Infants Flashcards
Principles of child development
. Development proceeds along predictable pathway/trajectory
. Range of normal development is wide
. Variety of factors affect child’s health (medical/social factors)
. Child’s developmental level affects the nature of examination
Pediatric health promotions
. Age=appropriate developmental milestones
. Health supervision visits per schedule
. Integrate physical exam findings w/ history/age
. Immunization schedule
. Screening per guidelines
. Anticipatory guidance
. Partnership and developing bond btw provider and patient
What are you checking during well child visits?
. Physical growth . Motor skills . Cognitive growth/milestones . Emotional growth and independence . Social growth and communication
Motor milestone in 1st year
. 3 mo: holds head up . 4 mo: rolls from front to back . 6mo: rolls from back to front, sits . 9 mo: crawls, stands w/ support, cruises . 12 mo: stands, walks a few steps
Schedule of pediatric appointments
. 2-5 days . 2 weeks . 1 mo . 2 mo . 4 mo . 6 mo . 9 mo . 1 yr . 15 mo . 18 mo . 24 mo . 30 mo . 3 years . Then yearly after that
Screenings completed in newborn nursery
. Newborn screen . Bilirubin level at 24 hrs . CCHD screen at 24 hrs . Hearing screen before discharge . Car seat check
Screenings completed at 1, 2, 4, and 6 months
. Post partum depression screen
What screening is completed at 12 mo
. Lead and Hb levels
Neonatal resuscitation at birth
. Place infant under radiant heat warmer . Dry and stimulate . Position w/ head in sniffing position . Clear airway w/ bulb suction . Assign APGARs . Further resuscitation if necessary
What do you do if baby is not to term, doesn’t have tone, is not breathing, or is not crying?
. Warm and maintain normal temperature
. Position airway
. Clear secretions, dry, and stimulation
What do you do if the baby had apnea, gasping, or HR under 100 bpm
. PPV
. SpO2
. Monitor
. Consider ECG monitor
What do you do if baby hands labored breathing or persistent cyanosis?
. Position and clear airway . SpO2 monitor . Supplemental O2 as needed . Considered CPAP . Complete post-resuscitation care and team briefing if situation gets better
What do you do if baby’s HR is under 100 bpm
. Check chest movement
. Ventilation corrective steps if needed
. ETT or laryngeal mask if needed
What do you do if baby’s HR is under 60 bpm?
. IV Epi
. If it is persistently below 60 then consider hypovolemia or pneumothorax
APGAR score
. Assesses newborn after birth
. Appearance: blue/pale = 0, pink body/blue extremities = 1, pink all over = 2
. Pulse: none = 0, under 100 = 1, over 100 = 2
. Respiration: absent = 0, slow and irregular = 1, good/strong = 2
. Activity: flaccid = 0, slow flexion of arms/legs = 1, active = 2
. Grimace: no response = 0, grimace = 1, crying/sneeze/cough = 2
. Performed at 1, 5, and 10 min after
Birth
. Low score doesn’t necessarily mean there is an issue
1 minute APGAR score ranges and meaning
. 0-4: severe depression, requiring immediate resuscitation
. 5-7: some nervous system depression
. 8-10 normal
5 minute APGAR score ranges and meanings
. 0-7: high risk for subsequent CNS and other organ system dysfunction
. 8-10 normal
Tips for examining newborns
. Have infant in parent’s arms or in car seat
. Prioritize comfort level of infant
. Best to examine 1 hr after feeding
. Hands and equipment should be warm
. Dim lights and swing baby to encourage eye opening
. Look at ears and mouth last
How to calm crying baby
. Swaddle . Sidelying . Sway/swing . Suck . Shush
Gestational age considered preterm
. Under 34 weeks
Gestational age considered late preterm
34-36 weeks
Gestational age considered term
. 37-42 weeks
Gestational age considered post term
. Over 42 weeks
Classification of birth weights
. Extremely low: under 1,000g
. very low: 1,500g
. Low: under 2500g
. Normal: equal to or over 2500 g
Risks for preterm infants
. Risk for both short term complications (respiratory and cardiovascular)
. Long term sequuelae (neurodevelopmental)
Risks for late preterm infants
. Prematurity-related complications
Posters infants risk
. Perinatal mortality or morbidity through asphyxia and meconium aspiration
What is directly related to inc. muscle tone and resistance to passive manipulation?
