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N827 > Growth and Development: Overview > Flashcards

Growth and Development: Overview Flashcards

1
Q

Birth-to-Toddler (0-3) ROS

A
  • Constitutional: level of alertness, activity, play, self wakes to feed
  • Eyes: Redness, discharge, alert to lights, eyes turning in or out
  • HENT: Discharge from ears/nose, alert to sound, mouth lesions, teeth present
  • CV: Color, warmth of skin
  • Respiratory: Chest shape, noisy breathing, rapid breathing, coughing
  • GI: #/consistency of stools/day, vomiting, difficulty with feeding, pain, flatulence
  • GU: #/saturation/characteristics of wet diapers, blood/discharge from vagina, Swelling/lumps in testes, circumcised?
  • MSK: Moving all extremities equally, swelling, pain, discoloration
  • Skin: Discolorations, rashes, dryness, changes in birthmarks, lumps, growths, hair loss
  • Neuro: any parental concern
  • Heme: bruising, bleeding
  • Immune: hives, sneezing, coughing, fevers
  • Lymph: lumps
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2
Q

Approach to Peds Exam

A
  • Always do parts of exam FIRST that require cooperation and quiet as possible
  • Allow child to sit with parent during an exam
  • Have safe and washable toys in exam room to act as distractions during the exam
  • If the child requires restraints due to procedure, always explain to parent first. Elicit parental cooperation when possible.
  • Comfort child when exam/procedure is complete
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3
Q

PE: Newborn

A
  • After obtaining Hx, PE would proceed
  • In the newborn assessment, it is essential to obtain and review, with the parent, the newborn record from the hospital
  • This review is not subjective since it must be interpreted
  • – Gestational age, prenatal care?, complications during pregnancy, complications during delivery
  • – Type of delivery/birth weight, complications after delivery, # of days in hospital/discharge weight, hearing test documented, HBV documented, newborn screen obtained, Apgar scores
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4
Q

Newborn PE: Constitutional

A
  • Distressed or alert
  • ill or well
  • quiet, active, crying, responsive to parents, easily consolable or non-consolable
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5
Q

Newborn PE: HEAD

A
  • Fontanelle palpation
  • – flat (usually 2-3cm; bulging or sunken
  • Shape
  • size
  • Head circumference
  • facial asymmetry
  • facial paralysis
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6
Q

Cephalohematoma

A
  • An area of bleeding over a cranial bone
  • Results from trauma as baby descends into birth canal
  • Does NOT cross suture line
  • May be squishy or firm, depending on size and amount of blood
  • Complications are rare (resolves without treatment)
  • May be associated with skull Fx
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7
Q

Caput Succedaneum

A
  • Diffuse soft tissue swelling of scalp
  • Result of trauma during delivery
  • Crosses suture lines
  • Swelling and bruising noted
  • No Tx needed
  • With large lesion observe for jaundice as blood is reabsorbed
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8
Q

Plagiocephaly

A
  • head flattened on one or both sides

- NL head circumference

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9
Q

Newborn PE: Skin

A
  • Color
  • Turgor
  • Temperature
  • Rashes
  • Borthmarks
  • Dryness
  • Peeling
  • Hair distribution
  • Nails
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10
Q

Lanugo

A
  • Fine dark hair over trunk and shoulder after birth
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11
Q

Vernix Caseosa

A
  • Cheesy white substance on the skin, more common in premature infants
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12
Q

Parchment-like skin

A
  • Dry, cracked skin, usually in post-mature infant
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13
Q

Acrocyanosis

A
  • Blue hands and feet with generalized mottling

- Central cyanosis is NOT NL

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14
Q

Milia

A
  • Multiple, firm, pearly papules usually scattered over the face
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15
Q

Erythema Toxicum

A
  • Firm, yellow 1-2mm papules/pustules with an erythematous flare scattered over the body
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16
Q

Cutis Marmorata

A
  • Mottling of skin
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17
Q

Harlequin Color Change

A
  • Division of the body into red and pale halves
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18
Q

Newborn PE: Eyes

A
  • Size, shape
  • Alert to light
  • Position (hypertelorism/hypotelorism)
  • Presence of red reflex
  • Pupillary reaction
  • Slant of palpebral fissures
  • Coordination of eye movements (uncoordinated NL until 6mo)
  • Redness
  • Discharge
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19
Q

