Intro to Peds Newborn/Infant Toddler Flashcards

1
Q

Objectives

A
  • Understand the components of a well exam during the newborn and toddler period
  • Understand normal vs. abnormal patterns of feeding, sleep, elimination, growth and development
  • Recognize signs and symptoms of common illnesses found in the newborn-toddler period
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2
Q

Vaccinations

  1. Hep B
  2. MMR
  3. Tdap
  4. Rotavirus
  5. Dtap
  6. Hib
  7. IPV
  8. PCV
  9. Varicella
  10. Meningitis
A
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3
Q

Newborn Well Exam

The AAP recommends well exams be performed during the following time periods?

A
  • 2 wks
  • 2, 4, 6, 9 mths
  • 12, 18, 24, 30, 36 mths
  • Then annually
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4
Q

General Components

  1. (1): concerns or questions, follow up on previous concerns, interval history
  2. (1): change in family or social hx, parents work outside the home, parental support, daycare
  3. (1): Nutrition, Elimination, Sleep, Behavior, Activities
  4. (1): Social/Emotional, Language/Communication, Cognitive, Motor
  5. (1): Head to Toe
  6. ______ Guidance
  7. Imm_______
A
  1. History
  2. Social/Family History
  3. ROS
  4. Developmental Surveillance
  5. Physical Exam
  6. Anticipatory Guidance
  7. Immunizations
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5
Q

Birth Weight Terms

  • LBW =
  • VLBW =
  • ELBW =
  • HBW =
  • NBW =
  • Females =
  • Males =
A
  • <2500gm
  • <1500gm
  • <1000, <750gm ILBW
  • >4000gm
  • 2.5-<4.0kg
  • 2.8-4.0kg, avg 3.5kg (7lb 12 oz)
  • 2.9-4.2 kg; avg 3.6kg (8lb)
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6
Q

Gestational Age Terms

  • Term =
  • Premature =
  • SGA =
  • LGA =
  • AGA =
  • IUGR: describe less than optimal pattern of growth over a period of time - it is possible to be IUGR not ___
A
  • completed 37 wks gestation till 42 wks
  • less than 37 wks gestation
  • <10th percentile
  • >90th percentile
  • 10-90th percentile
  • possible to be IUGR not SGA
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7
Q

Neonate Visit

(don’t have to memorize)

  • First visit after ____
  • Lots of history
  • Maternal
    • Any in_____
    • Med____
    • Hos_____
    • P____ care
    • Maternal _____ type
    • F____ history
    • S____ status
  • Labor and Delivery
    • weeks of _____
    • infant ____ type
    • type of _____
    • C_____
    • _____ scores
    • Group B ___ status
A
  • birth
  • Maternal
    • infections
    • medications
    • hospitalization
    • pre-natal
    • blood
    • family
    • smoking
  • L/D
    • gestation
    • blood
    • delivery
    • complications
    • APGAR
    • Strep
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8
Q

Neonate Visit

  • Screenings
    • H_____
    • Ca_____
    • Transcutaneous b_____ (TCB)
    • S_____ bilirubin
    • J_____
    • Ph____therapy
  • Measurements
    • Birth w____, l____, head _____, dis____ weight
  • Interventions
    • Prophylaxis ___
    • Vitamin __
    • Hep __
    • Circum_____
A
  • Screenings
    • Hearing
    • Cardiac
    • Bilirubin
    • Serum bilirubin
    • Jaundice
    • Phototherapy
  • Measurements
    • weight, length, HC, discharge weight
  • Interventions
    • Prophylaxis eye
    • K
    • Hep B
    • Circumcision
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9
Q

Neonate Visit

  • Ask about ______
  • _____
    • Breast, Formula, or Both
    • Infants feed on demand every __-__ hrs
    • Need about __-__oz of breastmilk/formula per lb of body weight
    • Plot weight, monitor c____
  • ____
    • On ___
    • In ___ crib/bassinet
    • # of hours
  • _____: color, consistency, frequency
A
  • concerns
  • Feeding
    • 1-2hrs
    • 2-2.5 oz
    • curve
  • Sleep
    • on back
    • in own crib
  • Stooling
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10
Q

