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
2
Q
Vaccinations
- Hep B
- MMR
- Tdap
- Rotavirus
- Dtap
- Hib
- IPV
- PCV
- Varicella
- Meningitis
A
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
4
Q
General Components
- (1): concerns or questions, follow up on previous concerns, interval history
- (1): change in family or social hx, parents work outside the home, parental support, daycare
- (1): Nutrition, Elimination, Sleep, Behavior, Activities
- (1): Social/Emotional, Language/Communication, Cognitive, Motor
- (1): Head to Toe
- ______ Guidance
- Imm_______
A
- History
- Social/Family History
- ROS
- Developmental Surveillance
- Physical Exam
- Anticipatory Guidance
- Immunizations
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)
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
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
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
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
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
11
Q
Neonatal Vital Signs
- RR
- HR
- HC
- Length
- Temp
A
- 40-60
- 120-160
- 33-37cm (10th-90th)
- 19-21” (48-53cm)
- 97-100.3F
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
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
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
15
Q
Reflexes
What are they and when are they expected to go away?
- Babinski
- Blinking
- Grasping
- Moro
- Rooting
- Stepping
- Sucking
- Swimming
- Tonic Neck
A
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
- Regards face =
- Optic blink - response to light =(2)
- Tracks smile or object (3)
- Rooting reflex; sucking =
- Crying face symmetric =
- Tracking or blinking in response to sound =
- Assess swallowing, gag reflex (2)
- Observe symmetry of shoulders =
- Pinch nostril, observe for opening of mouth with tip of tongue midline =
A
- Pain
- Deep Tendon
- Cranial Nerves
- CN II
- CN II/III
- CN III, IV, VI
- CN V
- CN VII
- CN VIII
- CN IX, X
- CN XI
- CN XII
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
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
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
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