Dacrostenosis

A
  • Clogged nasolacrimal tear duct
  • Causes tearing, mucous, discharge, swelling
  • Treatment: massage tear duct when changing diaper
  • Usually resolve by 12mo
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20
Q

Sclera

A
  • Check for color
  • – White is NL, blue or yellow not NL
  • – Blue is pathognomonic for osteogenesis imperfecta
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21
Q

Newborn PE: Ears

A
  • NL in size, shape, rotation, position and patency of auditory canal
  • NL canal and tympanic membrane
  • Alert to sound
  • Preauricular skin tags, sinus, or dimple
  • If ears are not NL, ALWAYS check kidneys
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22
Q

Newborn PE: Nose

A
  • Note for patency

- Nasal flaring is NEVER NL

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23
Q

Newborn PE: Mouth, Throat, Teeth

A
  • Size, symmetry of lips
  • Presence of philtrum (should NOT be smooth)
  • Palate intact by palpation
  • Gums NL
  • NL tongue size
  • Presence of teeth
  • Size of tonsils (more relevant in toddlers)
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24
Q

Epstein’s Pearls

A
  • Inclusion cysts of palate
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25
Q

Neck

A
  • NL ROM
  • No sinuses or cysts along middle or side of neck
  • Palpate neck for masses, usch as goiter
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26
Q

Torticollis

A
  • Asymmetric shortening of the sternocleidomastoid muscle resulting in the preferential turning of the head to one side
  • PT and gentle stretching usually effective
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27
Q

Thyroglossal vs. Branchial Cysts

A
  • Both are cyst structures that may not be obvious upon observation
  • May have small sinus tracts
  • Thyroglossal duct cysts are midline neck
  • Branchial Cleft duct cysts are on the side of the neck along the sternocleidomastoid muscle
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28
Q

Chest

A
  • Shape
  • Symmetry
  • Breast bones: Pectus excavatum (concave chest) vs. pectus carinatum (pigeon chest)
  • Nipple alignment
  • Extra nipple: supernumerary
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29
Q

APGAR Score

A

A - Activity: 0 Absent; 1 Arms and legs flexed; 2 Active movement
P - Pulse: 0 absent; 1 100bpm
G - Grimace (reflex irritability): 0 no response; 1 grimace; 2 sneeze, cough, pulls away
A - Appearance: 0 blue-gray, pale all over; 1 NL except extremities; 2 NL over entire body
R - Respirations: 0 absent; 1 slow irregular; 2 good, crying

30
Q

Eyes: Esotropia/Extropia

A
  • Esotropia: Inward deviation of one eye

- Exotropia: Outward deviation of one eye

31
Q

Eyes: Hypertropia/Hypotropia

A
  • Hypertropia: Upward deviation of one eye

- Hypotropia: Downward deviation of one eye

32
Q

Eyes: Hypertelorism/hypotelorism

A
  • Hypertelorism: Eyes set widely apart

- Hypotelorism: Eyes narrowly set

33
Q

Eyes: Palpebral Fissures

A
  • Upward slant in Down Syndrome
  • Downward slant in Marfan Syndrome
  • Narrow horizontal distance in Fetal ETOH syndrome
34
Q

The Face of Fetal Alcohol Syndrome

A
  • Small head
  • Epicanthal folds
  • Flat midface
  • Smooth philtrum
  • Underdeveloped jaw
  • Low nasal bridge
  • Small eye openings
  • Short nose
  • Thin upper lip
35
Q

Thyroglossal Cyst

A
  • A cyst that forms from a persistent thyroglossal duct

- Usually from the isthmus of the thyroid to the hyoid bone

36
Q

Branchial Cleft Cyst

A
  • a congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development
37
Q

Lung/Respiratory

A
  • RR: 30-60 breaths/min
  • With growth RR become slower
  • Unlabored
  • Apnea >15sec is NOT NL
  • Newborns do have irregular RR and short periods of apnea
38
Q

Cardiovascular

A
  • HR 100-160bpm
  • With growth HR slows
  • BP is lower in infants and increases with growth
  • Pulses should be symmetric in strength
39
Q

