- diamond shaped - 2.5 - 4cm - closes at 12 - 18 months

- triangular shaped - 0.5 - 1cm - closes at 2 months

Health assessment, development, defects & disorders Flashcards by sandy ang

Vital signs

● Temperature, Pulse, Respiration, Blood Pressure and Pain (TPR-BPP)
● For children 1 – 10 years old: Hypotension = <70mmHg + ( age in years x 2)

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Body measurements

● Weight
● Height/ Length
● Head Circumference
● Chest Circumference
● Abdominal Circumference

Compare with growth standard, highlight if
● Weight fall => 2 centile
● Weight or length <3rd centile of the

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Warnings signs to growth and development

at birth

Very irritable or inert; Stiff or floppy;

Cloudy or white pupil

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Warnings signs to growth and development

3 months

Complete head lag; Hands always fisted;
Asymmetry of lack of movement of limbs;
No visual fixation; No social response

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Warnings signs to growth and development

6 months

Any head lag; Moro reflex or asymmetric
tonic neck reflex persists; Poor social
response; Constant squint

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Warnings signs to growth and development

9 months

Hand regard persists; No tuneful babbles;
Not smiling; Not chewing; Abnormal tone;
Constant use of 1 hand only

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Warnings signs to growth and development

12 months

No imitating play or noises; No poking or
pincer grip; Not trying words; Not sitting
alone; Constant mouthing

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Warnings signs to growth and development

18 months

No understanding of use or command;
Casting and mouthing; No spontaneous
words; Not standing alone

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Warnings signs to growth and development

2 years

No words with meaning; Excessive
dribbling; Not walking alone; No
constructive play

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Warnings signs to growth and development

3 years

Echolalia jargon; No sentences; Most

words unintelligible; Very clumsy

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Warnings signs to growth and development

4 years

No cooperative play; Very immature
speech; Not drawing; No toilet
awareness

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Warnings signs to growth and development

5 years

Marked confusion of sounds, grammar

and articulation; Very clumsy hands

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Physical examination : head, face and neck

Inspection :
Shape and symmetry
Head control and posture
Range of motion

Palpation :
Skull for sutures
Fontanel
Depression
Swelling

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Frontal fontanel

diamond shaped
2.5 - 4cm
closes at 12 - 18 months

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Occipital fontanel

triangular shaped
0.5 - 1cm
closes at 2 months

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Abnormal of head

● Bulging or depressed fontanels
● Widened sutures or fontanels
● Craniosyntosis - premature fusing of the sutures
● Caput Succedaneum – edema of soft scalp in
newborn
● Cephalohematoma – hematoma between
periosteum and skull bone

What do you examine for eyes?

Size : symmetry ; colour ; motility

What is abnormal for eyes?

● Absent of red eye reflex

What is vision testing?

● Binocularity; Visual acuity

● Peripheral Vision; Color Vision

What are the symptoms of eyes?

● Amblyopia (lazy eye)
● Strabismus (misaligned eyes)
● Ptosis (dropping upper eyelid)
● Cataract

What are the risk factors for visual problems?

● Low birth weight of less than
1500gm
● Needed resuscitation / oxygen at
birth
● Maternal German measles or
toxoplasmosis infections during
pregnancy

What is the abnormal of mouth and palate?

Cleft lips

what do we inspect for mouth?

● Cleft Palate

● Tonsilitis

what do we inspect for ears?

● Size, postion & structure
● Deafness (Drugs, maternal infection)
● Abnormal or absent of ear/canal

what do we inspect for neck?

● Size and orientation of associated structures (Trachea, Thyroid gland, Lymph nodes) ● Webbing (Tuner’s Syndrome) ● Swelling (Infection)

what do we inspect gastrointestinal tract defects?

● Umblical hernia ● Inguinal hernia ● Anorectal Malformation ● Biliary Atresia

What is the genito-urinary tract defects?

● Cryptorchidism (undescended testes) ● Phimosis ● Hypospadias

What is the physical examination of spine?

● Spinal column ● Symmetry of scapulae, buttocks ● Shape of curvature like letter “C” at birth, the cervical spine gains its reverse ‘C’ by 3 months, and lumber spine at 6 months ● Tufts of hair, dimples and discoloration along the intact spine. eg. underlying spina bifida occulta

Spina bifidia occulta

Spina bifida occulta is when a baby's backbone (spine) does not fully form during pregnancy. Hair tuft

Meningocele

A meningocele is a birth defect where there is a sac protruding from the spinal column. Spinal fluid

Lipomyelomeningocele

A lipomyelomeningocele is a fatty mass under the skin on the child's back.

Myelomeningocele

A myelomeningocele (pronounced my-elo-men-IN-go-seal) is a defect of the backbone (spine) and spinal cord. Spinal nerves

What is the physical examination of spine?

Skeletal Defects: Scoliosis Arises at puberty Lateral curvature of the spine that occurs most frequently during the linear growth spurt (before 12 years old) of especially in female at the onset of early puberty

What is the physical examination of extremities?

``` Fingers and Toes Abnormality Inspect for symmetry in length, size & shape bilaterally ● Polydactyly (Extra digit) ● Syndactyly (Fused digit) ● Clubbed Fingers ```

What are the skeletal defects ( congenital )

● Dysplasia of Hip - Dislocation of the hip joint, ball out of socket

Congenital Club Foot (Congenital Talipes | Equino Varus)

- Foot appears like a golf club (lateral or medial) - Feet: Pigeon toe caused by internal tibial torsion, persisting after 3 months - Gait: Toe walking persisting beyond infancy.

Legs

Bowleg | Knockknee