Neonatal Stooling

  • Breastfed infants
    • M_____ first 24-48 hrs, color is dark ____
    • Then _____, s____ changing to ____ color
    • Can stool after each _____
    • Tends to be very s___ or w______
  • Formula fed infants
    • M_____ first 24-48 hrs
    • Then can be y____, t___, b_____
    • Tends to be ____ like peanut butter consistency
  • **THERE SHOULD NEVER BE ____ IN THE STOOL**
A
  • Breastfed
    • Meconium, dark
    • green, seedy, mustard
    • feeding
    • softy, watery
  • Formula
    • Meconium
    • yellow, tan, brown
    • thicker
  • BLOOD*! NEVERR
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11
Q

Neonatal Vital Signs

  1. RR
  2. HR
  3. HC
  4. Length
  5. Temp
A
  1. 40-60
  2. 120-160
  3. 33-37cm (10th-90th)
  4. 19-21” (48-53cm)
  5. 97-100.3F
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12
Q

Tone

  • Observe their position at rest
    • Are they r____, are they fl____
    • Are their arms _____
    • Do they sit in a ___ leg position
  • Move each major ____ through ROM
  • Positions
    • Head ____
    • V_____ Suspension
    • V_____ Suspension
A
  • Observe position at rest
    • rigid, flaccid
    • flexed
    • frog
  • Joint
  • Positions
    • Lift
    • Vertical
    • Ventral
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13
Q

Primitive Reflexes

  • _____ Grasp: Birth to 3-4 mths
  • _____ Grasp: Birth to 6-8 mths
  • S_____ Reflex: Birth-variable (3mths)
    • Holding onto a surface, allow one sole to touch the ground and see that the _____ leg will step _____
A
  • Palmar
  • Plantar
  • Stepping
    • Opposite leg, step forward
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14
Q

Primitive Reflexes

  • Rooting Reflex (birth to 3/4 mths) =
  • Moro Reflex (birth to 4 mths) =
  • Tonic Neck Reflex (birth to 2 mths) =
A
  • Turns head toward stimuli of cheek and begin sucking
  • Startle response, arms extend out while legs flex
  • Head turned to one side, Arm to which head is turned extend while the other flex
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15
Q

Reflexes

What are they and when are they expected to go away?

  1. Babinski
  2. Blinking
  3. Grasping
  4. Moro
  5. Rooting
  6. Stepping
  7. Sucking
  8. Swimming
  9. Tonic Neck
A
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16
Q

Sensory/DTR/Cranial Nerves

  • ____ Sensation
    • Flick hand or feet, look for child to withdraw and cry
  • ____ ____ Reflexes
    • Are variable due to the corticospinal pathways are not fully developed
  • Cranial Nerves
    1. Regards face =
    2. Optic blink - response to light =(2)
    3. Tracks smile or object (3)
    4. Rooting reflex; sucking =
    5. Crying face symmetric =
    6. Tracking or blinking in response to sound =
    7. Assess swallowing, gag reflex (2)
    8. Observe symmetry of shoulders =
    9. Pinch nostril, observe for opening of mouth with tip of tongue midline =
A
  • Pain
  • Deep Tendon
  • Cranial Nerves
    1. CN II
    2. CN II/III
    3. CN III, IV, VI
    4. CN V
    5. CN VII
    6. CN VIII
    7. CN IX, X
    8. CN XI
    9. CN XII
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17
Q

Anticipatory Guidance

  • Babies cannot be _____
  • Need to feel ____
  • Are much happier and more predictable when parents respond q____ and effectively
  • There are c_____ differences in child rearing, no one way to do things, many ways work
  • But need to be responsive to the needs of infants and reflect a c____ and nurturing style of parenting
  • Sl___, F____, Childc____, Re_____
A
  • spoiled (cannot self soothe when infant so okay to give them attention)
  • secure
  • quickly
  • cultural
  • caring
  • Sleep, Feeding, Childcare, Reassurance
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18
Q

