality < 1 month old in the US?
Congenital abnormalities
What vaccines may be given S/C
S/C only: MMR, MMRV and varicella
S/C or IM: IPV, PPSV23
At what age should at child have 10-25 words?
18 months
Should also be able to identify up to 4 body parts, use a cup well and stack 3-4 cubes
Higher paternal education is protective against obesity T/F
F - only higher maternal education has been shown to be protective
3 prenatal factors that increase the risk of obesity?
Excessive maternal weight gain during pregnancy (25-35 pounds is normal)
High birth weight
Gestational Diabetes
When should head lag disappear?
By about 4 months
Which hand is used for the congenital cardiac screen in newborns?
Right hand (preductal)
Passing criteria for a congenital cardiac screen?
O2 sats 95 or greater in right hand and foot
Plus difference between right hand and foot must be < 3%
Formula for mid parental height
Female: [Mother ht + (father height - 5 inches)]/2
Male: [(Mother ht + 5 inches) + father height]/2
Sequence that child can start copying shapes
Circle (3 yrs) Cross (3-4 yrs) Square (4 yrs) Triangle (5 yrs) Diamond (6 yrs)
At what age should HPV screening begin for females?
- Otherwise healthy: begin at 21 yrs and repeat every 3 yrs
2. HIV or otherwise immunocompromised: screened twice in the first year after diagnosis and then annually
When should an individual be screened for HIV?
All adolescents should be screened once between ages of 15 - 18. This includes those who do not report sexually activity
Those at high risk should have screening repeated annually
How many doses of HPV vaccine are indicated?
If started < 15 yrs, 2 doses only
If started at or > 15 yrs, 3 doses
Live attenuated flu vaccine is C/I for members of a household who live with an immunocompromised individual T/F
T
At what age is a premature infant expected to growth catch up to their peers?
By 2 yrs
Provided no significant congenital abnormalities, chronic disease or marked growth defects
Transient thrombocytopenia is a rare adverse effect following what vaccination?
MMR
Note: arthralgia is another side effect, can occur in up to 25% of post pubertal females
Hep B vaccine schedule for a infant born to a mother with positive surface antigen
All infants should get a dose of Hep B vaccine and Hep B immune globulin within 12 hours of delivery
Subsequent schedule depends on birth weight
- > 2 kg doses at 1 and 6 months of age
- < 2 kg doses at 1, 2 and 6 months (or 2, 4, 6 months)
At about what age does a child develop voluntary grasp?
Between 4 - 5 months
Typical vaccine schedule for MCV4?
11 -14 years and booster at 16
Note: If first does given > 16 yrs a booster is not indicated
An individual can have a PPD test on the same day as MMR vaccination T/F
T - PPD can be done any time before or on the day of immunisation.
Note: if any later the PPD will need to be postponed to 4 -6 weeks
Predictive genetic testing of children for adult-onset genetic disorders is not recommended until the child reaches adulthood or adolescence. T/F
T
If the child has a mature decision-making capacity, genetic counselling can be considered, with informed consent
Name 4 situations in which non-resuscitation of a neonate may be appropriate
- Confirmed gestation less than 23 weeks
- Birth weight less than 400 g
- Anencephaly
- Confirmed lethal genetic disorder or malformation
In a child with a known fatal disease organ donation should be discuss prior to death T/F
F - The family should not be approached by anyone about organ donation before the declaration of death
By what age can a child walk up and down stairs with two feet and one foot on each stair?
Two feet - 2 yrs
One foot - 3 years
Delayed pubertal development in boys is defined by?
Lack of testicular enlargement by 14 yrs of age
Or
If > 5 yrs have elapsed from initiation to completion of genital growth
At what SMR (sexual maturity rating) does peak growth velocity occur?
Females: 2-3
Males: 3-4
What is the most common cause of death in adolescence?
Unintentional injury (about 40%) - includes MVC, drowning
Note: next is suicide
Features of pubertal gynaecomastia?
< 4cm
Usually bilateral with one larger than the other
Note: tx is reassurance, usually soon regresses
What is the most common breast mass in teenagers?
