health supervision Flashcards
microcephaly
2-3 SD below avg.
congenital- abn induction or migration of brain tissue
acquired: late tired -1y. normal at birth then growth stop after insult
P: dev delay, low IQ, cerebral palsy, seizures
craniosynostosis
premature closure of 1+ cranial sutures.
80-90% sporatic. rest gentic syndrome or familial (alpert or crouson syndrome). RF- IU constrain, metabolic - hyperthyroidism, hypercalcemia.
P: sutures usually open until brain growth stop at age 5 (90% at age 2). shape dep on which closed. most common= sagittal suture = elongate skull= dolichocephaly
passive imunity
VZIG (VZV) and hep b and hep A (bf travel)
MMR
live attenuated.
Pneumococcal vaccine
two types
Prewar: bc most common cause of acute otitis and invasive bacterial infection in 2yo. adults at risk- SCA + asplenic, immunodef, chronic liver disease, nephrotic syndrome.
Tdap CI
if encephalopathy w/in 7 d of vaccination
Polio vaccine CI
OPV. don’t give to family of immunodef bc shed in stool.
live vaccine CI
preg women
hearing test
BAER-most accurate- EEG
EOE- normal cochlear hair cell
neonatal metabolic screen
treatable disease that can do irreversible brain damage if not caught early.
all screen congenital hypothyroidism, PKU
most- galactosemia, SCA, other blood dycrasias,
screen cholesterol
if fx when >2yo. if >75-90 percentile, get fasting lipid panel
Fe def anemia screeening
TB screen
if at risk= infected contacts, high risk pop, incarcerated, drugs user, HIV pos. CXR suspicious for TB, endemic area
Lead intox
plumbism.
circumcision needed if
1) phimosis- can’t retract foreskin. normal bf 6yo unless balloon foreskin when pee
2) paraphimosis- retracted foreskin= turniquet
3) balanitis- inflame of glans of penis- candida or gram neg in infants, STI in adults
CI: bleeding, diathesis, premature
tooth eruption
primary- 3-16mo avg 6. all by 2yo = 20teeth
secondary: 6-8yo - 32teeth
delay: >16mo- familial, hypothyroidism, down, ectodermal dysplasia (conical tooth)
early:
teenage mom
lbw, vertically acquired STI, poorer dev outcome, incr fetal death
cocaine and stimulants
cause placental infuse due to vasoconstriction and lbw. def in cog and information processing. no microcephaly
SGA babies risks
hypoglycemia- decr glycogen stores, heat loss, hypoxia, decr gluconeogenesis. usually asx. poor feeding, listlessness
hypothermia- cold stress, hypoxia, hypoglycemia, incr SA, decr subQ insulation
polycythemia- chornic hypoxia, maternal fetal transfusion. ruddy red skin. respiratory distress, food feeding, hyperviscois blood
immunodef, acute RF, GI perforation, meconium aspiration, intrauterine death
TORCH
toxo, rubella, CMV, Herpes 2,
congenital CMV
small head. calcification of lateral ventricles, lissencephaly= decr # of gyri and abn thick cortex. enlarged ventricles. progressive hearing loss. ck chorioretinitis, jaundice, petechiae, purport, ecchymosis, incr ALT, hepatomegaly, sz, lethargy, incr CSF protein >120.
antiviral tx decr hearing impairment and dev delay. start in 1st mo
strabismus assessment
hischberg lift reflex, cover/ncover test.
anemia
most common is Fe def in low income kids (35%). so do Fe trial in kids with mild anemia bf workup. f/u in 6wks