Feeding

  • Breast or Formula
    • On ____
    • Every _-_ hrs for the first week or so
    • Then every _-_ hrs
    • __-__min per breast
    • __-__ oz per feeding w formula
    • Often fall ____ during feedings, may need to stimulate them to stay alert
    • Don’t let neonate go more than __ hrs without eating
  • Commom complaints
    • Falling asleep at breast or bottle -> un____ some, ____ cheeck
    • G____: make sure ____ between breast or btwn every 1-2 oz of formula
A
  • Breast or Formula
    • demand
    • 1-2 hrs
    • 2-2.5 hrs
    • 10-15 min
    • 2-3 oz
    • asleep
  • Common complaints
    • undress, stroke
    • Gassy, burping
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19
Q

Sleep

AAP recommendations on creating a safe sleep environment include:

  • Place the baby on his or her ___ on a ___ sleep surface such as a crib or bassinet with a ___ fitting sheet
  • Avoid use of ____ bedding, including crib bumpers, blankets, pillows, and soft toys. The cribs should be ____
  • Share a bedroom with parents, but not the same sleeping surface, preferably until the baby turns 1 but at least for __ months. Room sharing decreases risk of ____ by 50%
  • Avoid baby’s exposure to sm___, alc___, illicit ____
A
  • back, firm, tight
  • no soft, cribs bare
  • share room 6m, decreases SIDS
  • no smoke, alc, drugs
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20
Q

SIDS

Sudden death of an infant less than __ year that remains ____ after a complete case investigation

  • High risk groups
    • Low _ _ _ families, gender?
    • Family hx of heavy ____ or drug abuse
    • Infants with low birth ___, bl___
    • Al____ and American ____ ethnicities
    • Subsequent s____ of SIDS victims
    • Pre____ infants with recurrent ap____ episodes
A

<1 yr, unexplained

  • SES
  • smoking
  • weight, black
  • Alaskin, Indian
  • Siblings
  • Premature, apneic
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21
Q

SIDS Interventions

  • “____ to sleep” (supine position)
  • Crib safety and bedding
    • ____ 2 3/8 inches apart, f___ mattress, no pl____
    • Crib alternatives include flat/l___/firm surface, dr____, M____ basket, etc
  • Avoid overh_____, maintain room temp 68-72F
  • Avoid bed ____/co-sleeping
  • Sleep in ____ room
  • Avoid al___/dr___. Especially cigarette smoking in hour or car and during breastfeeding
A
  • Back
  • Crib safety
    • Slats, firm, no plastic
    • low, drawer, Moses
  • overheating
  • avoid bed sharing
  • parents room
  • alc/drugs
22
Q

Neonatal Hyperbilirubinemia

Jaundice is a yellow discoloration of the sk___ and e___ by hyper_____ (elevated serum bilirubin concentration)

  • The serum bilirubin lvl requires to cause jaundice varies with skin t___ and body r____, but jaundice usually becomes visible on ___ at a lvl of 2-3 mg/dL and on ___ about 4-5 mg/dL
  • With increasing bilirubin lvls, jaundice seems to advance in a ___ to ___ direction
  • Occurs in greater than __% of all newborns
A

skin, eyes, hyerbilirubinemia

  • tone, region, sclera (2-3), face (4-5)
  • head to toe
  • 50%
23
Q

Metabolism of Bilirubin

  • Unconjugated -Indirect =
  • Conjugated - Direct =
  • Which one do we want?
A
  • Bound to albumin
  • After going through hepatocyte binds to glucoronic acid
  • We want conjugated bili - comes out through feces
24
Q

Jaundice

  • Neonatal hyperbilirubinemia in infants > __ weeks gestational age (GA) is defined as total serum or plasma bilirubin (TB) > __th percentile on the hour - specific Bhutani nomogram
  • High TB can lead to acute bilirubin _______**
  • Normal to slightly elevated bili at birth __mg/dL
  • Tx = ___therapy
A
  • 35wks, 95th percentile
  • encephalopathy
  • 1mg/dL
  • Photherapy
25
Q

