General Peds Flashcards
Primary vs secondary vs tertiary prevention
primary = avoid disease/injury
secondary = early detection; screenings
tertiary = reduce negative impact of already established disease
Fever in children is ____ deg F.
100.4 F
Normal systolic BP for infant, child, and adolescent
infant: 70-90
child: 90-110
adolescent: 90-120 (closer to adults)
Normal HR for infant, child, and adolescent
Infants: 140-160
children: 100-140
adolescents: <100
Tachycardia and bradycardia in in pediatric patients?
> 200 (usually SVT)
< 60
Elevated BP, pre-HTN, HTN in children
Elevated > 120
Pre-HTN >130
HTN >140
What are the age ranges of terms newborn, infant, child, adolescent?
Newborn: < 2 months
Infant: 2 to 24 months
Child: 2-4 yo (toddler/pre-school) AND 5-11 yo (school age)
Adolescent: 12-18 yo
Define developmental delay
child does not reach milestone (skill development) by expected time period
Why is infant head circumference so important?
Microcephalic needs to be picked up early to prevent lifelong problems
height and weight associated with malnourishment can be fixed without lifelong effects
Fine motor development from birth to 12 months
6 mon: rake
7 mon: inferior-scissors grasp
10 mon: pincer grasp
12 mon: fine pincer grasp
When should scribbling start?
1-2 yo
Developmental milestones at 1 yo
1st words
1st steps
Uses ONE word at a time
Follows a ONE step command
Developmental milestones at 2 yo
Uses 2-3 word phrases (“2 words together at 2”)
Follows 2 step commands
50% of what said (2/4) is understandable by strangers
Two for two points
Copies lines
Two for towers
Begin to stack blocks
Guidance to parents at 1 year old
Stop bottle and binkie
Begin whole milk
First dental visit
Guidance to parents at 2 year old
Car seat flipped
Use time outs
Developmental milestones at 3 yo
Uses 3 word sentences
Others can understand 3/4 of what he says
Rides TRI-cycle
Draws Circle
Developmental milestones at 4 yo
40 pounds
40 inches tall
Can draw a four sided figures
Spoken words 100% (4/4) understandable
Adolescent Risk Assessment
HEADS
Home Education/Eating Activities Drugs Safety/Sex/Suicide
Tanner Staging
sexual maturity rating (SMR) from 1 (prepubescent) to 5 (adult)
How is height of child estimated with calculation?
Boys:
(Father’s ht. + mother’s ht. + 13) / 2
Girls:
{(father’s ht. – 13) + mother’s ht.} / 2
Normal etiologies of short stature
constitutional growth delay
familial short stature
How is Constitutional growth delay different than Familial short stature?
- short parents in familial
- delayed puberty and bone lag (2-3 yrs) in constitutional delay
- adult height normal in constitutional and short in familial
- both have +fhx and normal growth velocity, PE, and labs
Examples of pathological short stature
Turners syndrome, fetal alcohol syndrome, hypothyroid, renal tubular acidosis, Celiac’s Disease
Abnormal variants of tall stature
Klinefelter syndrome: chromosome XXY; small testes, delayed puberty, gynecomastia, long legs, low testosterone
Marfan syndrome: autosomal dominant
Excessive GH: gigantism (before closure), acromegaly (after epiphysis closure)
screening test vs diagnostic test
screenings done in absence of signs or symptoms
5 traditional pediatric screening tests
- Anemia
- Lead
- Hearing
- Vision
- Developmental milestones/language
AAP Guidelines for anemia screening
- H&H at 12 mon
- starting in adolescence, all non-pregnant women every 5 to 10 yrs
- annually for women with high risk (heavy menses, low intake, +hx)
High risk factors for anemia in infants
- Prematurity
- Untreated maternal anemia
- Use of non-iron fortified formula and cereal
- Exclusive breastfeeding after 4 months
- Early use of cows milk before 12 months
- Overconsumption of milk
- Lead exposure
Most common cause of anemia in childhood (6 months-2 yrs)
iron deficiency
Characteristics of blood in lab that would indicate iron deficiency
microcytic, hypochromic
Low Hgb/Hct, low MCV, low serum ferritin, high RDW
How can iron deficiency be prevented?
