Infant Health

Question 1

Infant - Ages

Answer 1

-Newborn: <28 days
-Infant: 28 days-1 years

Question 2

Infant - Well-Child Visits

Answer 2

-1st: within 48-72 hours post discharge
-2nd: 3-5 days after first
-Then, at months 1, 2, 4, 6, 9, and 12

Question 3

Infant - Vital Signs

Answer 3

-HR = 100-150 bpm
-RR = 30-55 breaths pm
-BP = SBP 80-100 mmHg, DBP 55-65 mmHg

Question 4

Infant - Head Control

Answer 4

-By 4 months, however it is still normal for an infant to reach anywhere between 4-6 months
-No head lag by 6 months

Question 5

Infant - Periorbital Edema

Answer 5

-Can indicate nephrotic disease if present in infants

Question 6

Infant - Cheilosis

Answer 6

-Vitamin deficiency, fissures in lips

Question 7

Infant - Asymmetry of Tonsils

Answer 7

-Can indicate tonsillar lymphoma

Question 8

Infant - Gynecomastia and Galactorrhea

Answer 8

-Normal until about 3 months of age because of surge of maternal hormones at birth

-Mild pectus carinatum (pigeon chest) or mild pectus excavator are common findings in infants

Question 9

Infant - Liver

Answer 9

-Can be palpable 1-2cm below right costal margin

Question 10

Infant - Descended Testes

Answer 10

-Testes should fully descend by 3 months

Question 11

Infant - Phimosis

Answer 11

-Foreskin that does not retract over the tip of the penis - considered normal amongst infants, but should resolve by 3 years of age

Question 12

Infant - Developmental Dysplasia of Hip

Answer 12

-Allis sign = have infant standing in front of you and check for asymmetry at the hip, and check the popliteal crease to see if they both line up
-Galeazzi Sign: unequal knee height = patient lies on their back on the exam table, puts their knees up, and you check the knee height for symmetry
-Skin folds (gluteal folds and upper thigh folds) = check for symmetry
-Barlow and Ortolani = usually used for children below 3 months

Question 13

Infant - Lymph Nodes

Answer 13

-If you feel supraclavicular lymph nodes, the patient needs to go to the hospital right away - concerning for Non-Hodgkins Lymphoma
-Generalized lymphadenopathy, not localized to one area, is indicative of leukemia
-Shotty (hardened) lymph nodes in the neck are indicative of a post-respiratory infection
-Lymph nodes >3mm also warrant hospital referral

Question 14

Infant - Cognitive Development

Answer 14

-Visual acuity = measured by blink reflex and pupil constriction
-Hearing loss = loss of >20 decibles - high-risk for patients in the NICU due to some antibiotics which can be ototoxic

Question 15

Infant - Psychosocial Development

Answer 15

-Temperament = A difference in temperament between baby and parents puts the baby at risk for abuse - ask the parents “What is your baby like?”
-Separation anxiety starts happening at 6-9 months
-Attachment = Bond between baby and parents (important)

-Shrill or high-pitched cry can indicate increase ICP

Question 16

Infant - Breastfeeding & Formula

Answer 16

-If parents want to wean from the breast, advise them to begin with eliminating the middle feed, then work towards morning and night feeds
-Encourage moms to breastfeed, even if HIV positive
-Formulas = FDA approved are the recommended formulas for babies
-If solely breastfeeding, babies must feed ‘on demand’

-Formula schedule:
*1st days = 1-2 oz every 2-3 hours
*2 months = 4-5 oz every 3-4 hours
*6-12 months = 6-8 oz, 5-6 times every 24 hours
*12-24 months = switch to milk, one feeding at a time every few days or weeks

Question 17

Infant - Food Schedule

Answer 17

-Solid foods = begin as early as 6 months - start with fortified cereals
-Wait 2-3 days between introducing new foods, as allergic reactions appear between 2nd and 4th exposure
-Finger foods = start by 8 months (cheese, pasta, chopped veggies) - diameter of the airway is about the size of a dime, so cut up foods very well
-Potentially allergic foods (peanut butter, eggs, shellfish) = start introducing along with other foods - no need to wait to introduce any more
-Juice and cow’s milk = should be given after 12 months old for allergy reasons
-No sugar or caffeinated drinks until about age 2

Question 18

Infant - Dental Health

Answer 18

-No bottle in the crib/bed = can lead to tooth decay
-1st dental visit by 1 year of age

Question 19

Infant - Sleep

Answer 19

-Should sleep between 8-12 hours/night with 2-3 naps daily for the 1st year - totaling 16-18 hours/day
-Sleep on back until 1 year to prevent SIDS - Pacifier to go to sleep is OK, as it may help reduce risk of SIDS
-Nothing in the crib that can suffocate the baby (toys, teddy bears, blankets, pillows)

Question 20

Infant - Motor Development

Answer 20

-“Tummy Time” = develops head control neck, and shoulder strength

Question 21

Infant - Screen Time

Answer 21

-No screen time until about 18 months

Question 22

Infant - Warning Signs/Reasons to Refer

Answer 22

-Apparent visual delay
-Does not raise head while on belly by 3 months
-Does not try to pick up toys by 6 months
-No reaction to noice/voices
-Does not laugh
-Does not seek interpersonal contact
-Does not sit up

Question 23

Infant - Fever

Answer 23

-Fever in the very young infant:
*Baby <28 days old with a fever needs a sepsis work-up (CBC, blood culture, UA and culture, spinal tap) - consider group B strep infection passed from mom to baby
*Fever is a rectal temperature >100.4F
*If a baby comes in with a fever, but a cause cannot be found, think UTI

-Management:
*Acetaminophen 10-15 mg/kg every 4-6 hours
*Ibuprofen 5-10 mg/kg 3-4 times per day (approved after 3-6 months of age short-term

Question 24

Infant - Fever & Illness Classification

Answer 24

-Mildly ill = temp above 100.4F, smile, feed normally, and appear alert and active
-Moderately ill = temp below 102F, irritable or fussy, easy to console, may smile, continue to feed normally
-Severely ill = temp above 104F, appear listless, may not feed at all or feed poorly, recommended for hospital admission

Question 25

Infant - Peanut Allergy

Answer 25

-Most common cause of severe allergy attacks

Question 26

Infant - Stage Appropriate Screening

Answer 26

-Ages and Stages Questionnaire = parent’s assessment of their child’s language, social, motor, and problem solving skills
-Denver Developmental Screening Test, second edition (Denver II) = detects developmental delays or children at risk for developmental problems - done by professional, not parents - not to measure intelligence