Risk factors for Jaundice

Major Risk Factors

  • Pre____ TB or TcB level in the high risk zone
  • Jaundice observed in the first __ hrs
  • ____ group incompatability with positive direct antiglobin test, other known h_____ disase (G6PD deficiency), elevated ETCOc
  • Gestational age __-__ wks
  • Previous _____ received phototherapy
  • Cephalohematoma or significant b_____
  • Exclusive breastfeeding, particularly if nursing is not going ___ and ___ loss is excessive
  • East ____ race
A
  • predischarge
  • 24
  • blood, hemolytic
  • 35-36wks
  • siblings
  • bruising
  • well, weight loss
  • Asian
26
Q

Hemolytic Anemia

  • ____ Incompatibility
    • More common and severe in infants of ____ descent
    • Mothers __ type -> Baby is either __ or _
    • Increased in pre____
    • F____ born infants
  • __ Factor Incompatibility
    • Mother Rh ____
    • Infant Rh ____
    • Production of _____ that pass thru the placenta at birth
    • First pregnancy is ____
    • Second pregnancy if infant Rh+ can lead to _____
A
  • ABO
    • African
    • O, A or B
    • premature
    • First
  • Rh
    • negative
    • positive
    • antibodies
    • fine
    • anemia
27
Q

Causes of Jaundice

Unconjugated Hyperbilirubinemia

  • (1): Resulting from rapid breakdown of RBC and poor clearance in the liver, quick rise then drop
  • (1): Occurs in the first few days of life when breast milk not in or infant not eating enough, may have weight loss, dehydration from lack of nutrition
  • (1): Develops after the 5-7 days of life in breastfed infants peeks at week 2. Felt related to increased concentration of B-glucuronidase in breast milk, causing an increase in the deconjugation and reabsorption of bilirubin.
A

Physiologic

Breastfeeding Jaundice

Breast Milk Jaundice

28
Q

Pathologic Hyperbilirubinemia

  • Diagnosis of pathologic hyperbilirubinemia include
    • Jaundice appears in the first __ hrs
    • After ____ wk of life or lasts > __ wks
    • Total serum bilirubin (TSB) rises by > __ mg/dl/day
    • TSB > __ mg/dL
    • Infant shows __/__ of illness
  • Common causes
    • Immune and Non-immune hemolytic ____
    • G___ deficiency
    • H____ reabsorption
    • Se____
    • Hypo______
A
  • Diagnosis
    • 24
    • 1 wk, lasts >2 wks
    • rises by >5mg/dL
    • >18 mg/dL
    • S/S
  • Common causes
    • anemia
    • G6PD
    • Hematoma
    • Sepsis
    • Hypothyroidism
29
Q

Jaundice

  • Presentation
    • Dis_____ of the skin
    • Starts from ____caudal presentaton
  • Treatment
    • Based on r___ f____
    • P___therapy
    • ____ breastfeeding
    • ____ with formula
    • S____ total bilirubin lvls
    • Consider re-____ trending upward or in the moderate to high range on graph (for hydration and phototherapy)
A
  • Presentation
    • Discoloration
    • Cephalocaudal
  • Treatment
    • risk factors
    • phototherapy
    • continue
    • supplement
    • Serial
    • re-admission
30
Q

Acrocyanosis

=

  • Per____ and Per_____
  • Common in the first few ____ after delivery in full term and preterm newborns
  • Usually resolves in __-__ hrs
A

Benign, characterized by cyanosis of the hands, feet, and may also occur in face

  • Peripheral and Persistent
  • hours
  • resolves 24-48 hrs
31
Q

Erythema Toxicum Neonatum

=

  • Onset at 3-14 days of life
  • Characterized by small 1-3mm wh___-y____ papules, ves___ and pus___ that are surrounded by a macular er_____ base
  • Baby can have few to several ____ lesions
  • Lesions are ___ typically found in mucous membranes, palms, and soles
  • Lesions are _____ and they usually resolve within 3-14 days without permanent sequela
A

Benign self limited disorder affecting 30-70% full term newborns (only 5% of premature infants)

  • white-yellow, vesicles, pustules, erythematous base
  • hundred
  • not found there
  • transitory
32
Q

