Intro to Pediatrics Flashcards
What is the typical age range of patients that pediatricians see? What are the exceptions?
Birth to 21
Patients with special needs may receive care from a physician up until age 26 or older
Goals of pediatric care (2)
- Optimize growth and development
2. Understand normal growth, development, and behavior
Key components of pediatric health promotion (7)
- Age appropriate developmental achievements
- Health supervision visits
- Integration of physical exam findings with health promotion
- Immunizations
- Screening labs and procedures
- Anticipatory guidance
- Partnership between physician, child/adolescent, and family
Differences in obtaining a pediatric patient’s history vs. an adult patient
Mainly, patient’s parent(s) are the historian, but older children may provide some of their own history
Components of pediatric history (5)
- Prenatal and birth history
- Developmental history
- Social history of family
- Environmental risks (i.e. lead exposure, mold, swimming pool at home, etc.)
- Immunization history
What may be difficult about obtaining a pediatric patient’s history?
Parents have preconceived ideas and concerns about child’s illness
Health maintenance visits must address what important general concerns? (2)
Medical and psychosocial
development, nutrition, growth, etc.
What are the subdivisions of pregnancy and birth history? (4)
- Maternal and paternal medical and genetic history
- Maternal past obstetric history
- Current antepartum and intrapartum obstetric history (i.e. how did the birth go?)
- Apgar scores (quantified score regarding how baby is doing after birth)
Other components/considerations regarding pediatric history? (2)
- Feeding history
2. Family history
What are the subdivisions of family history? (6)
- Developmental disabilities
- Congenital abnormalities or syndromes
- Chromosomal problems
- Growth problems
- Consanguinity
- Ethnic background
What are the subdivisions of social history? (6)
- Living situation
- Composition of family
- Pets
- Parents occupations
- Daycare
- Smoking
Understanding the normal physical, cognitive, and social development facilitates ________ ________ and ________ ________ and is the basis for distinguishing ________ from ________ findings
effective interviews; physical examinations; normal; abnormal
Understanding ________ ________ helps better focus the physician and patient interaction
developmental stages
The AAP (American Academy of Pediatrics) recommends that physicians and other healthcare providers use what for infants as young as several months of age?
Standardized Screening Instruments
At what ages do you assess developmental milestones? (11)
- 2 months
- 4 months
- 6 months
- 9 months
- 12 months
- 15 months
- 18 months
- 24 months
- 3 years
- 4 years
- 5 years
Who publishes guidelines for health supervision visits and the key age appropriate components of these visits?
The AAP (American Academy of Pediatrics)
Immunizations are a mainstay for ________ ________ and have been heralded as the most ________ clinical achievement in public health worldwide
health promotion; significant
What are the pediatric age specific screenings and their associated ages? (13)
- Behavioral and mental health (all ages)
- Blood pressure (after age 3)
- BMI (after age 2)
- Cholesterol screening (ages 9-11 and 17-21)
- Dental assessments (age of first tooth; varies)
- Developmental screenings (at key ages)
- Hearing screen (birth and whenever there are concerns)
- Newborn metabolic screening (birth and between 1-2 weeks of age)
- STIs (sexually active adolescents)
- TB risk assessment (should be evaluated after 1 year)
- Vision screening (at age 3 and yearly afterwards)
- Lead screening (12 months and 24 months)
- Hemoglobin (12 months; if premature, test at birth and 4 months)
What is growth is an indication of? (3)
- Overall well being
- Status of chronic disease
- Interpersonal and physiologic stress
Babies gain approximately how many lbs a month for the next 3 months following birth?
2 lbs
Babies are expected to have doubled their birth weight by the time they are how old?
4-5 months
What is the expected weight loss in the first few days following birth?
Loss of 5-10% of birth weight
When should babies be back up to birth weight?
7-10 days of age
Babies are expected to have tripled their birth weight by the time they are how old?
12 months
Babies are expected to have quadrupled their birth weight by the time they are how old?
2 years
What is the average birth weight of a baby?
3.5 kg (7.7 lbs)
Average weight for a 1 year old baby
10 kg (22 lbs)
Average weight for a 5 year old child
20 kg (44 lbs)
Average weight for a 10 year old child
30 kg (66 lbs)
Average daily weight gain during first 3-4 months
20-30 g (0.7-1 oz)
Average daily weight gain during 5-12 months
15-20 g (0.5-0.7 oz)
Average length at birth
20 inches
Average length for a 1 year old baby
30 inches
Average length for a 3 year old child
3 feet
When is a child expected to have doubled their birth length?
