Final Material Flashcards
toddlers (1-3yrs)
- -develop autonomy
- -explore independence
- -language development expands
mortality rate for toddlers (1-3)
- -50/50 internal Vs external
- -most external are due to injuries
word comprehension at: 9 m 12m 2yrs 4yrs
9m = word comprehension 12m = babbling 2yrs = ~270 words, commands 4yrs = ~1,600 words, intelligible speech & <5 word sentences
preschoolers (3-5yrs)
generally =
- -32-40lbs & 36”-45” tall
- -toilet trained
- -follows simple directions
- -cooperative play
- -brain at 90% adult weight
- -read one syllable words & write name
- -gender ID
mortality rate in preschoolers (3-5yrs)
external cause 2:1
50% MVA
25% homicide
25% other injuries
gait & stance variations in toddlers & preschoolers
- *most neonates = bowlegged (gene varus)
- -tip-toe gait = common until age 2
gait & stance variations in 3-4years
- *most kids = knock-kneed (gene-valgus) stance that usually spontaneously resolves by age 7
- -maybe bcuz… metatarsus adducts, internal tibial torsion, or increased femoral anteversion
gait & stance variations
–criteria for referral to ortho =
–bowing beyond age 2
–bowing that increases
–unilateral bowing
–knock-knees associated with short stature
(may consider bracing)
causes of toeing in
- -femoral anteversion (MC)
- -tibial torsion
- -metatarsus varus (adductus)
- -talipes equinovarus (clubfoot)
femoral anteversion
- -MC in 2-3y.o.a
- -causes excessive IR of femur
- -usually resolves on its own
tibial torsion
- -due to excess IR of tibia
- -check patella position (patella face out or straight ahead)
- -if persists beyond 16-18m tx w/ ext rot splint
metatarsus varus (adducteurs)
- -forefoot virus give look of kidney foot.
- -determine if flexible or rigid
- -most resolve spontaneously but some may need casting and corrective shoes
talipes equinovarus (clubfoot)
3 features:
1) plantar flexion of foot
2) varus/inversion deformity
3) forefoot varus
- -if tx shortly after birth correction is rapid.
- -use manipulation to stretch contracted medial & posterior tissues & splinting
flat feet & arch development
- -birth–> 3-4yrs feet = flat
- -arch is filled w fat
- -as lig & tendons get stronger = arch appears
- -flexible flat feet are usually asymptomatic; younger kids often use toeing-in to compensate
pes planus
–check if rigid or flexible
- —check normal heel cord length (full dorsiflexion/planar flexion should be achieved)
- -check if there is normal longitudinal arch in non-weight bearing position
- -if these are normal, it is a flexible flatfoot. = just needs development time.
- <4 years = no tx
- -avoid: overuse, walk & play barefoot, passive/active stretch of gastrocs to reduce stress on ligs of longitudinal arch, toe curl & arch curl exercises
rigid flatfoot
- -may be due to tarsal colition
- -vertical talus or other congenital problems
- -x-ray or oath referral may be needed.
Toddler Fx’s
- -tibial stress Fx seen w/ onset of walking
- -presents w/ painful limp, normal hip/knee/ankle/LB exams + (+) T palpation of tibia
- -X-ray show hairline stress Fx (bone scan is better)
- -Tx = casting, decreased weight bearing for 3-6wks, supportive shoes, decreased hardness of floor/surface.
Iron deficiency Anemia (IDA)
MC nutritional deficiency in kids
- -MC @ 6m-2yrs
- -breast milk not high in Fe
- -S/Sx: pallor, fatigue, irritability, anorexia, poor muscle tone
- -Dx: CBC
- -Tx: iron supplements W/ Vit. C to assist absorption
subluxation of radial head
- -infants & toddlers have elbow pain, cry, hold in pronated position, point tenderness
- -MC = kid lifted by hand (x-ray will be normal)
- -Tx: elbow in supination & move from full flexion –> ext.
- -click may be present, may sling, RICE
Fever
–pathophysiology
–oral temp >99.6
–child is acting ill
–body’s response to viral or bacterial is GOOD!!
MOST FEVERS ARE SELF-LIMITING
Fever
–management
–resuure parents & kid
–look for SEARCH signs
–ID cause of fever
–home advice: fluids, less clothes
– >102 = tylenol & monitor 1-4hours
– >103 same, wait 30mins sponge bath, wait 30 mins & recheck temp.
IF DOESN’T DROP = REFER
SEARCH signs =
- -Social Stimulation
- -Energy State
- -Appearance
- -Reaction to parent
- -Cry
- -Hydration
Fever
–red flags for referral
- > 104 & acting ill
- > 102 for >24h
- -any fever longer than 3days
- -infants less than 3-6m & >100 & SEARCH signs
- -febrile seizures
- -child is irritable, drowsy, lethargic, acts/looks sick
- -petchial rash, respiratory distress, or other signs of severe illness
febrile seizures/convulsions
- -caused by rising body temp; tonic-clonic contractions lasting 2-3min
- -familial tendency, rare after age 5