Transient Neonatal Pustular Melanosis

Benign, self limited condition with no known sequela

  • Overall incidence about 2.2%
  • More common in ____ infants 4-5% (less than 1% in white babies)
  • (3) stages of skin eruption
  • On the face, neck and under chin, e_____, lower back, shins, p___ and s____
  • Differential dx: Neonatal H_____
A
  • more common in Black
  1. 1-4 mm non-erythematous pustules with milky fluid
  2. Ruptured vesicopustules with scaling
  3. Hyperpigmented macules
  • extremities, palms, soles
  • Herpes
33
Q

Slate Gray Nevi

=

  • Diameter maybe >__ cm
  • Commonly locate on (2) regions
  • Begin to fade by first or second ____ of life
  • By __-__ yrs of age, disappear
A

Congenital Blue-grey pigemented macule with indefinite borders (formally named mongolian spot, congenital dermal melanocytosis)

  • 10cm
  • Sacral gluteal region, shoulder
  • year
  • 6-10 yrs disappear
34
Q

Cafe-Au Lai Macules

=

  • More than 6 concern for ______
  • M_____ at well exams and monitor for ch_____
A

Common hyperpigmentation macules of different sizes

  • neurofibromatosis (if not related to NF-can fade/go away)
  • Measure, changes
35
Q

Hemangioma

=

  • Will ____ first year of life then in____
  • If close to eyes need to refer to ___ology for treatment
A

Usually benign, Vascular Tumor

  • grow, involute
  • dermatology
36
Q

Vascular Lesions

What conditions do these pictures show?

A

Port Wine Stain- Nevus Flammeus (may stay forever but can fade)

Salmon Patch/Stork bite-Nevus Simplex (sometimes called angel kisses when on forehead)

37
Q

Seborrheic Dermatitis- AKA cradle cap

=

  • Can attach to hair _____
  • Associated with patchy r__ness, small bumps, fissuring, and occassionally w_____.
  • In infants, it is usually not ____ as opposed to children and adults
  • Usually present in the first __ months.
  • Is it malignant?
  • More severe or persistent forms can be ______
  • Consider con____ treatments first
  • Removing scales is possible using what? after doing what?
  • Brush away from the _____
  • Emollient, such as V_____, or appliyng fragrant free oil overnight and then shampoo in the morning
A

Scaling, thick, yellow/white, crusty or greasy patches on the scalp, face, between folds of skin and on skin rich in oil glands

  • follicles
  • redness, weeping
  • not as itchy in infants
  • 3 mths
  • Ususally benign and self limiting w resolution within a month
  • treated
  • conservative
  • soft toothbrush or comb after shampooing
  • away from eyes
  • Vaseline
38
Q

Neonatal Acne

  • 20% of infants
  • Stimulation of sebaceous ____ by _____ endogenous androgens
  • Onset at after __ wks
  • Inflammatory p____ and pu____, no come____ lesions (like teenagers)
  • On f___ and ch____
  • ___-limiting
A
  • sebaceous glands by maternal endogenous androgens
  • 2 wks
  • papules, pustules, no comedome lesions
  • face, cheeks
  • self-limiting (will go away by itself, do not squeeze/pop will cause scarring)
39
Q

Milia

=

  • Frequently found on (2)
  • Resolves when?
A

White papules caused by retention of keratin and sebaceous material in pilaceous follicles

  • nose and cheeks
  • resolve in first few weeks of life
40
Q

Prickly Heat

(miliaria crystallina or miliaria rubra)

Accumulation of ____ beneath sweat ducts that are obstructed by _____

  • Occurs with per____ due to heat
  • The rash can look like a ____ of tiny bubbles under skin or cluster of small p_____
A

Accumulation of sweat beneath ducts obstructed by keratin

  • perspiration
  • cluster of bubbles under skin, cluster of small pimples
41
Q

Crying

  • Infants cry _-_ hrs/day
  • They cry because they are? (Identify why and address it)
  • Usually are ____ to console
  • Infant self sooth by suckling (offer ____, ____ to suck on can help)
A
  • 1-3 hrs
  • Hungry, Bored, Wet, Tired, Pain, Teething, Illness
  • easy
  • pacifier, pinky
42
Q