Fibroadenoma
Note: painless rubbery mass located in the upper outer quadrant that does not change in size throughout her cycle; a well-circumscribed, smooth, mobile lesion. Tx is reassurance. Compare to fibrocystic changes which are pain and worse prior to/during menstrual cycle.
An infants testes should usually descend by what age?
6 months
AAP recommends referral to a surgeon if testes have not descended by what age?
6 months
Note: will typically then get orchiopexy between 6 - 18 months
When should a child be screened for high cholesterol?
If no risk factors: once between 9 to 11 yrs old age and again at 17-21
If risk factors: between 2 - 8 yrs old.
Note: RFs - DM, obesity, ESRD, post heart or renal tx; fhx of early MI, stroke or peripheral vascular disease or parent with total cholesterol > 240
A child is travelling to a country with a polio outbreak, they have received all their IPV vaccines. Is a booster indicated?
A booster is indicated if their last polio was > 1 yr ago and they will be in the country for > 4 weeks and polio have been identified in the last year
When should HPV vaccination begin?
11-12 yrs with 2nd dose in 6 -12 months
Note: can give as early as 9 years in those who have been sexually abused
In an unvaccinated child who is otherwise healthy at what age is HiB not required?
Over 5 yrs old
Intranasal flu vaccine in CI in those with chronic renal disease T/F
T
Other CIs: asthma /reactive airway disease (if < 4; caution if > 5); diabetes mellitus; immunosuppressed; daily salicylate therapy; CSF leak or cochlear implant
At what age should PPSV23 be given (when it is indicated)?
2 yrs old (and should be > 8 weeks since final PCV13)
Note: indicated in those at high risk of invasive pneumococcal disease
What are the first 3 sets of teeth to erupt
Mandibular central incisors -> maxillary central incisors -> maxillary lateral incisors
Note: next -> first molars -> canines -> second molars
Contra indications to Rotavirus vaccine
- Hx of intusseception
- Severe combined immunodeficiency
Note: Rotarix (oral human attenuated monovalent) contains latex and hence allergy is a CI. In this case give RotaTeq (oral human-bovine reassortant pentavalent). RotaTeq is 3 dose series
At what age is only one flu vaccine recommended in a child who has never had the vaccine?
9 yrs is the minimum
At what age can intranasal vs regular flu vaccine be given?
Regular from 6 months old
Intranasal from 2 yrs old and it is only recommended in those who would not otherwise get the vaccine (eg due to refusal)
What are the ADA screening recommendations for T2 DM
- Overweight with BMI > 85% for age/sex
PLUS - One or more of:
Family hx of T2 DM in 1st or 2nd degree relative
Race (African American; Native American; Hispanic; Asian American; Pacific Islander)
Maternal hx of gestational DM
Features of insulin resistance (acanthosis nigricans, HTN, dyslipidaemia, PCOS, hx of small for gestational age)
If meets criteria: screen at 10 yr or onset of puberty and repeat every 3 yrs
Who should receive pertussis chemoprophylaxis?
ALL household contacts of index case and other close contacts even if already vaccinated.
Note: this includes healthcare workers caring for high risk children and pregnant females
Child between 6-11 months old traveling to a measles endemic country what prophylaxis is recommended?
A single dose of MMR
Note: MMRV not given to those < 1 yr. Also they will still need the typical 2 doses of MMR at a later date
A child with Hepatitis A should be excluded from school for 10 days from symptom onset T/F
F - should be excluded from school but only for 7 days from symptoms onset. After 7 days shedding in stool diminishes
Note: boosters are not recommended for close contacts as the vaccine is v effective
What commonly given paediatric vaccines need to be stored in the freezer?
Those containing varicella
MMRV or monovalent varicella
Note: MMR is the only vaccine that can be stored in either fridge OR freezer
The minimum duration between 1st and 2nd dose of varicella vaccine is 4 weeks T/F
F - it is 4 weeks if the series is started over 13 yrs old; if < 13 years old it is 3 months