Abdomen

A
  • Slightly protuberant ABD
  • Moves slowly with respiration
  • Positive bowel sounds
  • No organomegaly
  • Umbilical hernia - common in infancy and monitoring is usual course
  • Check status of umbilical cord (clean, small amt. of blood)
40
Q

GU - Male

A
  • Penis should have midline urethral opening
  • Phimosis (tight foreskin) is expected at birth
  • Testes palpable and able to be brought into scrotal sac
  • Hydocele: clear fluid in the scrotum; usually resolves in 12mo; if not consider hernia; best seen by transillumination
  • Palpate groin for inguinal hernia
  • Tanner I pubertal stage
41
Q

GU - Female

A
  • Labia majora are large and surround the labia minora
  • Labia and vagina should be opened with clear discharge. Newborns can have bloody discharge called pseudomenses
  • Examine for labial fusion
42
Q

Labial Fusion/Adhesion

A
  • Fusion of the labia minora that covers the vagina
  • Common, generally benign
  • Surgery contraindicated
  • Gentle lubrication with vaseline
  • Gentle traction
43
Q

Hips

A
  • Elicit Ortolani, Barlow, and Galeazzi maneuvers for congenital hip dislocations
  • Ortolani: Knees flexed with hip abducted with hands over femoral head
  • Barlow: Knees flexed and hip adducted with hands over femoral head
  • Galeazzi: Knee height symmetry
  • Make sure that gluteal folds are symmetric
44
Q

Extremities/Spine

A
  • Symmetric Movements of all extremities
  • Check for swelling of all extremities
  • Observe for pain with palpation or movement of extremities especially in neonate when fractures of clavicle, humerus, femur can occur
  • Observe for in-toeing (internal tibial torsion) or out-toeing (external tibial torsion), bowleg (Genu varum), or knock-knee (Genu valgum), & NL variants which improve with time
  • Straight spine without dimples, sinuses
45
Q

Metatarsus Adductus

A
  • In-turning of the foot only

- Exercise the foot in the opposite direction

46
Q

Lymph Nodes

A
  • Palpate all lymph nodes for adenopathy
  • Most common are in cervical chain
  • Note size, shape, mobility, and location
47
Q

Neurologic

A
  • Assessment of development is the MO IMPORTANT part of the pediatric neurologic exam
  • This is done throughout the life of the child
  • Muscle Tone, movement, symmetry of movement
  • DTRs
  • Cranial nerves
  • Newborn/infant reflexes
48
Q

8 Principles of Development

A

1) Growth and development (G&D) is orderly and sequential
2) The pace of G&D is specific for each child
3) G&D occur in cephalocaudal and proximodistal direction
4) G&D become increasingly integrated
5) G&D become organized and differentitated
6) G&D are affected by the internal and external environment
7) Certain periods are critical
8) Development is continuous without smooth transitions

49
Q

Developmental Screening Tools

A
  • Screening tools generally measure 5 attributes of development:
    1) Communication/Language
    2) Gross motor
    3) Fine Motor
    4) Problem solving
    5) Personal social
  • Essential in identifying developmental delays early, scientifically documented to improve outcome
  • Required for reimbursement by Medicaid
  • Recommended by AAP
50
Q

Developmental Screening Challenges

A
  • Accuracy of clinical judgment
  • Accuracy of Parental Hx
  • Accuracy, validity, and sensitivity of screening tool
  • Ignoring screening results
  • Not referring for services needed to make gains in development
  • Must account for prematurity when using the screen
51
Q

Types of Screening Tools

A
  • Most Common: ASQ, PEDS/PED:DM, M-CHAT

- Others: Denver II, BINS, Brigance, SESBI-R, BDIST

52
Q

ASQ - Ages and Stages Questionnaire

A
  • High reliability - 90%
  • 4-60mo of age
  • Parents complete tool and provider scores the tool
  • Quick and accurate
53
Q

PEDS: DM - Parents’ Evaluation of Developmental Status: Developmental Milestones

A
  • Reliability - 80%
  • 0-8yrs
  • Parents complete tool and provider scores
  • Quick and fairly accurate, but not as reliable as ASQ
54
Q

Denver II and PDQ - Prescreening Developmental Questionnaire

A
  • Parents must complete PDQ before Denver
  • Must be administered by trained person
  • 0-6yrs
  • Reliability 80%, but scoring questionable
  • Requires more time than ASQ or PEDS
55
Q