Colic

In_____ crying in an otherwise healthy infant starting at __ wks and begins to improve at ~ __ months

  • 7-40% of full term infants
  • Rule of 3’s =
  • Peaks during what times of the day?
  • What is the cause? Can be very difficult to parent, may interefere with infant/caregiver b_____
A

Inconsolable crying, 2wks -> 3mths

  • 3hrs/day, 3days/wk, >3wks
  • late afternoon/early evening
  • No clear understing of etiology or pathophysiology, interferes w infant/caregiver bonding
43
Q

GI

Gastroesophageal Reflux

=

  • Different from vomiting in that vomiting is a _____ expulsion of stomach contents
  • Common for infants to spit up after ____
  • Most common cause is from ingestion of ___ while sucking
  • Frequent _____ will decrease spitting up
  • Over _____ causes an increase in reflux
A

AKA spitting up- regurgitation

  • forceful
  • eating
  • air
  • burping
  • overfeeding increases reflux
44
Q

Gastroesophageal Reflux Disease

Term used when presence of ___ loss, dis____ are present

  • Infant will usually pull ___ up when feeding or cry when spitting up
  • Will initially want to eat more and then will ___ eating as it is associated with discomfort
  • Initial treatment rx (1)
  • Consider _____ to GI if weight loss present
  • May consider _____ to cows milk protein especially if diarrhea present
A

weight loss, discomfort

  • pull legs up
  • eat more then avoid eating bc discomfort
  • Famotidine
  • referral
  • intolerance
45
Q

Diarrhea

Acute =

Chronic =

May be infectious or non infectious

  • History =
  • Physical Exam = _____ Status
A

Transient, self limited

> 2 wks duration

  • Length of illness, Stools…frequency, consistency, presence of blood, oral intake (assoc vomiting), asctd symptoms (fever, rash), UO, contacts with other infectious illness
  • Hydration Status
    • Moist mucosa, presence of saliva and tears, skin turgor, weight, # of diapers, alertness, temp, HEENT, ABD
46
Q

Diarrhea

Etiology =

Testing =

A

Usually viral, if blood present eval for colitis or bacterial infection

Usually none unless duration longer than a week, then obtain stool culture and sensitivity along with Ova and Parasites, consider E-coli if risk factors

47
Q

Diarrhea

Treatment =

A

Hydration is Key

  • Pedialyte, Ricealyte (ORS): 1mL of ORS per kg of body weight every 5 minutes over 3 to 4 hours
  • Assess for dehydration
    • Obtain weight and compare to last weight
    • 6-9%…dry mouth, absence of tears
    • >10% sunken eyes, poor turgor, sunken fontanels
48
Q

Symptoms of Severe Dehydration

*Is a medical _____*

And should seek immediate medical attention. These children appear ____ (difficult to keep awake) or may be un____. They also may have: poor ____ or may be unable to drink

  • A parched mouth and t_____
  • Minimal or no ____ output
  • Increased ___ rate, ___ pulses, ___ breathing, cool, m___ extremities
  • Cap refill that is very ____ or minimal
  • Deeply ____ eyes (and/or fontanel in baby)
  • Check urine d_____
A

Emergency!*

lethargic, unconscious, poor drinking

  • parched tongue
  • no urine
  • increased HR, weak pulses, deep breathing, mottle extremities
  • prolonged
  • sunken
  • dipstick
49
Q

Diarrhea

Follow up =

Hospitalize if?

A

Phone in 12 and 24 hrs, intake, # of diapers, fever, activity, F/U in office 48hrs

Unable to keep fluids in, Bloody diarrhea, Lethargy, Concern about parenting, >10% dehydration (sunken fontanels, poor turgor)

50
Q

Food Protein Enterocolitis

  • Usually within first few days of life
  • Will show signs of milk/casein _____
  • If severe will have vomiting and diarrhea, milder forms may have ____ tinged diarrhea
  • Can be associated with ______
A
  • few days of life
  • milk/casein allergy
  • blood
  • eczema (very macular unlike other conditions more pustular)