Growth, development and health supervision in peds module 1

Question 1

ACE what is it stand for and definition.

Answer 1

( Adverse Childhood Experience) score is related
to childhood trauma and the risk for future health
problems, as well as perpetuating the cycle of violence.

Question 2

Direction of growth

Answer 2

a. cephalo-caudal: Head to toe

b. proximo-distal: Center to out

Question 3

Palmar grasp reflex versus Pincer grasp

Answer 3

Palmar grasp: this grasp progresses from your child using his “pinky finger” side of the hand only to pick up objects to using the central portion of the palm to pick up objects from a flat surface. This grasp does not involve the use of the thumb. bringing the fingers in toward the palm, allowing babies to curl their fingers around an object

The pincer grasp is the coordination of the index finger and thumb to hold an item. Each time you hold a pen or button your shirt, you’re using the pincer grasp. Even helps with eating food

Question 4

Neonate:

Answer 4

First 28 days of life

Question 5

Infancy:

Answer 5

1 month to 1 year

Question 6

Toddler:

Answer 6

1 to 3 years

Question 7

Preschooler:

Answer 7

3 to 5 years

Question 8

Middle Childhood:

Answer 8

6 to 12 years (school-age children)

Question 9

Adolescent:

Answer 9

13 to 17 years

Question 10

Late adolescent:

Answer 10

18-21 years

Question 11

Erikson type of stages

Answer 11

psychosocial stages

Question 12

Piaget type of stages

Answer 12

cognitive stages (describing how people learn and think)

Question 13

The standard schedule for healthcare visits:

Answer 13

3-5 DOL, by 1 month, 2mo, 4mo, 6mo, 9mo, 12mo,

15mo, 18mo, 24mo, 30mo, then yearly until age 21

Question 14

Risk factors for developmental delay

Answer 14

►Prematurity/low birthweight
►Problems during pregnancy
►High bilirubin at birth (jaundice)
►Elevated lead levels
►Prenatal drug or alcohol use
►Other diagnoses (HIV, congenital anomalies, metabolic
disorders, etc.)

Question 15

Identification of hearing loss is

crucial by

Answer 15

6 months

All newborns should have hearing screening before
discharge.

Question 16

Types of hearing screening:

What happens if screening fails?

Answer 16

a. Otoacoustic emissions (OAE’s)
b. Auditory brain response (ABR)

Failed screen is repeated, if still fail
refer to audiology within 2-3 months

Question 17

Pure Tone audiometry what and when does it happen?

Answer 17

Universal hearing screening again at ages 4, 5, 6, 8
and 10

Ages 7,9,11-21 and age-appropriate risk assessment
should be performed. (Bright Futures/AAP,2020)

►Measures hearing through a range of frequency (Hz)
and Loudness (decibels)
►Child wears headphones
►Room must be quiet
►Child needs to understand instructions

Question 18

Vision screening what happens and when? Neonate, infant, by 2 months and older child what should you expect.

Answer 18

►Vision assessment is performed at all health
supervision visits.
►Vision screening; Red light reflex

►Neonate: should fixate on an object 10-12 inches

►Infant: Follow an object to midline

►By 2 months: follow an object 180°

►Older child up to 3 years: focuses
and tracks object, report squinting,
bumping onto things

Question 19

When to refer: vision screening

Answer 19

►Ages 3-5: visual acuity<20/40

►Greater than 6 years of age- visual acuity <20/30
►*** or if there is a 2 line difference between eyes
► Healthy People 20/20 goals
a. Increase proportion of children 5 yrs. or younger who
receive vision screening

Question 20

Hypertension screening: other risk factors for HTN

Answer 20

sleep-disordered breathing, chronic kidney disease, history of prematurity.

Question 21

Hypertension screening: when to start?

Answer 21

►Universal hypertension screening is recommended for
all children starting at age 3yrs

►Children with some conditions should start earlier
►Different than adults
►Utilizes gender, age, and height

Question 22

Preferred method of hypertension screening.

Answer 22

Auscultation is preferred method

►Correct measurement technique is essential!
►If elevated, must repeat manually!!

►Interventions include: Lifestyle modifications, weight
management, possible medications. Children with comorbidities require more intensive management.

Question 23

Hypertension screening for children 1-13 yrs. %?

normal bp?

Answer 23

►Normal SBP or DBP <90th %
►Elevated BP (Prehypertensive) SBP or DBP > 90%, <
95%
►Hypertension > 95%
A. Stage 1 HTN ≥ Between 95% and 99% + 5 mm Hg
B. Stage 2 ≥ 99% +5 mm Hg

Normal BP:

►Normal BP: < 120/80
►Elevated BP: 120-129/<80
►Stage 1 HTN: 130-139/80-89
►Stage 2 HTN: ≥ 140/90

Question 24

Hypertension screening-how?

Answer 24

► Cuff (bladder) width should be 40% of the mid-upper arm
circumference AND bladder should encircle 80-100% of arm
► Err on the side of a larger cuff!
► Child should be sitting quietly
for 5 minutes, feet on floor
► Right arm preferred
► Needs to be confirmed on
3 separate visits, with
counseling on lifestyle modifications

Question 25

Infants, birth to 36 months: growth charts

Answer 25

a. Length-for-age and Weight-for-age

b. Head circumference-for-age and Weight-for-length

Question 26

Children and adolescents, 2 to 20 years: growth charts

Answer 26

a. Stature-for-age and Weight-for-age

b. BMI-for-age

Question 27

WHO growth charts up until which age?

Answer 27

Age 2 only

Question 28

CDC growth charts up to age?

Answer 28

Age 2 plus > age 2 yrs

Question 29

BMI Values

Answer 29

CDC Growth Charts 5th-95th percentile
≥ 95% = (Obesity)
> 85%-and < 95% = Overweight
< 5%=underweight
5% -84% Normal