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
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
- 1-4 mm non-erythematous pustules with milky fluid
- Ruptured vesicopustules with scaling
- 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)