. Greater fetal maturity
Seesaw respiration
. Chest wall retracts and abdomen rises w/ inspiration
Moro reflex
. Extend head -> extension, flexion of arms, legs
. Appears at birth
. Disappears 4-6 mo
. CNS origin: brainstem vestibular nuclei
. Persistence beyond 8 mo suggests cerebral dysfunction
Grasp reflex
. Finger in palm -> hand, elbow, shoulder flexion
. Appears at birth
. 4-6 mo disappears
. CNS origin: brain stem vestibular nuclei
. Persistence beyond 4 mo suggests cerebral dysfunction
. Persistence of clenched hand beyond 2 months suggests CNS damage, esp. if fingers overlap thumb
Rooting reflex
. Cheek stimulus -> turns mouth to that side
. Appears at birth
. Disappears 4-6 mo
. CNS: brain stem trigeminal system
. Absence indicates severe generalized or CNS disease
Trunk incurvation reflex
. Withdrawal from stroking along ventral surface
. Appears att birth
. Disappears 6-9 months
. CNS: spinal cord
. Absence suggests transverse spinal cord lesion or injury
. Persistence may. Indicate delayed development
Placing reflex
. Steps up when dorsum of foot stimulated
. Appears at birth
. Disappears 4-6 mo
. CNS: cerebral cortex
. Absence may indicate paralysis
. Babies born breech delivery may not have placing reflex
Tonic neck reflex
. Fencing posture when supine . Appears at birth . Disappears 4-6 mo . CNS: Brea is stem vestibular nuclei . Persistence beyond 2 months suggests neuro disease
Parachute reflex
. Stimulate fall-> extends arms . Appears 6-8 months . Never disappears . CNS: brains stem vestibular . Delay in appearance may predict future delays in voluntary motor development
positive support reflex
. Hold the baby round trunk and lower him until his feet touch a flat surface
. Hips, knees, and ankles will extend and it will stand up, partially bear weight and then sag after 20-30 s
. Lack of reflex suggests hypotonia or flaccidity
. Fixed extension and adduction of legs (scissoring) suggests spasticity due to neuro disease
Plantar grasp reflex
. Birth to 6-8 months
. Touch sole at base of toes
. Toes will curl
. Persistence beyond 4 mo suggests neuro disease, beyond 6 mo strongly suggests it
. Asymmetric response suggests fracture of clavicle, humerus, or brachial plexus injuries
Landau reflex
. Birth to 6 mo
. Suspend the baby prone w/ 1 hand
. His head willing up
. Persistence may indicate delayed development
Plethora
. Excess of bodily fluid, particularly blood (overheated, facial presentation, polycythemia)
. Indicative of cyanotic heart disease
Cyanosis in infants
. Would be visible if deoxygenated Hb content is over 3g
. If present throughout the body including the mucous membranes and tongue (central cyanosis)
. Cyanosis in just extremities (peripheral cyanosis/acrocyanosis)
. Acrocyanosis from exposure to cold and polycythemia
Erb-duchene deformity
. Paralysis of upper brachial plexus (C5-6)
. Arm hangs at side w/ elbow extended and the forearm pronated
. Waiter’s tip hand/erb’s palsy occurs
Klumpke’s deformity
. Paralysis fo lower brachial plexus (C8-T1)
. Claw hand w/ forearm is supinator and wrist and fingers are flexed
Caput succedaneum
. Edematous swelling formed on presenting portion of scalp of infant during birth
. Effusion overlies periosteum
. Anatomic landmark that enables this condition to cross suture lines
Cephalohematoma
. Swelling in which effusion lies under periosteum
. Consists of blood not serum
. Anatomic location does not cross suture lines
Epstein pearls
. Happen when skin of baby’s mouth is trapped during development process
. As mouth continues to develop and take shape, this trapped skin can fill w/ Keratin
. Keratin is what makes up inside of epistein pearl
Vernix caseosa
. Coating that protects unborn baby’s skin from amniotic fluid
. W/o protection, baby’s skin would chap or wrinkle in uterus
Harlequin color change
. Newborn babies
. Momentary red color changes of half the child sharply demarcated at body midline
. Transient change occurs in 10% of healthily newborns
. Usually seen btw 2 and 5 days of birth
. Lasts from 30 s to 20 minutes and then fades
Mottling
. In contrast w/ cutis marmorata, the mottling does not resolve when skin is warmed
. Discoloration is blue instead of red
. Lesion is more intense and is persistent
Erythema toxicum neonatorum
. Common rash seen in full term newborns
. Appears in 1st few days after birth and fades w/in a week
Assessment of hip dysphasia
. Develops due to acetabulum that is too shallow
. More common in girls
. More common w/ left hip
. Risk factor: LGA, breech
. Treatment: hip immobilization, rarely surgery
Barlow’s and Orotolani’s
Barlow: evaluates hip to determine if they can be easily dislocated
. Orotolani’s: detect dislocated or subluxation hips, determines if they can be reduced
. If either test is abnormal do hip ultrasound to confirm findings j
Failure to thrive
. Decelerated or arrested physical growth
. Weight and height measurements fall below the 3rd or 5h percentiles or a downward trend in percentiles
. Usually weight change precedes height change
. Can be from inadequate caloric intake, inadequate caloric absorption/usage
. Inc. metabolic demands
Formula intolerance
. Baby has trouble digesting formula
. May be sensitive to ingredient
. Different than allergy, allergy means the baby’s immune system reacts to protein in formula and can be life threatening
. Diarrhea, blood/mucus in your baby’s stools, vomiting, pulling legs up to tummy, colic makes your baby cry constantly, trouble gaining weight or weight loss
Gastroenteritis
. Infection in bowel causing diarrhea
. For the 1st 24-48 hrs a child may have vomiting and fever
. Diarrhea develops during this time and lasts 4-10 days
Cystic fibrosis
. Caused by mutation in a gene (CFTR)
. Controls flow of salt in and out of cells
. Condition causes thick mucous to build up in body
. All babies have a newborn screening test for CF so it can be found and treated early
Hirschsprung disease
. Involves missing nerve cells in muscles of part or all of the large intestine
. Present at birth
. Causes issues passing stool
. Symptoms: failure to have bowel movement w/in 48 hours after birth, swollen belly, vomiting
. Surgery needed to bypass affected part of colon or remove it