Breastfed infants should have iron supplements at 4 mon and start iron-fortified cereals at 6 mon
Non-breast feeding infants should receive iron-fortified formula
Supplement iron drops for preterm infants
ADR of iron treatment
GI bleeds, constipation
CDC acceptable blood lead level
< 10 mcg/dL
Affects of lead at low levels (+10) and higher levels (+40)
Abd pain, constipation, hearing loss, osteopenia and decreased bone growth, microcytic anemia, dental caries, cognitive delays
>40: spontaneous abortions, renal disease, seizures, encephalopathy, and death
AAP recommendations for lead screening
- Universal screening at 6 mon
- Lead level at 1 and 2 yrs old
- Sooner/more frequent if RFs: language delay, chronic anemia, pica, high risk geographic area, any yes responses on screening questionnaire
Lead toxicity treatment
- Reduce Environmental Exposure
- Maximize Nutrition (Calcium, zinc) to inhibit lead effects
- Above 45 mcg/dL treated with chelation
AAP guidelines of hearing screens?
- All newborns
- Universal objective screen by 4 yo
- then 5, 6, 8, 10 yo
Who is at higher risk of hearing loss and needs more frequent/earlier screenings?
- Parental concerns about hearing, speech, language or dev. delays
- +FHX of childhood hearing loss
- Craniofacial anomalies
- Syndromes associated with hearing loss
- H/O recurrent otitis media or otitis effusion
Vision testing done in infancy
Object tracking
Red reflex
Corneal light testing
Vision testing in toddler/preschool
Cover Test
Red reflex
Corneal light testing
Vision testing in school-aged children
Pediatric Eye Chart
AAP Guidelines: Universal screen beginning at 36 months
Then 4, 5, 6, 8, 10, 12, 15, 18 years
strabismus
“Crossed Eyes”
General term for misalignment or deviating eye
Esotropia = inward
Exotropia = Outward
amblyopia
“Lazy Eye”
The lack of clear vision in one eye will cause it to developAmblyopia
Vision testing for adolescents
Snellen Eye Chart, same as adults
AAP Guidelines for developmental screening
- Objective Standard Developmental Screening at 9, 18, and 30 months
- Objective M-CHAT screening test at 18, 24, 36 months
- Regular psychosocial and behavioral assessment at every well check
Earlier screening or referral for risk factors
Denver II Development Screening Test
Enables tester to compare a child’s development with that of over 2,000 children who were in the standardized population
Provides broad variety of standardized items to give quick over-view of the child’s development
Also contains behavior rating scale
Main signs of Autism
- Social interaction impairment
- Communication impairment
- Repetitive, stereotyped behaviors
AAP Guidelines for BP checks
screening at 3 yo and every visit thereafter
AAP Guidelines for cholesterol checks
screening at 11-12 yo and between 17-21
AAP Guidelines for GC/Chlamydia checks
annually for all sexually active females
males if UV shows +leuks
SMR stages of females
Stage I: prepubescent
Stage II: Hair: Sparse, long, lightly pigmented hair along labia
Breast: Budding
Stage III: Hair: Darker, coarser, curly hair along pubic region
Breast: Fullness of breast tissue
Stage IV: Hair: Adult type, less distribution
Breast: Secondary mound (areola development)
Stage V: Hair to medial thighs
Breast: Darkening of tissue, mature
SMR stages of males
Stage I: prepubescent
Stage II: Sparse, long, lightly pigmented hair along base of penis; generalized enlargement of penis and testes
Stage III: Darker, coarser, curly hair along pubic region; further enlargement of phallus length and testes; scrotal texture changes
Stage IV: Adult type hair; penis increases in circumference, darkening of scrotal skin
Stage V: hair to medial thighs; adult size, length, and color of genitals
Process of screening and referring hearing in newborns
- Pass or not pass newborn screen
- If not pass do confirmatory test w/i 3 months
- if still no pass, then dx with congenital permanent hearing loss
- Refer for intervention within 6 months
How is ADHD diagnosed?
1) hyperactivity, impulsivity, or inattentiveness before age 12
2) symptoms must occur in 2 settings
3) at least 6 sx’s of inattention of hyperactivity for 6 months (careless mistakes, difficulty organizing, doesn’t complete assignments, fidgets, restless, talks excessively, difficulty waiting turn, interrupts others, etc.)
parental and teacher rating scale for ADHD
Conners’ scale
Treatment for ADHD
1st line: CNS stimulants (Methylphenidates, amphetamines) in combo with behavior therapy
others: Atomoxetine (SNRI), other anti-depressants
Brain dysfunction in ADHD
frontal lobe is smaller and under-responsive to stimulation
ADD vs ADHD
ADD just has inattentive component whereas ADHD also has hyperactivity
AAP guidelines for iron supplements
3 months old
1 ounce = _____ kcal.
20
normal daily intake for infant born full term
100-120 kcals/day