M-CHAT - Modified Checklist for Autism in Toddlers

A
  • Now recommended by the AAP for toddler developmental assessment
  • Used 16-30mo
  • ONLY a screen for possibility of autism, NOT diagnostic
56
Q

BINS, Brigance, SESBI-R, BDIST

A
  • BINS: Bailey Infant Neurodevelopmental Screener; 3-24mo
  • Brigance: 0-90mo
  • SESBI-R: Sutter Eyberg Student Behavior Inventory Screening Test; 0-8yrs; professionally administed, not realistic for PCP
57
Q

Cranial Nerves

A

I) Olfactory: Difficult to test
II) Optic (Vision): Alerts to light
III IV, VI) Oculomotor, Trochlear, Abducens: Ability to gaze in all directions
V, IX, X, XII) Trigeminal, glossopharyngeal, vagus, hypoglossal: Sucking and swallowing
VII) Facial: Symmetric movement of face
VIII) Acoustic: Alerts to sounds; startles at loud noise)
XI) Spinal Accessory: Symmetry of infant’s shoulders; sternocleidomastoid, and trapezius muscles)

58
Q

Newborn Reflexes: Basics

A
  • Newborn reflexes are present at birth
  • Abnormal if they persist after a certain age
  • Infant reflexes appear later than newborn reflexes
59
Q

Stepping Reflex (NR)

A
  • Infant held as weight bearing and steps along raising one foot at a time
  • Disappears by 2mo
60
Q

Truncal Incurvation (Gallant’s reflex)

A
  • Hold infant firmly suspended in prone position with examiners hand supporting chest
  • With opposite hand, stroke along spine lightly with fingernail just adjacent to spine from shoulders to coccyx
  • Hips and buttocks curve/turn slightly towards stimulus side
  • Extinct by 2mo
61
Q

Rooting Reflex

A
  • Touch or stroke cheek
  • Infant’s head turns toward stimulus and mouth should open
  • Extinct by 4mo
62
Q

Sucking reflex

A
  • Gently stroke the lips
  • Infant’s mouth opens, sucking begins
  • Gloved finger inserted into the mouth evaluates strength of suck reflex
  • Extinct by 4mo
63
Q

Moro Reflex

A
  • Support infant at 30-degree angle above flat surface with examiner’s hand; Allow head and trunk to drop back to surface supported by examiner’s hand or
  • Pull infant up by hads to 30-degree angle above examining table; gently drop infant back to surface quickly and release arms
  • Arms extend and abduct; hands open; fingers fan out; thumb and forefinger form a C
  • Then arms flex and adduct; knees clench; hips flex; eyes open; infant may cry
  • Extinct by 4mo
64
Q

Asymmetric Tonic Neck Reflex (ATNR) (Fencer’s reflex)

A
  • With infant on flat surface turn head 90-degrees towards surface
  • Arm and leg extend on ipsilateral side infant is turned toward and arm and leg on opposite side flex.
  • Extinct by 6mo
65
Q

Palmar Reflex

A
  • Fingers clasp examiner’s thumbs

- Extinct by 6mo

66
Q

Infant Reflexes

A
  • Landau
  • Neck righting
  • Parachute
67
Q

Landau Reflex

A
  • Suspend infant by abdomen and infant lifts head and arms

- 3mo-2yrs

68
Q

Neck Righting

A
  • With infant supine, turn head to one side and trunk rotates in direction of head
  • 6mo-2yrs
69
Q

Parachute Reflex

A
  • Suspend infant prone and infant should extend arms, hands, and fingers
  • 8mo+
70
Q

Babinski Reflex

A
  • 0-2yrs
71
Q

Pediatric Growth Charts

A
  • Essential to plot growth throughout the lifespan of the child
  • Each chart is gender specific
  • 2 sets of charts: 0-36mo & 2yrs up to 18-20yrs
  • Head circumference is plotted up to 36mo
  • Growth charts also contain BMI
  • Special charts available for premature infants, SGA, Down syndrome
72
Q

Calculating BMI

A
  • Weight in kg/(Height in meters)(Height in meters)

- 30: obese

N827 (19 decks)

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