4 years old
Average annual height increase between age 4 and puberty
2-3 inches
Average head circumference (HC) in a baby
35 cm
Average increase in HC during first year
1 cm/month (2 cm/month during first 3 months, then slower)
What is the average total HC increase for the rest of life?
10 cm
What is the “Safe to Sleep” campaign?
Movement to have babies sleep in the supine position without pillows or extra bedding; aimed to combat SIDS
Is bed sharing appropriate?
NO
What is the aim of “Tummy Time”?
Increase shoulder girdle strength; reduce the likelihood of occiput flattening and cranial deformation as the result of the “Safe to Sleep” campaign
Does the child have to be supervised during “Tummy Time”?
YES
What is plagiocephaly? Which side is this more common?
Asymmetric cranium; right side
What is craniosynostosis?
Premature closing of the sutures
When do girls typically reach their full height?
2 years after their first period
Milestone achievement is ________
sequential
When are Well Child Checks (WCC) preformed?
birth to 72 months
Yearly WCCs are recommended between what ages?
6-18 years
Which ages are most neglected in regards to WCCs?
11-18 years
Why are WCCs important? (2)
- Determines if a child is within range of normal development
- Helps determine if Early Intervention is needed
What are the key developmental concepts? (8)
- Proceeds in a cephalocaudal fashion
- Proximal control occurs before distal control
- Control of the shoulders and pelvic girdle develops before reaching and standing
- Gross motor develops before fine motor skills
- Body and brain grow together
- Motor control is intimately entwined with communication and cognitive development
- Most of the foundation that allows for milestone emergence occurs in the first 10 months after birth
- Parents should be concerned if a baby does not appear to be acquiring early movement patterns
Where do primitive reflexes manifest from? (2)
Brainstem and spinal cord
What are primitive reflexes?
Stereotypic movements generated in response to specific sensory stimuli
How long are primitive reflexes present?
3-6 months after birth
What are the primitive reflexes? (4)
- Suck reflex
- Moro reflex
- Asymmetric tonic neck reflex (ATNR) / “Fencing” reflex
- Hand grasp
What is the Moro reflex?
Abrupt extension of an infant’s neck, symmetrical abduction and extension of the arms, and extension of the trunk, followed by adduction of the arms; occurs spontaneously after a loud noise
The Moro reflex is associated with development of ________ ________ and is used to evaluate the integrity of the ________ and to detect ________ ________
cortical functioning; CNS; peripheral problems
An asymmetrical Moro reflex may indicate what?
Unilateral weakness
What is the Asymmetric Tonic Neck reflex (ATNR)?
An infant’s head is directed to one side and tone in the extensor muscles increase on that side and in the flexor muscles of the opposite side; think “Fencing” reflex!
The ATNR is considered one of the first steps in the coordination of ________ and ________
vision; reaching
Task: Sits alone momentarily
4-8 months
Task: Rolls back to stomach
4-10 months
Task: Sits steadily
5-9 months
Task: Gets to sitting
6-11 months
Task: Pulls to standing
6-12 months
Task: Stands alone
9-16 months
Task: Walks 3 steps alone
9-17 months
The fine pincer grasp is observed in children by what age typically?
12 months
Task: Copies circle
3 years
Task: Copies square
4 years
Task: Copies triangle
5 years
2 month milestones (4)
- Social smile
- Lifts head while prone
- Fixes on face
- Smiles responsively
4 month milestones (3)
- Laughs, coos
- Rolls
- Reaches
6 month milestones (4)
- Babbles
- Sits
- Raking grasp
- Feeds self
9 month milestones (4)
- “Mama”, “Dada”, stranger anxiety
- Pulls to stand
- Pincer grasp
- Plays pat-a-cake
12 month milestones (3)
- One word, specific to mama, dada
- Cruises and/or walks
- Indicates wants, not by crying, points
15 month milestones (3)
- 2-5 words, 1 step command
- Builds 2 block tower
- Waves goodbye
18 month milestones (3)
- 2-word phrases
- Crawls up stairs
- Plays with others
24 month milestones (3)
- 10-20 words, 2 step command
- Walks up/down stairs
- Parallel play
By 2 years, ____% of speech is intelligible
50%
By 3 years, ____% of speech is intelligible
75%
By 4 years, ____% of speech is intelligible
100%
Percentage of children in the U.S. with developmental or behavioral disabilities
15-18%
Percentage of children under age 3 with some sort of delay
15%
Percentage of primary care visits for children under age 3
45%
What is Early Intervention?
Term used to describe the services and supports that are available to babies and young children with developmental delays and disabilities and their families. May include speech therapy, physical therapy, and other types of services based on the needs of the child and family.
